Tuesday, June 15, 2021
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An Emphasis on Safety: Addressing COVID-19 vaccine hesitancy among pregnant women
By Calvin Johnson, MD, Professor of Anesthesiology, Cedars Sinai Medical Center, Los Angeles
Published June 3, 2021

(Courtesy photo)

Even as the number of COVID-19 vaccine doses administered increases, there are still lingering concerns in the public surrounding side effects in women, particularly among expecting mothers. General misinformation regarding vaccines led to a fear of how the COVID-19 vaccine could affect maternal health and fetal development. But physicians and medical experts are now trying to correct the record, educate expecting mothers, and highlight the safety of vaccines. We are at a key pivot point in this pandemic, so getting as many people vaccinated as quickly as possible will help save lives, reduce the risk of dangerous variants, and help us return to the people, places, and activities we’ve been missing. The benefits far outweigh the minimal risks and data collected from pregnant women who have taken the COVID-19 vaccine so far has been overwhelmingly positive, but is it enough to ease doubt?

 One main source of doubt stems from the exclusion of expecting mothers during the trial period. This led to questions about increased risk for preterm delivery or cesarean delivery, formation of blood clots, or stillbirth. Our patients’ concerns should be taken seriously – with physicians taking the time to help women make an informed decision about whether to take the vaccine. There is now enough evidence to clearly recommend that the benefits to a mother and her unborn baby of taking the Pfizer or Moderna vaccine vastly exceed its risks, so we must share information and answer questions for this vulnerable population.

The pause in Johnson & Johnson vaccine production was controversial, but I believe it should be viewed as positive in that it demonstrated a re-confirmation of a “safety first” standard guiding vaccine approval and distribution. As of April 25, 2021, data from the Johnson & Johnson vaccine shows just 15 cases of adverse reaction to the vaccine, out of the 7.2 million doses administered, including only six cases of rare blood clots and one death. That means there is a 0.00000088 % chance of forming a rare blood clot and a 0.00000015% chance of death with the Johnson & Johnson vaccine. So we can feel confident that the Johnson & Johnson vaccine should continue to be used widely across the country. At the same time, there is now plenty of the Pfizer and Moderna vaccines to use these as the recommended choice for the sub-population of pregnant patients.

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 The many layers of scrutiny and cautious review of the vaccine candidates, including the CDC’s willingness to stop and then re-confirm their safety finding regarding general use of the Johnson & Johnson version, should boost confidence and show there are guardrails and protections in place. Patient safety is the North Star always, and the best medical minds have looked at the vaccine efficacy and vaccine safety and given their blessing to COVID vaccination as an important strategy for protecting the safety and well-being of women and expectant mothers.

Not only is the COVID vaccine safe for the fetus if the mom takes it, there is also new research showing that women who receive COVID-19 mRNA vaccines produced by Pfizer or Moderna while in their third trimester of pregnancy actually pass protective antibodies through umbilical cord blood to their babies. In fact, the research demonstrated that 99% of newborns had protective antibodies after their mothers received both vaccine doses, and 44% of babies had antibodies after one dose. That is great news! Additionally, a new study from Northwestern Medicine found that the placentas of pregnant participants who received the COVID-19 vaccine showed no evidence of damage – which further adds to the medical literature supporting vaccine safety for pregnant mothers. Early rumors that the vaccine causes infertility have been dispelled, and participants in the clinical trials were able to conceive after vaccination.

Research on the COVID-19 vaccines and the disease itself will continue for years, and additional data will help show the effects on pregnant people and other patient populations more accurately. For now, we have a strong enough body of research to persuasively prove that the risks of not getting vaccinated far exceed the risks tied to being vaccinated. Even before giving birth, an expecting mother can take many valuable steps to positively influence the long-term health of her baby – and now we know that taking the COVID vaccine while pregnant should be on that priority list.

Calvin Johnson, MD is an anesthesiologist at Cedars Sinai Medical Center, Los Angeles. He specializes in Obstetric Anesthesiology, Regional anesthesiology, pediatric anesthesiology and pain medicine. He is a member of the Cedars Sinai Medical Center COVID19 Airway Team and Invasive Line Placement ICU Team. Dr. Johnson also serves as a Diplomate for the American Board of Anesthesiology, American Board of Pediatric Anesthesiology, and American Board of Pain Medicine.

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