Midwife Monday: COVID Vaccine Education for Pregnant, Breastfeeding and Women Planning to Become Pregnant

Happy Monday! Anyone need some newborn squeezes to start their week? They’re plenty over here! Our little guy is already outgrowing newborn clothes – someone please make him stop!

I was asked to put some talking points together this week for a group on the COVID vaccines and women who are pregnant, breastfeeding or thinking about being pregnant!

It turned out to be really helpful information…so of course I’m sharing it!

The organizations to follow for guidelines and recommendations as evidence is published are:

Evidence and recommendations are changing daily so please make sure you’re reading the most up to date information!

The following is a summary of the points offered on each webpage.

For further details, please see the original source and always talk with your provider for further guidance, question or concerns!

CDC Guidance for Pregnancy and Breastfeeding

  • The CDC recommends that if you are pregnant and/or breastfeeding and you are in a high risk population, you should consider getting the vaccine.
  • 2020 studies on pregnant women have shown that pregnant women that get COVID are at higher risk to be hospitalized with COVID and have complications – including ICU admission, need for ventilation by machines or death. Preterm birth is also a risk factor for pregnant women with COVID (preterm birth is defined as a birth before 37 weeks).
  • For people wanting to become pregnant, the vaccine is not a live vaccine and therefore you can try to conceive any time you would like after the vaccine is received. Some vaccines have a 28 day waiting period before conception is recommended to prevent adverse side effects to the fetus.
  • For those choosing not to get the vaccine or who are unable to get the vaccine now, continue standard precautions and mask wearing to reduce transmission. The virus is still as contagious as ever.
  • SIDE EFFECTS: It is well documented with both vaccines that fever, greater than 100.4F, occurs in about 15% of people who get the vaccine and especially after the 2nd dose. This is unlikely harmful to you or your baby (whether pregnant or not) and is a normal immune system response. Tylenol is recommended for any fever and is safe to take during pregnancy.
  • Routine testing for COVID antibodies at the beginning of pregnancy is not recommended at this time or before getting the vaccine.

ACOG (American College of Obstetricians and Gynecologists) Advice for Pregnancy Women

  • One vaccine is not recommended over another at this time but individuals should complete the 2 dose series with the SAME vaccine.
  • The COVID vaccine should not be received within 14 days of another vaccine (ex. if you are pregnant and received the TDaP (whooping cough) or flu vaccines, you should wait 14 days before receiving the COVID vaccine). *The exception is Rhogam for RH negative women which should not be withheld.*
  • No one should be tested to see if they are pregnant or not before receiving the vaccine.
  • This is a great explanation on how mRNA works:
    • “The development and use of mRNA vaccines is relatively new. These vaccines consist of messenger RNA (mRNA) encapsulated by a lipid nanoparticle (LNP) for delivery into the host cells. These vaccines utilize the body’s own cells to generate the coronavirus spike protein (the relevant antigens), which, similar to all other vaccines, stimulates immune cells to create antibodies against COVID-19. The mRNA vaccines are not live virus vaccines, nor do they use an adjuvant to enhance vaccine efficacy. These vaccines do not enter the nucleus and do not alter human DNA in vaccine recipients.”
  • And another review on the side effects – in short, side effects are to be expected:
    • “Most study participants for both the Pfizer-BioNtech and Moderna vaccines experienced mild side effects similar to influenza-like illness symptoms following vaccination. In the Pfizer-BioNtech study subgroup of persons age 18-55 years fever greater than 38°C occurred in 3.7% after the first dose and 15.8% after the second dose (FDA 2020). In the Moderna vaccine trials, fever greater than 38°C was reported in 0.8% of vaccine recipients after the first dose, and 15.6% of vaccine recipients after the second dose (FDA 2020). Most of these symptoms resolved by day 3 after vaccination for both vaccines.”

Academy of Breastfeeding Medicine (ABM)

  • This ABM statement only applies to the Pfizer vaccine trial which did not enroll breastfeeding women.
  • The proposed benefit of the vaccine for breastfeeding mothers is an immune response after the vaccine that increases IgA antibodies that are detectable in the breast milk 5-7 days after the vaccine – these antibodies could provide immunity to the baby/child in the future.
  • Continue to follow ABM for a statement on the Moderna trials this month.

American Academy of Pediatrics

  • Pfizer is currently conducting a trial for children (the lowest age being tested is 12 years old).
  • A study in the United Kingdom is examining children ages 5-12 years old.
  • Trials in children are important because sometimes children have reactions to vaccines that adults do not have.
  • The AAP agrees that there is unlikely any harm to the breastfeeding child of a mother who receives the vaccine.
  • What about school’s requiring the vaccine to attend school? This is decided on a state level and will vary state to state.

Lastly, some other things to think about regarding the vaccine…

  • At this time there are two vaccines and their dosing is different. Both are a series of 2 vaccines but they are received either 21 or 28 days apart from each other depending which vaccine you get. Also, one vaccine has a cut off of 18 years of age while the other is 16 years of age.
  • The second vaccine in the series is very important for boosting the immune response to the vaccine.
  • At this time, even if you receive the vaccine, it is unknown how long your immunity will last. The first people to receive the vaccine received it in May 2020.
  • The vaccines went through the same safety protocols and testing like any other vaccine – although the trials were fast, the process was the same as any other vaccine.
  • The vaccine is not 100% effective – just like some people never established immunity to the varicella vaccine or the rubella vaccine – but trials show 95% immunity!
  • Lastly, a reminder: the recommendations and evidence are always changing. Revisit the information regularly to see if there are updates or new recommendations. Women that are pregnant and/or breastfeeding in the trials are being followed and new evidence will continue to be published.

Hope that helps answer some questions! Let me know what other questions you guys have.

Jamie


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