COVID: To Vaccinate or Not in Pregnancy and Breastfeeding
When we had our first child, I had not yet started medical school. I was blissfully unaware of the inherent risks in any pregnancy. By the time we had our second, my eyes were opened. Years of medical training had populated my imagination with many of the things that can and do go wrong. Now, when I talk to my patients about making decisions in pregnancy and breast-feeding, I remind both of us that there is no such thing in life as zero risk, much as we yearn for it. To live, is to risk. How then to make a decision about whether or not to get the COVID vaccine in pregnancy or when breastfeeding? Fortunately, there is an incredible tool created by experts at the University of Massachusetts Medical School – Baystate. It is six pages of paper (click on this link or see below) that help you think through the two options: 1) getting vaccinated as soon as possible or 2) waiting for more information. It walks you through the risks of COVID in pregnancy, which include: preterm delivery, severe illness, and an increased risk of death compared with non-pregnant people of the same age. And it includes the risks of getting the vaccine, including preliminary research looking at a small number of women who became pregnant during the vaccine studies who did not show an increased risk of miscarriage during two months of follow up. It includes facts such as 1/100 people who get the vaccine have gotten a high fever and acknowledges that persistent high fever during the first trimester may increase the risk of fetal abnormalities or miscarriage. It includes a list of factors that place you more at risk of getting sick from COVID and factors that place you at less risk. And finally, it includes narratives from pregnant doctors and their reasons for deciding to get or not get the vaccine. The calculus around getting the vaccine in breastfeeding is easier. The tool clarifies that the vaccine contains no live virus, that mRNA in the vaccine is unlikely to be passed on in breastmilk, and that antibodies created by the vaccine may pass into breastmilk, which could be helpful to protect babies from infections. In short, thoughtful people created a thoughtful tool to enable informed decision making, which is the best that we can do. We can never reduce our risk to zero at any point in life, but we can make the best decisions possible based on the information we have at the time. Thank you Dr. Elizabeth Schoenfeld and your team for providing actionable information to women and doctors like me. Keep up the amazing work.