The governments of Ontario, Manitoba, Prince Edward Island, New Brunswick, and Quebec recently announced that all pregnant people residing in those provinces are now eligible to receive a COVID-19 vaccine. Meanwhile, in Alberta, pregnant people have been eligible for vaccination since March, and Saskatchewan started prioritizing that same group earlier in April.
This is huge news, first because any new group added to the slowly growing list of vaccinated adults brings us one step closer to herd immunity, but also because pregnancy is a risk factor for COVID, and can have serious effects on pregnant people who contract it. This includes an increased risk of being taken into intensive care with respiratory complications and of early labour. And with the racial health disparities relating to COVID, this is even worse for Black and other racialized pregnant people. Data in Canada is slim, but researchers in the U.S. found that Black people having babies during the pandemic are experiencing limited support during labour, social isolation, and economic anxieties, all of which lead to negative outcomes for them, and their children.
If you’re pregnant and eligible, it’s understandable to have questions as to how the vaccine itself might affect you. To break down what this all means, and how to make the best decision for you and your baby, Refinery29 spoke to Dr. Constance Nasello, an OBGYN and president of the Ontario Society of Obstetricians and Gynaecologists, and Dr. Kelly Grindrod, a pharmacist and associate professor at the University of Waterloo School of Pharmacy, about pregnancy and the COVID vaccine.
Why are pregnant people now being prioritized for vaccines in Canada?
Mainly, because pregnant people who contract COVID-19 seem to be having more complications and are getting much sicker. In fact, according to Dr. Nasello, pregnant individuals with COVID are seven times more likely to end up in an ICU bed, and 10 times more likely to be hospitalized. Prior to the pandemic, there would usually be about one or two pregnant people admitted in the ICU in all of Ontario at any given time, said Dr. Nasello. But more recently, hospitals like Mount Sinai in Toronto have reported up to six pregnant ICU patients at a time.
Why are pregnant people getting so sick? There are a few factors – the new, highly transmissible strains for one and decreased lung capacity as the baby grows, to name a few. But also, typically, a pregnant person’s immune system is suppressed right from the moment they conceive. “Our body's immune system is geared to recognize foreign DNA,” Dr. Nasello said. “If we did not suppress our immune system, then our immune system would attack the DNA of the embryo and we would be unable to carry pregnancies.” This is nature’s way of allowing healthy pregnancies, but can also leave us more susceptible to pick up colds and flus, and yes, COVID.
What are the risks for a pregnant person getting the vaccine?
While there’s not a whole lot that’s been studied on the Canadian front (clinical trials for both the Pfizer and Moderna vaccines here did not include pregnant people (which is standard), although Pfizer announced a U.S.-based clinical trial in February 2021, with results still to come) we do have some important insights.
A study published in The New England Journal of Medicine in April looked at over 30,000 pregnant people aged 16 to 54 who received the vaccine. It found that any adverse pregnancy and neonatal outcomes reported were similar to the ones found in studies involving pregnant people conducted before the pandemic. In other words, the vaccine doesn’t appear to be causing additional adverse effects.
The NEJM study also found that injection-site pain was reported more frequently among pregnant people than among non-pregnant people, whereas headache, myalgia, chills, and fever were reported less frequently. As for the health of the pregnancy itself, preliminary findings “did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines,” according to the study. In Canada and the U.S., public health organizations are closely monitoring pregnant people who received the vaccine. The CDC has said that what they’ve seen is “preliminary but reassuring.”
Long-term data is of course limited because the virus and vaccine are so new, but the World Health Organization has said that “we don’t have any specific reason to believe there will be risks that would outweigh the benefits of vaccination for pregnant women.” Canada's Chief Public Health Officer Dr. Theresa Tam has also stressed that the risks of contracting COVID-19 while pregnant outweighed any potential risks posed by the vaccine. “We are seeing a higher risk of severe outcomes,” she told CBC last week. “So, if you look at the risk and benefit balance, in my mind, the benefits outweigh the risk, but have a look at your local situation."
Actually, many medical professionals are more worried about the ways that COVID-19 itself could affect a pregnancy, such as preeclampsia or early labour. (Again, data is limited, but the risk of a pregnant parent transmitting the virus to their baby in the womb is low.) “When you have a parent who's pregnant, and they're in the ICU, sometimes one of the ways of treating them is to deliver the baby early,” Dr. Grinrod said. “So, [a preterm birth] then becomes an effect of COVID.”
Could getting the vaccine while pregnant affect my unborn child?
Though clinical trials studying how the COVID-19 vaccine affects pregnant people are still underway, earlier studies in animals who received Moderna, Pfizer, or Johnson & Johnson vaccines found that there were no safety concerns regarding pregnancy.
In fact, “we are starting to see information that when parents are vaccinated in pregnancy, they end up with a higher antibody level than from natural infection,” said Dr. Nasello. This is great news because in general, antibodies travel across the placenta to offer protection to the fetus. Several recent studies have also found that the COVID-19 vaccines are highly effective in producing antibodies in pregnant and lactating people, and that these protective antibodies can be passed to the newborns through breast milk and the placenta.
When it comes to safety concerns around breastfeeding in particular, the Society of Obstetricians and Gynaecologists of Canada has issued a consensus statement in favour of vaccination: “Women who are pregnant or breastfeeding should be offered vaccination at anytime if they are eligible and no contraindications exist.” Dr. Grindrod added that parental vaccination is also important to help create a bubble of safety around a newborn, who likely won’t be able to get a vaccine of their own for the foreseeable future.
Hmmm, but as a pregnant person, I’m also really concerned about blood clots.
Both doctors told Refinery29 that there is always a risk of complications like blood clots in any pregnant individual, with or without a vaccine. “The highest risk of blood clotting at any one time is in pregnant people,” said Dr. Nasello.
What’s more, because the risk is already high in pregnant individuals, should a vaccinated person get a clot, it would be nearly impossible to determine the cause. But according to Thrombosis Canada, there is generally no increase in the overall risk of blood clots after receiving any of the approved COVID vaccines. What people are concerned about with AstraZeneca is vaccine-induced immune thrombotic thrombocytopenia (VITT), which are very rare cases of blood clots associated with low levels of blood platelets. (There have only been five reports of this kind of blood clots reported in Canada out of more than 1.1 million doses given.)
Okay, so from a doctor’s perspective, should I be getting this vaccine if I’m pregnant?
“Absolutely,” said Dr. Nasello. “We know a lot now about the mRNA vaccines, and if that is available to you, go for it.”
“I think it's very important for people who are pregnant to seriously consider the vaccine,” added Dr. Grindrod. “And if someone chose to get vaccinated, I would absolutely support that decision, because I think right now, the benefits of the vaccine and what it offers in terms of protection, clearly appear to outweigh the risk of COVID during pregnancy.”
What do I need to do before I show up for my vaccine?
“Don't hesitate to call your obstetrician, your midwife, your family doctor,” Dr. Grindrod said of talking it through with someone you trust. “It just gives you a chance to walk in there feeling comfortable with the decision.” Dr. Tam has echoed the sentiment, advising pregnant people to check with their physician, depending on which trimester of pregnancy they are in.
But this informed consent shouldn’t be a barrier to actually going in and getting the shot. “Please talk to your obstetrical provider, but that should not ever be an absolute requirement,” said Dr. Nasello. “You do not need permission from your healthcare or your obstetrical-care provider. That is something that is a vestige of medical patriarchy, and there is no reason that pregnant people are unable to make their own decisions.”
COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.