Vaccination for pregnant people
Pregnant people are encouraged to get the vaccine as soon as possible. It is safe during any stage of pregnancy. To help educate our community about the safety of the COVID vaccine during pregnancy, see the below update from Dr. Modupe Tunde-Byass and Dr. Kalpana Sharma on COVID-19 vaccines and use in pregnancy. Both doctors are Obstetricians at North York General Hospital's Maternal Newborn and Paediatric Department.
Also see the following video featuring experts from our Maternal Newborn and Family Medicine units (from May 2021):
Dr. Modupe Tunde-Byass and Dr. Kalpana Sharma, Obstetricians at North York General Hospital's Maternal Newborn and Paediatric Department, provide an update on COVID-19 vaccines and use in pregnancy (January 2022).
Q: What are the risks to my baby if I get COVID-19 while pregnant?
Dr. Tunde-Byass: We have data coming in regarding risks to the pregnancy itself with COVID-19 infection. These studies raise several concerns:
- Preterm Birth: Internationally we have seen a 17 to 20% increase in the rate of preterm birth. It is important to note that the category of preterm delivery that has seen the largest overall increased rate of delivery is in the “extremely premature,” or between 20-27 weeks. Fortunately, most cases of preterm birth are still occurring late in the third trimester where the effects of prematurity on the baby would be the mildest. The main reasons we see people deliver prematurely are because of fetal distress, fetal growth restriction and preeclampsia/HELLP syndrome. These risks are linked to disease severity, so if you are very sick you are more likely to need to deliver your baby prematurely. We continue to see that preterm birth is most associated with infection in the third trimester.
- Preeclampsia: The risk of preeclampsia seems to be greater in your pregnancy if you have a COVID infection at any time of your pregnancy. That risk seems to be about two times higher when compared to people without a COVID infection.
- Stillbirth: Disturbingly we are seeing a higher risk of stillbirth, about twice as high for people infected with COVID when compared to those who are uninfected. This higher risk does not seem to be dependent on the variant of concern and has been stable across each of the waves.
- Fetal growth restriction: Rates of low birth weight are increased by about 1.58 times.
Some good news is that we have not noted any risk of structural anomalies or miscarriages from COVID-19 infection to date.
Q: What are the risks to me if I get COVID-19 while pregnant?
Dr. Sharma: We do believe there is a spectrum of disease. While some may experience mild flu like symptoms, others may experience moderate to severe symptoms including lung infections, severe breathing problems and the need for oxygen/ intubation or hospitalization.
From our most recent data when compared to reproductive aged peers, pregnant people who contract COVID-19 are:
- 2.9 times more likely to be hospitalized
- 5 to 6 times more likely to be admitted to the ICU
- Those that are admitted to the ICU may have to stay for up to 3 times longer.
One study showed a 20 times higher likelihood of maternal death when compared to the average age matched population. We are seeing higher rates of preeclampsia, as Dr. Tunde-Byass mentioned, in patients who have had COVID-19 at any point in pregnancy. We are also seeing higher rates of cesarean section.
We know that certain risk factors will increase your risk of severe illness. Age over 35, obesity, diabetes, high blood pressure, being part of a minority ethnic group, and being in your last trimester of pregnancy all increase the risk of severe illness and can have a greater impact on your pregnancy.
Q: What trimester is best to get the vaccine?
Dr. Tunde-Byass: The best time to get vaccinated or get your booster shot is as soon as possible! You can get the vaccine in any trimester of pregnancy. We have a vaccine clinic at North York General that is open to pregnant patients who are delivering their babies at NYGH and their partners. You can book your vaccine here at North York General hospital.
You can also book a vaccine appointment at a City of Toronto-run clinic using the COVID-19 vaccine booking portal, attend a hospital immunization clinic, a pop-up clinic or a participating pharmacy among other options. See the NYGH COVID-19 vaccine page for more information.
Q: I’m in my third trimester. Should I get the vaccine now or wait until the baby is born?
