Dr. Modupe Tunde-Byass and Dr. Kalpana Sharma, Obstetricians at North York General Hospital's Maternal Newborn and Paediatric Department, answer frequently asked questions about the new COVID-19 vaccines and use in pregnancy.
Here’s what they had to say:
Q: I’m being so careful. Am I really likely to get COVID-19 while pregnant?
Dr. Tunde-Byass: We know that pregnant people are being very careful to not contract COVID-19. They are working from home and practicing mask wearing, hand hygiene and social distancing. We have seen in the past that from March 2020 to March 2021, about 1.16% of pregnant people across the country tested positive for COVID-19.
Unfortunately, in the last few weeks with the variant of concern from the UK, the number of infected pregnant patients has increased. This variant of concern seems to be affecting reproductive aged people more frequently. This new variant seems to be preferentially making younger people, such as pregnant people sick, and we are seeing far more pregnant people admitted at the hospital under our care.
Q: What are the risks to my pregnancy if I get COVID-19?
Dr. Sharma: From our most recent data, about 85-90% of pregnant people with COVID-19 will have mild flu-like symptoms. About 10-15% may experience moderate to severe symptoms including lung infections, severe breathing problems and the need for oxygen or hospitalization. We know that certain risk factors will increase your risk of severe illness. Age over 35, obesity, diabetes, high blood pressure, being as part of a minority ethnic group, and being in your last trimester of pregnancy all increase the risk of severe illness and therefore can have a greater impact on your pregnancy.
When we look at studies out of the US that compare pregnant people to people the same age with COVID-19, pregnant people have a five-times greater risk of hospitalization, two-times greater risk of ICU admission and two-times increased risk of needing to be on a ventilator. Similar data has been shown here in Canada.
The more severe the illness, the more complications we are seeing in pregnancy. Pregnant people word-wide seem to be at a three-times higher risk of cesarean section and nine times higher risk of low birth weight infant. There is a 20% increased risk of preterm delivery compared to the regular population, especially if infected in the third trimester.
Q: What trimester is best to get the vaccine?
Dr. Tunde-Byass: The best time to get vaccinated is as soon as possible! You can get the vaccine in any trimester of pregnancy. We have opened a vaccine clinic at North York General that is open to pregnant patients who are delivering their babies at NYGH and their partners, as well as other pregnant people in the community. You can book your vaccine here at North York General Hospital.
You can also search by postal code at www.vaccineto.ca to register for the vaccine through public health.
Q: I’m in my third trimester. Should I get the vaccine now or afterwards when the baby is born?
Dr. Tunde-Byass: We know that COVID-19 infection in your third trimester increases your risk of preterm labour and severe illness from COVID-19, so we would advise receiving the vaccine as soon as you can. The sooner you get it, the sooner you are protecting yourself and your baby. We are starting to see evidence that the antibodies made will be passed through the placenta and umbilical cord to the baby and the earlier you get the vaccine, the more likely it is that baby will receive this passive immunity from you. Waiting to receive the vaccine will allow the virus to continue to spread and mutate, which means that the pandemic may go on longer and current vaccines may no longer be effective.
Q: Pregnant people weren’t included in the vaccine trials. How do you know the vaccine is safe for me?
Dr. Sharma: Not tested doesn’t mean not safe. We have been giving vaccines to pregnant people for a long time such as the Tdap and flu vaccines. We have seen individuals who participated in the clinical trials that did become pregnant with no reports of adverse effects to date. As time has gone on, we now have population data that show safety in many women who have chosen to receive the vaccine in pregnancy.
There is a lot of misinformation out there. The vaccines available are not “live vaccines” and therefore do not put the baby at risk of being infected with COVID-19. The vaccines will not affect your DNA or the baby’s DNA. From the studies thus far, there is absolutely no increased risk for infertility, miscarriage, stillbirth or birth defects with the COVID-19 vaccines.
Q: What about the vaccine side effects? Are they more for pregnant women?
