COVID vaccine and Pregnancy with Dr. Constance Nasello

Is the vaccine safe for pregnant and breastfeeding women?   Dr. Constance Nasello who specializes in obstetrics and gynecology answers common questions about the new COVID vaccines.

For more information on the COVID vaccine please visit: https://www.askontariodoctors.ca/covidvaccine

Transcript

Spotlight on Health - Season 2, Episode 3 - COVID vaccine and Pregnancy with Dr. Constance Nasello

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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.

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Anne Marie Flanagan: I’m Anne Marie Flanagan. I’m the Director of Media Relations and Social Media at the Ontario Medical Association.

Dr. Constance Nasello: And I'm Dr. Connie Nasello. I'm an obstetrician and gynaecologist and chair of the OMA Section on Obstetrics and Gynaecology and president of the Ontario Society of Obstetricians and Gynaecologists.

Flanagan: And we're here today to talk about the COVID-19 vaccine in pregnant or breastfeeding women.

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Flanagan: What should pregnant or breastfeeding women know about the COVID-19 vaccine? And should they be considering getting it?

Dr. Nasello: What we know right now is that pregnant women, although they are not at higher risk of acquiring COVID-19, once they become infected with the virus, pregnant women tend to have a more severe reaction. And that's not unusual about viruses in pregnancy. And, in fact, this seems to be more severe.

Eight to 11% of pregnant women who acquire COVID-19 will need to be hospitalized for the illness. An additional 2-4% of women will end up in the intensive care unit and may be subject to long-term intubation. And that has its risks, both for the pregnancy, for mom and baby.

The COVID-19 vaccines that have currently been approved in Canada are the Pfizer and Moderna vaccines. And, both of those are messenger RNA vaccine-derived. And the interesting thing about these two vaccines is they contain no virus, they contain no adjuvants, and they contain no preservatives—which is part of the reason they have to be in cold storage, so that it preserves the vaccine.

The current recommendations from the Society of Obstetricians and Gynaecologists of Canada, the Society of Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, and multiple other societies and associations that look after women, is to support women that wish to receive the vaccine in pregnancy, and particularly women that are at higher risk. So, those would be healthcare workers, frontline workers outside of the healthcare system, physicians and nurses that treat these patients on a regular basis.

And when we look at the population, 50% of the population is female, but upwards of 40-50% of women are actually in the reproductive age group. So, we are seeing women that have become pregnant during the pandemic. And we know that they are more likely to acquire a severe form of COVID-19. And so, those women should be given a choice and given adequate information to make that choice in order to decide for themselves whether they would like the vaccines to protect themselves and their baby.

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Flanagan: Is there a sense of why COVID impacts pregnant women more seriously, or there's more complications?

Dr. Nasello: Well, pregnancy itself is an immune-deficient state, and it needs to be taken into consideration. With pregnancy, if the immune system were not suppressed, we wouldn't actually be able to carry pregnancies because it's foreign tissue. So, what benefits the fetus, however, puts mom at higher risk of severe infections.

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Flanagan: And I assume, along the same vein, that there's certain treatments and medication that can't or shouldn't be taken in pregnancy.

Dr. Nasello: That's not entirely true. The underlying issue is that nothing is tested in pregnancy. Women have been excluded from medication and vaccine trials—if they happen to be pregnant or lactating—for over 60 years. So, a lot of the time we actually have to figure out, as obstetricians, whether a particular medicine or vaccination would be useful to a pregnant woman.

Now, women that are pregnant also need to understand that these vaccines have not been actually tested in pregnant women. But when we look at the issues around the virus, it appears that the risk of having a severe infection from acquiring the—the virus, is much higher than the unknown theoretic risk that pregnant women may have on exposure to vaccines.

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Flanagan: You spoke a little bit about medical testing, and we know that, for most of medical history, women have been underrepresented in a lot of tests, and that pregnant women haven't really been involved in these kinds of tests at all. Do you think that might change anytime in the future?

Dr. Nasello: Actually, there is a movement to go ahead with vaccination trials in pregnant women and lactating women. It's been put forward by an organization called PREVENT, which stands for Pregnant Women and Vaccines Against Emerging Epidemic Threats. And this is an organization that has been endorsed by the World Health Organization. And so, what they're looking at is the ethics of including patients that are pregnant or lactating in trials, and what things should be considered.

The other thing that is also important is, currently, for women that do decide to take the COVID-19 vaccine, we need to have follow-up studies. And so, right now, the University of Washington is voluntarily enrolling women who have received the COVID-19 vaccines while they're pregnant or lactating, and it will follow them up to make sure that there are no adverse reactions that appear to be specific to pregnancy.

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Flanagan: For the purposes of these conversations, we tend to group pregnant and breastfeeding women together. Is there a difference there? Are there different levels of risk that should be considered for those two different situations?

Dr. Nasello: What we know about breastfeeding is that a very, very tiny amount of medications and vaccines can cross into breast milk. So, for the most part, we do consider breastfeeding women to actually be safe, especially women that have chronic illnesses.

And that is actually where the bulk of our information comes for medications, is from women that have had to remain on their particular medication in pregnancy to treat underlying conditions. But the importance of follow-up research is emphasized. Currently, we do know in both vaccine trials that approximately 25 women became pregnant during the trials, and they, so far, have not exhibited any adverse effects.

For women, though, that are considering getting pregnant, then we would recommend waiting until they're finished the vaccine course to become pregnant. But, those women that do become pregnant should not be alarmed

about having had vaccination and the fact that they're pregnant. We have not seen anything that is of concern yet, and would not recommend a pregnancy termination.

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Flanagan: If someone was considering becoming pregnant over the next six months or so, should they be reaching out to their doctor in advance and seeking some of this information?

Dr. Nasello: Absolutely. We tend to believe that the more information women have, the better enabled they are to make choices. And, we certainly would support them speaking to their family doctor, their nurse practitioner, their obstetrician or midwife, whoever is providing their care at that particular time. Get some counseling in that regard.

However, one of the things that has become very much a concern regarding the vaccinations and regarding medications in pregnancy, is that there is still this sense amongst women that, regards to medications, that women are being infantilized. And that is one of those underlying, paternalistic, held over in medicine. And as more women become physicians, become obstetricians and gynaecologists, we are increasingly trying to push back on those barriers that either don't make sense or are frankly discriminatory.

Pregnant individuals should be encouraged to discuss vaccination with their obstetrical provider. But that in itself should not be a barrier to timely vaccination, for the woman who is at risk and wishes to get the vaccine.

And that's where we ran into disagreement with the Vaccine Task Force, who used a recommendation that it should not ever be given to pregnant or lactating women. There was enough discomfort, even among pregnant obstetricians, that we needed to speak up on this matter.

Actually they revised it, but they only used part of the recommendation; they still required a permission form to be signed by the obstetrical provider. Once we realized that was happening, we pushed back on social media. A standard consent form and a discussion when they're getting the vaccine just to make sure that people understand and have considered the issues around the vaccine and pregnancy; it is still the patient's choice.

Flanagan: Well, that sounds like an incredible bit of advocacy to me, to get that choice back into the hands of women. Would you agree that the more information they have, the better situation they're in?

Dr. Nasello: Absolutely. And the more information, the better able they are to make choices that are meaningful for themselves.

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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.

For more information, please visit our website at oma.org.

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