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'No concerns that we're seeing': Utah doctors explain how COVID-19 vaccines factor in women's health, pregnancy

By Carter Williams, KSL.com | Posted - Apr. 16, 2021 at 2:35 p.m.



SALT LAKE CITY — Now that everyone in Utah 16 and over are eligible to receive the COVID-19 vaccine, the number of people vaccinated in the state is on the rise.

Over 1.15 million Utahns have received at least one dose of a COVID-19 vaccine, and over 700,000 Utahns are considered fully vaccinated since December 2020.

Over the past months, medical experts have learned more about COVID-19 and the vaccines that protect against it. For instance, vaccines and pregnancy were one of the largest unknowns heading into the vaccination process since pregnant women weren't included in initial clinical trials.

That's changed in recent months. Dr. Sean Esplin, medical director of women's health for Intermountain Healthcare, said Friday that there are thousands of pregnant women who have now received the vaccine. There's now research that shows major benefits about the vaccine in pregnant and breastfeeding women.

As the vaccination process continues, Esplin urged expectant mothers to get vaccinated and addressed other concerns about vaccines and women's health, including the recent pause of the Johnson & Johnson vaccine.

COVID-19 vaccines and pregnancy

Questions about vaccines and pregnancy were one of the more frequent topics KSL.com readers asked about in the first few weeks of the COVID-19 vaccine rollout. There wasn't a very clear answer about this in January, other than it was believed the risk for adverse effects was low. The Centers for Disease Control and Prevention recommended that those who were pregnant should discuss concerns with their health care provider.

Now there's a lot more data available. More than 50,000 pregnant women have received a COVID-19 vaccine, and researchers have been "following them very closely" to ensure there aren't any major complications as a result, Esplin said. That includes regular checkups for women who signed up to report their symptoms, as well as looking at medical data.

"To this point, there are no concerns that we're seeing among pregnant women to say, 'Hey, there's a higher risk of the vaccine during pregnancy,'" he said during a question-and-answer forum with members of the media. "That's really reassuring."

In the end, the decision to get vaccinated comes down to risk and benefit.

It wasn't exactly clear what impact COVID-19 had on pregnancy early in the pandemic because researchers were still racing to find anything they could to understand how the disease impacts people.

Esplin explained Friday that studies now show there are higher risks for pregnant women to experience more severe symptoms from COVID-19 compared to women who are not pregnant. The risk increases for pregnant women who have other COVID-19 risk factors like diabetes, high blood pressure, asthma and obesity.

"If you're pregnant and you get the infection, you have a higher chance of needing help breathing because your lungs can be more affected," he said. "You might have a higher chance of being admitted to the hospital or the ICU, and even a higher chance of having a death because of this. That's not unusual because we know with other viral infections — for example, just the regular flu — if you get that while you're pregnant, you can have a more severe course."

In terms of the vaccine, there have been mostly minor side effects reported overall. Esplin pointed out that the Pfizer-BioNTech and Moderna vaccines are mRNA vaccines, while the Johnson & Johnson vaccine is an attenuated virus vaccine.


To this point, there are no concerns that we're seeing among pregnant women to say, 'Hey, there's a higher risk of the vaccine during pregnancy.' ... That's really reassuring.

–Dr. Sean Esplin, medical director of women's health for Intermountain Healthcare


The risks for the mRNA vaccines have been extremely low, Esplin said. Earlier this week, Utah joined many other areas that paused the use of the Johnson & Johnson vaccine due to the finding of a half-dozen patients who developed a specific blood clot after receiving it.

While Esplin said blood clots occur more frequently in women, there were no reports of pregnant women developing clots after receiving the Johnson & Johnson vaccine.

He viewed the stoppage as proof that the evaluating system in place during emergency use authorization is working. Even though it was paused, he said the cases were still rare enough to consider that vaccine option riskier than infection.

"The problems that we're seeing are very infrequent — it's one in a million," he said. "If you look at the number of lives that are saved by vaccinating, the risk benefit-ratio there actually still favors being vaccinated."

