Major health organizations now disagree on whether or not people who are pregnant should get a COVID-19 vaccine. But experts in the U.S. maintain that the benefits likely outweigh the risks, so it’s worth seriously considering getting the vaccine—even if you’re pregnant.
The World Health Organization updated its website this week to recommend against pregnant people getting the Moderna COVID-19 vaccine. “While pregnancy puts women at a higher risk of severe COVID-19, the use of this vaccine in pregnant women is currently not recommended, unless they are at risk of high exposure (e.g. health workers),” the site reads. And regarding the Pfizer/BioNTech vaccine, the WHO says that “due to insufficient data, WHO does not recommend the vaccination of pregnant women at this time.”
The new recommendations came as a bit of a surprise to many experts in the U.S., especially considering that the Centers for Disease Control and Prevention have consistently advocated for pregnant people to consider getting vaccinated. Right now only those in certain prioritized groups should get a COVID-19 vaccine, the CDC says. And if someone is in one of those groups and also happens to be pregnant, they “may choose to be vaccinated,” the CDC says.
In response to the WHO update, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) said in a statement that they will “continue to stress that both COVID-19 vaccines currently authorized by the U.S. Food and Drug Administration (FDA) should not be withheld from pregnant individuals who choose to receive the vaccine.”
Part of the issue here, as the WHO points out, is that we don’t have as much data for pregnant people getting the vaccine as we do for people who aren’t pregnant. This is a long-running conundrum in medicine in which pregnant people are intentionally left out of clinical trials for understandable (but not necessarily scientifically sound) reasons. Sometimes pregnant people are excluded from trials due to worries about legal liability or the idea that pregnant people are overall more “vulnerable” or in need of specialized research, a review in the journal Women’s Health Issues explains. In many cases, the worry is not about the health of the pregnant person but of some unknown possible risk to the developing fetus. Depending on the treatment that’s being studied, those worries may or may not have science to back them up. Or the potential outcome of the trial (like, say, a treatment for morning sickness) may greatly benefit from being tested in pregnant people and therefore outweigh the risks.
The end result is that we are left with very little data about what medical treatments may or may not be safe for pregnant people, ACOG explains. So many medical professionals tend to err on the side of caution and not recommend potentially helpful treatments—not because there is evidence that those treatments or medications can do harm, but because there is a lack of conclusive evidence either way.
But as the CDC explains, it’s important to understand that COVID-19 poses unique risks to pregnant people. People who are pregnant and develop symptomatic COVID-19 infections are more likely to experience severe complications from the disease, SELF explained previously. They are also more likely to experience pregnancy and delivery complications, such as preterm birth.
On the other hand, we know that the most common side effects of the COVID-19 vaccines are mild (unpleasant and flulike, but temporary). And “based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant,” the CDC says. Preliminary data from the FDA’s developmental and reproductive toxicity studies of both vaccines have not turned up any worrying findings so far, ACOG says.
So any discussion of the possible unknown risks associated with the vaccines needs to be properly weighed against the risks to pregnant people that—we are beginning to understand more and more clearly—can come with COVID-19.
Ultimately, getting a COVID-19 vaccine while pregnant can be a complex, confusing, and personal decision. It should be based on your individual risk factors for severe COVID-19 outcomes and pregnancy complications as well as how likely you are to be exposed. So it’s a decision that deserves to be discussed carefully and thoroughly with a health care professional—and not dismissed outright.