It’s understandable that a mother of an unborn baby would want to do everything she can to protect her child and keep him or her safe. That’s why the decision to get the COVID-19 vaccine is so difficult for many pregnant and nursing mothers.

Dr. Kara Coassolo, an obstetrician with Lehigh Valley Health Network who specializes in maternal-fetal medicine (perinatology), said some women she has spoken to are concerned that there are still things the medical community might not know about the vaccine and pregnancy, so they want to wait and get vaccinated after the baby is born.

Coassolo said the danger with this is that it leaves women unprotected against the COVID virus now when the case numbers are increasing due to the delta variant.

“We do believe that the COVID vaccine is safe for pregnant and nursing mothers,” she said.

V-safe health checker

Coassolo said the Centers for Disease Control and Prevention created a voluntary program called V-safe that asks people who have been vaccinated for COVID-19 to answer some questions.

As of Aug. 9, more than 147,000 pregnant women have opted to participate in V-safe health checker. There have been no instances of side effects greater than that in the regular population. Likewise, there have been no increases in pregnancy complications in the population of pregnant women.

“That is reassuring information,” Coassolo said.

Some of the complications that the CDC is looking for are preterm birth, miscarriages, stillborn babies, or anything that is higher than what typically occurs in the general population of pregnant women. The CDC is following closely more than 5,000 who have volunteered to participate in the V-safe COVID-19 Vaccine Pregnancy Registry.

More participants are welcome to register. Information about V-safe is available at www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafepregnancyregistry.html.

“We know that those things happen in the general population, so you have to look at the numbers in the women who have been vaccinated with COVID compared to what they know has occurred in the general population,” Coassolo said. “We know those aren’t any higher.”

Research and safety

Although because of the pandemic, researchers didn’t have the luxury of time to study the vaccine for years, Coassolo said there are other ways to base safety, which is done for all medicines, surgeries and procedures. This involves comparing the treatment and its possible harm to the known harm without using it.

“The two most common vaccines, the Pfizer and the Moderna, are mRNA vaccines. That does not cause any changes in a baby. It does not cause anything to cross the placenta except for the antibodies that the mom naturally makes after the vaccine, which is actually good. That’s what we want to happen,” she said.

On the other hand, the medical community knows the harm pregnant women face if they get COVID. Even though pregnant women are generally young and healthy and that population has had less serious symptoms with COVID-19, pregnancy changes the dynamic for those women.

“Pregnant women are at higher risk of having serious complications from COVID. They are more likely to get respiratory diseases like pneumonia. They are more likely to be admitted to the hospital, to need a ventilator, to need to be in the ICU, unfortunately even to pass away from COVID,” she said. “That’s part of the reason why we are recommending to women who are considering getting pregnant to be vaccinated, and if they haven’t gotten vaccinated, to get vaccinated during pregnancy.”

Why are pregnant women at higher risk?

The reason why pregnancy elevates a woman’s risk of serious complications is because pregnancy causes an increased metabolic demand on the woman. Not only is her body supplying what she needs, but also it supplies the needs of the growing baby. This can place a strain on her body, Coassolo said.

There are also changes in respiration, lung function, and the physiologic changes, especially in the third trimester of pregnancy. If a woman’s lungs become damaged due to COVID-19, it makes it harder for her to provide oxygen to lung tissues. That is why they are at a greater risk of developing pneumonia.

For years, the medical community has recommended that pregnant women get the influenza vaccine, because they are at greater risk of complications from the flu. When COVID first struck the United States, they thought it might also cause complications.

“Now we know from gathering the data that it does have a higher risk for complications for pregnant women,” she said.

Researchers have also discovered that COVID can also cause inflammation to other organs, including the placenta. The placenta provides nutrients and oxygen to the growing baby and removes waste products from the baby’s body.

Researchers have found cellular and blood vessel changes in the placenta, similar to when a woman has medical issues such as high blood pressure during in pregnancy, Coassolo said.

“When women do get COVID in pregnancy, even if they recover from that disease or have mild disease, they can be at an increased risk of having a baby that doesn’t grow optimally during the pregnancy or being delivered early,” she said.

The vaccine, though, does not cause preterm delivery, nor does it cause stunted growth in the baby. Since the mother doesn’t get sick with COVID and the placenta doesn’t get inflamed, it continues to work normally, providing nutrients to the baby. Plus, the antibodies from the vaccine have been found in the newborn babies, as well as in the mother’s breast milk, Coassolo said.

“That’s good. We know that that happens with other things, too. That mom is able to provide some immunologic protection for baby for many diseases. After COVID vaccination, if she is breast-feeding, it can actually provide some benefit to the baby,” she said.

Infertility concerns

Another concern some women have about the vaccine concerns fertility.

“The COVID vaccine does not cause infertility,” she said. “There’s no scientific evidence that an mRNA vaccine should cause infertility in a woman.” This also includes men.

Coassolo added that she thinks getting the vaccine can also benefit a family with young children, since the vaccine has not been approved for children under 12 years old.

If the mother gets vaccinated, then it could help to keep her children healthy, because she is less likely to get sick or very ill from COVID.