Dr. Tunde-Byass: Over 30,000 women have registered in the US Vaccine Adverse Effect Reporting system and the risk of a side effect from the vaccine seems to be about the same as in the general population. You may develop a fever after vaccination, pain and swelling at the injection site, swollen lymph nodes, muscle aches and pains – none of these pose any risk to the pregnancy. You can take Acetaminophen (Tylenol) if needed. Serious side effects such as anaphylaxis are very rare.
Q: I just received the Tdap (Tetanus, Diphtheria, Pertussis) vaccine. Can I get my COVID Vaccine right away or do I have to wait?
Dr. Sharma: The recommendation is that COVID-19 vaccines should not be given within 14 days of another vaccine such as Tdap and influenza vaccine. This is mostly so we can tell what side effects you may have from a particular vaccine.
Q: How about other shots in pregnancy like Rhogham?
Dr. Sharma: Rhogam does not interfere with the immune response to the COVID-19 vaccines and can be given at any time around your vaccinations.
Q: I’m having a high risk pregnancy. Should I get the vaccine?
Dr. Tunde-Byass: Most patients with either high or low-risk pregnancies will benefit from receiving the COVID-19 vaccine and being protected from getting infected. Infection with COVID-19 may increase the risks of your pregnancy even further if you are high risk or in the last three months of your pregnancy. Please speak with your obstetrician/health care provider about the specific details surrounding your pregnancy to determine if you will benefit from the vaccine if you are concerned.
Q: Is the vaccine safe for both me and my baby while breastfeeding?
Dr. Sharma: As far as we have seen, the vaccine is safe for you and for the baby while breastfeeding. I received my own vaccine while breastfeeding my son. There is evidence that you can pass along antibodies in your breast milk to the baby which can help protect the baby too!
Q: What is best vaccine to get?
Dr. Tunde-Byass: The best vaccine is first one you can get into your arm. This is because ALL vaccines protect you from getting sick from COVID or ending up in hospital or ICU. The COVID-19 vaccines that can be used in pregnant women are: Pfizer, Moderna, Astra-Zeneca and Johnson & Johnson. All the vaccines are two doses, with the exception of Johnson & Johnson which is one dose.
We still recommend wearing mask around others and practice physical distancing until we reach herd immunity.
Q: Why do I need to keep wearing a mask and distancing after getting my vaccine if it works so well?
Dr. Tunde-Byass: This can be confusing. The fact is that about 3-4 weeks after getting the first dose of the vaccine your chance of catching COVID 19 is significantly reduced because of how well it works, but before this time you could catch COVID-19 and transmit it to others without knowing it. You will still continue to wear your mask and social distance until the majority of people in Canada are vaccinated.
Q: I have a lot of allergies – is it save for me to get the vaccine?
Dr. Sharma: The short answer is YES. The only allergies that prevent you from getting the vaccine are if you have allergic reactions to the first dose of the vaccine or you have allergy to a component of the vaccine called Polyethylene glycol (PEG ) for Pfizer/Modena or Polysorbate for AstraZeneca. PEG is generally a safe substance that is found in shampoos, toothpaste and laxatives. Otherwise, people with unrelated allergy to food, drugs, insect venom (bee stings) and environmental allergies can receive the vaccine. They do not need to be seen by an allergist before getting the vaccine.
Q: I am worried that these vaccines were developed too quickly - are they safe?
Dr. Tunde-Byass: Yes, they are safe. The mRNA technology has been around for over 10 years. It is being used in gene therapy and cancer treatment. The reasons the vaccines was developed so quickly is because there are so many researchers all over the world who worked together to create a vaccine that is safe and effective. Due to the urgency of a global pandemic, most of the red tape that delays vaccine development was removed to speed up production of an effective vaccine.
When should I or should I get a vaccine if I have had COVID?
Dr. Tunde-Byass: If you have had COVID you should still get vaccinated because we don’t know how long you would be protected from getting sick again after recovering from COVID and you still could be at risk of catching another variant. Until recently the recommendation was to wait for three months after having COVID to get the vaccine, but now the guidelines say as long as you are cleared by the public health, you can get vaccinated.
Q: I have COVID-19 and I am pregnant. What should I do?
Dr. Sharma: Please contact your care provider (OB/GP/Midwife) while you are isolating so that we can advise you. Please also continue to follow directions from Public Health about quarantine during this time.