Dr. Tunde-Byass: We know that COVID-19 infection in your third trimester increases your risk of preterm delivery 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. Booster shots have been shown to significantly protect you against infection. We have 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 pregnant people?
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 people who have chosen to receive the vaccine in pregnancy.
Thus far there are no reported differences in rates of miscarriage, preeclampsia, stillbirth, growth restriction, congenital anomalies and preterm birth in those who are vaccinated. There have not been any differences shown in what trimester you get the vaccine and in the number of doses given. A study done in Ontario even showed a trend in lower risks of severe bleeding, infection, cesarean section and NICU admission in those who had at least one dose of the COVID-19 vaccine in pregnancy versus those who waited until after the pregnancy was over.
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. They do not contain pork, gelatin, mercury, aluminum or formaldehyde.
Q: What about the vaccine side effects for pregnant people?
Dr. Tunde-Byass: Over 185,000 pregnant people have registered in the US Vaccine Adverse Effect Reporting system (V-SAFE) and the risk of a side effect from the vaccine seems to be about the same as in the general population. Pregnancy outcomes are being reported through this reporting system as well as through numerous other studies.
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-19 vaccine right away or do I have to wait?
Dr. Sharma: The current recommendation is that you can get the vaccines as close together as needed. This is a change from the previous recommendation of not giving COVID-19 vaccines within 14 days of providing a Tdap vaccine. This was mostly so we could tell which side effects were related to the COVID-19 vaccine. Now we have lots of data regarding COVID-19 vaccine side effects, so the new recommendations are clear in saying you can get the vaccines as close together as needed.
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 about the specific details surrounding your pregnancy 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-19 or ending up in hospital or ICU. The current recommended vaccines are Pfizer and Moderna. They are considered essentially interchangeable at this point and you can get either one.
We still recommend wearing masks around others and practice physical distancing as the pandemic continues.
Q: Why do I need to get vaccinated when all my vaccinated friends are still getting COVID-19?
Dr. Sharma: This can be confusing. We do see vaccine immunity waning over time, especially about 6 months after your second dose. Fortunately, getting a booster is highly effective against preventing infection and brings your immunity right back up.
Getting vaccinated doesn’t mean that you won’t get COVID-19. But it does mean that you are less likely to get sick if you are exposed to COVID-19 and less likely to pass it along to loved ones in your life. A good analogy is wearing a seatbelt when you drive a car. Wearing a seatbelt doesn’t mean you won’t get in an accident, but it will likely prevent a severe injury or death.
Q: I’m unvaccinated but my family is fully vaccinated. We are all being 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.
Unfortunately, in the last few weeks with the new variant, the number of infected pregnant patients has increased despite being careful. We are seeing far more pregnant people admitted at the hospital under our care. The best course of action is for everyone to get vaccinated and get their booster shots.
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 an 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 allergies 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 were 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. At this point there are several BILLION doses of vaccine that have been administered worldwide and we have that real world data to go on.
Q: Should I get a vaccine if I had COVID-19?
Dr. Tunde-Byass: If you have had COVID-19 you should still get vaccinated. The current recommended waiting time is 30 days after infection.
Q: I am pregnant and suspect I have COVID-19. What should I do?
Dr. Sharma: Please get tested. We have advocated and pregnant people have been prioritized for testing. You should not be turned away from a PCR test. Please contact your care provider (OB/GP/Midwife) while you are isolating so that we can advise you. There are several community supports that can follow you during your illness to make sure you are safe. Please come to the hospital if you are experiencing severe chest pain or shortness of breath. Also continue to follow directions from Public Health about quarantining.
Your care provider may decide to follow you more closely in your pregnancy after your COVID-19 infection resolves, using ultrasounds to monitor fetal growth and well being. They may ask you to monitor your blood pressure at home and self monitor for symptoms of preeclampsia.
Q: I have received two doses of the COVID-19. Do I need a booster?
Dr. Tunde-Byass: People who receive two doses can become infected with COVID-19. This may start as mild but could lead to serious illness. The booster can increase protection to about 85% from the 35% protection provided by two doses over time. The booster dose is safe in pregnancy.