“UPDATE: Covid Vaccine in Pregnancy” – with Dr. Nathan Fox

In this extra episode, Dr. Fox gives an update on the COVID-19 vaccine: what we know and his opinion on whether women should get it during pregnancy. The vaccine is expected to be safe during pregnancy with no effect on fertility. Learn more about why Dr. Fox says “if I were pregnant, I’d get the vaccine.”

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2020_03_17 covid update
Hey, everyone. Welcome to the Healthful Woman podcast. Today is Monday, March 22nd, 2021. I know that we have a podcast today that was dropped, in terms of pre-implantation genetic testing, but I decided to record one extra podcast and drop it today, just to give an update on the COVID vaccine in pregnancy.

So, we’ve had over 1,000 downloads of our original COVID vaccine podcast, which is actually the most downloaded podcast we’ve had. And there’s been a ton of interest in the topic of the vaccine in pregnancy, specifically. I’m asked this multiple times a day, every day, by pregnant women who are, you know, curious, or confused, or concerned. And the main question is, “I’m pregnant. Should I get the vaccine, should I not get the vaccine? When should I get the vaccine? What are the risks? What should I do?”

So, I wanted to give a brief update of where we are to date. So, as revealed, and this was covered in the original podcast, the vaccine is expected to be safe in pregnancy. There’s no live virus in it. You cannot get COVID from the vaccine. This business that’s been going around social media about it affecting fertility in the future is really unfortunate. It was based on nothing, no data whatsoever. Someone just said it, and said, “Hey, it might do this,” and it went wildfire on social media, which is a problem. No one thinks it’s gonna do that. And it’s also expected to work like it would in non-pregnant women or anybody.

So true, when they first did the vaccine it was not tested in pregnant women, which I think is a mistake, but that’s what they did. But there really was no reason to think it would have been harmful, right? We give vaccines in pregnancy. There was nothing about this vaccine in particular that we expected to be dangerous for pregnant women or for their fetuses. And so, my overall take at the time, and what I was saying in the podcast in January, was that we can’t say anything is 100%. But personally, I would get the vaccine, pregnant, because I view the risks of COVID to be greater than the risks of the vaccine. I really don’t have tremendous concern over the vaccine itself. And there’s also practical advantages to getting the vaccine. For example, not needing to quarantine, and potentially, being able to leave the house, and, you know, you can take off your mask, things like that. So, I was in favor of it and that’s what I stated in the podcast.

Okay. So, it’s been a couple months since then. So, since the podcast, there have been some additional positive developments. First, purely anecdotally, many of our own pregnant patients have gotten the vaccine and they’ve been doing very well. And so, you know, just our own experience seeing women get this, their side effects seem to be similar to everybody else, they seem to be doing very, very well with it. And I think the ones that I’ve spoken to, after it’s done, they feel relieved that they had it done because they know that they’re gonna have some protection. And again, just this idea that they’re not gonna get COVID or very, very, very unlikely they’re gonna get COVID, and they’re gonna potentially be able to sort of go back to living their lives, has really been helpful. Even just from a mental health perspective, sort of getting that off the table is really nice.

There was also data out of Israel this week, that babies born to women who got the COVID vaccine have antibodies themselves. I didn’t see the original study or data, but apparently, the report that I read is that 40 out of 40 babies who were tested from their cord blood had antibodies. Meaning, 40 women who got vaccinated in pregnancy, their babies were tested from the cord blood, which is the baby’s blood, and all 40 had antibodies against COVID. Now, it’s not surprising, right? This happens with other vaccines, but it wasn’t certain. So, it’s nice to have that information. It’s nice to know.

Since COVID isn’t really a disease of newborns, I don’t know if these results are critical in terms of the decision-making process about getting the vaccine or not getting the vaccine. But it definitely seems like a plus for the baby to be born with antibodies. We don’t yet know, is it really 100%? Meaning, if we test 4,000 babies, is it gonna be all 4000? We also don’t know how long are these antibodies gonna last in the babies. Are they protected for a month, for three months, for a year? No one knows for sure. Also, it’s not entirely clear yet, at what point in pregnancy should a woman be vaccinated in order to, you know, maximize the chance her baby will have antibodies. This is unknown. We don’t really know. And again, I wouldn’t specifically get vaccinated at a certain time in order to try to give antibodies to the newborn, because again, this isn’t really a disease of newborns, fortunately.

More importantly in terms of data, the CDC put out a vaccine safety update the beginning of March of this year. You can find it on the CDC website. And I’m actually gonna pull it up and go through it just to see what it is. Now, one of the nice things about this update is they reported their data on pregnant women, specifically. And the CDC knows of over 30,000 pregnant women who got either the Pfizer or Moderna vaccine. The numbers are likely to be larger, because not all pregnant women who get the vaccine repor it, or maybe they’re not asked about it, or maybe they don’t know they were pregnant, so it’s probably much greater than 30,000 women. But there’s at least 30,000 women who got the vaccine.

And in terms of side effects from the vaccine, it seems to be very similar to non-pregnant people who have the vaccine, in terms of, you know, pain, or swelling, or redness, very, very similar. You know, pregnant and non-pregnant, it’s about, you know, 80% will have some pain at the site of injection. The other things like swelling, redness, and itching are all, you know, under 10%. In terms of how people feel after the first dose, again, most people, whether pregnant or non-pregnant, similarly, about 20% will have some symptoms after the first dose, things like fatigue, or headaches, or, you know, muscle soreness, or chills. After the second dose, it’s higher, but not different pregnant to non-pregnant.

