There is SO MUCH information out there right now about the newly approved COVID-19 vaccines. Healthcare workers have started receiving their vaccinations this week and photos of vaccinations have flooded social media. Misinformation has also flooded social media. This post shares the science behind the vaccine as well as recommendations for pregnant and lactating women, who were excluded from trials to date. Want to know my story and my choice as a lactating woman, keep reading til the end!
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(At the time of this post, two vaccines are approved under emergency use (EUA - emergency use authorization) by the FDA - one by Pfizer and one by Moderna.)
The BASICS on the COVID Vaccine
Both the Pfizer vaccine and the Moderna vaccine are mRNA vaccines (messenger RNA). The vaccine itself is a piece of mRNA that encodes for the spike protein of COVID; that piece of mRNA is packed in a fatty surrounding layer to allow it entry into the cells in our arm on injection. It's important to recognize that you are NOT given the virus. You are NOT given something that will be incorporated into your DNA. You are NOT given the mRNA or DNA for the entire virus.
Once the mRNA enters our cells, our ribosomes (the protein makers in our cells) will take the mRNA and use the genetic information to produce the spike protein part of the COVID-19 virus. This spike protein is something our body will recognize as FOREIGN and develop an immune response against it.
At this time, the vaccine is given in 2 doses a few weeks apart (Pfizer vaccine is 3 weeks apart and Moderna is 4 weeks). The Pfizer vaccine has to be stored at very low temperatures to remain stable, while Moderna's vaccine does not have the same temperature requirements.
For the Pfizer vaccine, 43,000 people were randomized into the study with over 21,000 people being given the vaccine and 21,000 getting a placebo injection (no medication). The vaccine was 95% effective in preventing COVID19. From a safety standpoint, the vaccine side-effects included short-term mild-to-moderate pain at the injection site, fatigue and headache. There were very few serious side effects, including shoulder injury related to vaccine administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia. Here is a good review of how the Pfizer vaccine works.
In a study of 30,000, the Moderna vaccine has been shown to have 94.1% efficacy against symptomatic viral infection - 11 people who received two doses of the vaccine developed COVID-19 symptoms after being infected with the pandemic coronavirus, compared to 185 symptomatic cases in a placebo group. The Moderna vaccine also had 100% efficacy against severe disease with ZERO cases of severe disease in the vaccinated cohort compared to 30 cases in the placebo group (including one death). (Click here to read more.)
Here are the 8 things that the CDC thinks we ALL need to know about the COVID-19 vaccine.
Here is a really great review from EMRAP if you're looking to better understand the science behind the mRNA vaccines.
COVID-19 Vaccine in Pregnant and Lactating Women
The Pfizer and Moderna studies did NOT include pregnant and (most) did NOT include lactating women.
We extrapolate some information from OTHER vaccines. We have NOT had an mRNA in the past, so there's not a ton of data. But it can be compared to a dead virus (as opposed to a live virus). In pregnancy, vaccinations that have been contraindicated in pregnancy include LIVE virus vaccines (like MMR) and those that can wait until after pregnancy (such as the HPV vaccine). Dead virus vaccines such as tetanus and influenza ARE RECOMMENDED in pregnancy. The mRNA vaccine will be most comparable to the dead virus vaccines which is why scientist extrapolate that it is probably safe for pregnant women.
There are some associated poor fetal outcomes that may be associated with COVID-19 infection in pregnancy. There also MAY be an increased likelihood of pregnancy complications (pre-term labor, still birth, etc) or increased SEVERE COVID-19 disease with increased admission to ICU and potentially increased risk of death.
Similarly in breastfeeding, we extrapolate data from other vaccinations. There are no vaccines that cannot be given to breastfeeding/lactating women.
This vaccination is a RISK-BENEFIT decision. What risk are YOU willing to take? The risk of not knowing about the safety of the vaccine. The potential risk of increased pregnancy complications. The risk of a severe COVID-19 infection. Maybe you're willing to stay quarantined in order to decrease your risk.
See the below YouTube video from Mama Doctor Jones, an OBGYN on the COVID-19 vaccination in pregnancy and breastfeeding.
Here is another YouTube video by Dr. Marta Perez, another OBGYN, sharing information on the COVID-19 vaccine in pregnancy and breastfeeding/lactating women. She reviews the Society for Maternal Fetal Medicine's statement (linked here) which STRONGLY RECOMMENDS that pregnant women have ACCESS to COVID-19 vaccines, and that pregnant women engage in shared decision-making (a risk-benefit discussion) with their OBGYN's. And a follow up video with frequently asked questions (and answers)!
And one more YouTube video from Dr. Natalie Crawford, a reproductive endocrinologist (aka fertility specialist).
The American College of OBGYN's statement is also included here.
Does the COVID Vaccine cause INFERTILITY?
Many people have asked about the COVID vaccine causing infertility in females. This all stemmed from a fake news article who's headline states the head of Pfizer research claimed the vaccination is female sterilization. The theory behind this statement is that the mRNA for the COVID spike protein is similar to a protein syncytin-1 which is required for placenta formation and thus could lead to infertility.
The YouTube video below by fertility specialist Dr. Natalie Crawford addresses this false claim.
***One really important point she makes is that women who have HAD COVID and thus have made antibodies to the spike protein are not having increased first-trimester miscarriages, which would be expected if the antibodies targeted the syncytin-1 protein.
Okay. That was a LOT of information.
Let's get personal...
I'm an Emergency Medicine Physician. I've been working on the front-lines for six months. Why not all 9 months you ask?
Well the first day the hospital closed down for COVID, I was in the hospital AS A PATIENT.
In the ICU in fact. I had severe HELLP syndrome and required a week in the ICU. For the first three months of the COVID pandemic, I was on maternity leave doing my best to keep my healing self and my newborn baby safe from this vaccine. I returned to work just in time for Florida's first COVID peak. Since then I've been pumping at work and honestly TERRIFIED about bringing this virus home to my babe or any of my family. Then a month ago, I tested positive for COVID and the remainder of my family was symptomatic.
Yesterday I got the COVID vaccine.
To all those pregnant, breastfeeding or lactating women, I see you! I understand the risk-benefit discussions going on in your head, because I struggled through them as well. Getting the vaccine was NOT a no-brainer for me. I had the virus. I was probably protected. Should I still get it? Should I risk a complication? Should I risk something happening to my miracle baby? (Yup, I'm a #fertilitywarrior and this baby took 3 years to create and a bajillion dollars in IVF).
I decided to get the vaccination because I am TIRED.
Tired of seeing patients die.
Tired of worrying about my loved ones dying.
Tired of feeling powerless over this vaccine.
Tired of feeling that my JOB puts my life and the lives of those I care about at risk.
I share this article to share the information we do have.
The science of this vaccine makes sense. And it doesn't make sense that I, as a lactating woman, would have any adverse effects from the vaccine based on how the science works.
So many people are worried about long-term side effects of vaccines.
And I get it. It's a new treatment. It is approved under emergency use authorization.
But y'all I'm afraid of the long term effects of COVID.
I'm afraid of what we DON'T know about COVID.
We don’t know who will get severe disease or why.
We don’t know who will have venous thromboembolic disease as a result of COVID.
We don’t know what 1 year, 5 year and 10 year effects COVID may have.
We don’t know who will DIE from COVID.
We are ALL in a tough spot. We have to individually do a risk-benefit analysis.
For me the risk of a side effect from the vaccine seemed MINIMAL compared to the risk of getting COVID again and having a worse illness. The risk to my baby seemed MINIMAL when I thought about the science and how the vaccine functioned.
Your risk-benefit analysis may be totally different. That is OKAY. Just make sure it is an informed decision. Hopefully this article will help you to make that informed choice.