So, for example, in terms of fatigue, about 60%, whether pregnant or non-pregnant will have it. Headaches, about 50%. Myalgias, which is like muscle pains, or like when you feel when you have the flu, also about 50%. Things like chills and fever about 25%, and again, similar pregnant and not pregnant. Okay, so that’s side effects.

In terms of safety for pregnancy, the people who the CDC knows are pregnant, they try to get data on them afterwards, so they contact them to enroll in a pregnancy registry. The participants are contacted every trimester, then after delivery, and again, when the baby’s three months old. Most of these women, that hasn’t happened yet, but that’s what they plan to do, and they’ll look at outcomes. So far, they’ve enrolled almost 2,000 women, this is as of February 19th. So, as of a month ago, they reported it March 1. And this number, again, is gonna grow.

And the nice thing is in these nearly 2,000 women, thus far, there have been no complications related to pregnancy noted. Meaning, the likelihood of an adverse outcome in pregnancy is no different from what you would expect in any population of pregnant women. So, in their own data, for example, 15% of women had a miscarriage, which is actually lower than you would expect in the population, which is closer to 25%. I’m not saying that the vaccine lowers the chance of miscarriage, but it certainly doesn’t seem to be higher. Things like stillbirth, you know, 1% or less across the board, not different if you got the vaccine or not. Outcomes like pre-eclampsia, outcomes like preterm birth, outcomes like birth defects, outcomes like the baby’s growth being small, all pretty much exactly the same as what you would expect in the overall population.

Now, this isn’t a perfect study because in a perfect study, you would sort of randomize pregnant women to get the vaccine or not get the vaccine, like they did in the original studies, and see how many get infected and look at side effects, but that didn’t happen. So, this is the best data available. And it’s not perfect, but it’s really reassuring.

And so, for me personally, in terms of, you know, how I look at this, my take on it has not really changed. This just sorta supports what I thought. Again, personally, if I were pregnant, I’d get the vaccine. I’m not pregnant, I did get the vaccine, but if I were, I would still get it. If someone’s not comfortable getting the vaccine, obviously, that’s fine. There are ways to potentially prevent getting COVID other than the vaccine, but they’re very difficult, you know, wearing a mask, social distancing, really sort of avoiding people. And are you confident you can really pull that off? So, maybe someone who, you know, doesn’t have any kids and is able to just sort of stay indoors, and in their home, and in their basement. And they’ve got a couple months left of pregnancy and they just say, “You know, I’ll just wait until after I deliver.” Okay, that strategy is likely gonna work. You’re not likely to get COVID in the next two months.

But is that really possible for you? For example, are you now out of the house, going to work? Do you have kids coming in and out of the house? Do you have visitors? Do you live near other people? And so, it’s something to keep in mind that if you’re uncomfortable with the vaccine and you want to use other strategies to avoid getting COVID, are you able to pull that off? That’s an important consideration.

For women who are just anxious about getting the vaccine, which is understandable, this is a very anxiety provoking situation to be in with COVID, and the vaccine, and uncertainty, and you’re pregnant, you don’t really know, I try to ask women, you know, “Why are you more anxious about the vaccine than about COVID, right?” And, yeah, we don’t know the long-term effects of the vaccine, but we don’t know the long-term effects of either the vaccine or the virus.

And I put my money on the virus being worse than the vaccine in terms of long-term effects. I don’t expect there to be long-term effects from the vaccine. You know, can I say that 100%? Nobody can say that 100%. But if there’s gonna be long term effects from either of those two, I would imagine it’s more likely to be from the virus than from the vaccine.

So again, this is always a personal decision. Not everyone’s gonna decide the same thing, given the same facts, and that’s fine. But for pregnant women who are thinking about getting the vaccine, I am encouraging of it. I think it’s a good decision. I think that the likelihood of a complication from the vaccine is very, very low. And I think that it is the best way we know to avoid getting COVID and avoid getting sick from COVID, which we know can be problematic in anybody, but certainly in pregnant women. And I personally, would rather have a little bit of anxiety before getting the vaccine and right after getting the vaccine than the rest of pregnancy, hoping you don’t get the virus.

In terms of when to get it, my personal opinion is, get it whenever you can. If it’s your turn, go get it. I don’t particularly think, at this moment, we know that it’s better to wait until later in pregnancy in terms of maybe giving the baby antibodies. I don’t have a fear about the first trimester. There’s no reason to think it’s gonna cause a miscarriage or birth defect. So, I’m perfectly fine with women getting it in the first trimester.

If someone happens to be very uncomfortable with that and they say, “All right, I’m eight weeks, I’m gonna wait a month and then get it,” fine. Okay, like that’s your strategy, that’s okay. But I don’t personally advise women that they need to wait till after the first trimester. And I think that whenever it’s your turn, if you’re gonna get it, get it. And I think that you’ll probably find you’ll feel a lot less anxious afterwards, because now you should not be at risk for getting COVID or getting sick from it.

I hope this is helpful. Obviously, this is something that you have to discuss with your own doctor and, you know, make a decision for yourself if this is something you’re comfortable with. But I thought that giving this update on the data and where we are right now would hopefully be helpful.

Have a wonderful day. Enjoy the rest of the podcast. There’s one today, obviously one Thursday, as well. And also, we’re just really excited to report that in the podcast, we have surpassed 50,000 downloads within the first year. Our first-year anniversary is coming up in a couple of weeks, and I am just floored at the response to the podcast.

Thank you so much for listening. I really hope this has been helpful to you, overall if you’re pregnant, in your pregnancy, and we plan to keep on doing this, both the Healthful Woman Podcast, and of course, the High Risk Birth Stories which we launched just recently. Thanks a lot. Have a great day.