That's why he said he would be comfortable with the vaccine still being administered if federal officials greenlight the vaccine again, which is expected to come as early as next week.

If those are the risks, then what are the benefits? That's what is currently being studied as more pregnant women get the vaccine. However, there are some early indications that there are plenty of benefits from it.

One study published in the American Journal of Obstetrics and Gynecology last month found that women either pregnant or breastfeeding at the time they got the vaccine had a better immune response compared to women who were infected by COVID-19. That is, they had more antibodies through a vaccine than if their body's immune system fought off the virus.

"You're more protected if you've got the vaccine than if you've had the natural COVID infection, so that's really awesome," Esplin said. "We can show that, just as we'd expect, the vaccine produces the response that we want and it's in levels much higher than if you had gotten the infection yourself."

The other benefits from that are that antibodies cross over the placenta to a baby and also cross over from breastfeeding, Esplin added.

"We've always known that breastfeeding is really important for newborns to have protection, so we offer immunizations during pregnancy," he said. "We offer the (tetanus, diphtheria, pertussis) and the influenza vaccine. Part of that is to protect the mother, but a part of that is to also protect the baby; so, finding that these COVID antibodies are reaching the baby means that if you want to be safe yourself in your pregnancy, and you want to keep your baby as safe as possible in respect to COVID, get the vaccine. The earlier you get it, the higher the (antibody) levels will get to your baby."

Esplin clarified there isn't a specific best time during a pregnancy to receive the vaccine.

"I think the best time is when you're offered," he said. "I'm not telling people to wait any particular time."

Women and the Johnson & Johnson vaccine

In a joint statement, the CDC and the Food and Drug Administration confirmed all six cases of blood clots from the Johnson & Johnson vaccine involved women between the ages of 18 and 48. The symptoms for all six were reported between six and 13 days after inoculation.

"Treatment of this specific type of blood clot is different from the treatment that might typically be administered," the agencies wrote. "Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous and alternative treatments need to be given."

Esplin said all six cases involved blood clots in one of the large veins in the brain.

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Since women are more likely to develop blood clots, and all six reported cases involved women, he was explained how people, especially women, who received the Johnson & Johnson vaccine should monitor their systems.

An "unusual headache," shortness in breath or chest pain, swelling in the legs with one more swollen than the other, or redness/tenderness are the biggest signs of blood clots, Esplin explained.

"It's important for you to notify your doctor if you have those kinds of symptoms and be evaluated," he said. "We're learning, and we now know the right way to treat that."

Medical professionals reminded individuals Friday that the number of cases indicates that developing those symptoms are extremely rare. It appears that if those symptoms don't develop after about three weeks, then an individual is in the clear.

Esplin said he wanted to reassure anyone still within that three-week window.

"The odds are you're going to be just fine," he added.

Vaccines and menstrual cycles

There's a new study that's underway looking into any possible effects of the COVID-19 vaccine on menstrual cycles. The idea emerged after the study's leader, Dr. Kate Clancy, an associate professor and director of graduate studies at the University of Illinois, began a social media thread in February about possible menstrual cycle complications after receiving the COVID-19 vaccine.

In a tweet Feb. 24, she asked: "A colleague told me she has heard from others that their periods were heavy post-vax. I'm curious whether other menstruators have noticed changes too?"

The many responses to that thread were in the process of being documented and approved for official study, the university stated earlier this month.

Esplin said he's not aware of any medical information regarding impacts on menstrual cycles or infertility to this point. That includes notices from the American Society of Reproductive Medicine. In many cases, he said, anecdotal documentation is difficult to prove causation.

"There is no evidence that the vaccine has any effect on infertility or the menstrual cycle that we're aware of at this point," he said. "The interesting thing is when you get the vaccine and anything happens, you think, 'Oh, it's the vaccine that's causing it.' There is no real evidence to support any of those concerns."

Anyone who does have a serious health change they believe might be related to the vaccine, including changes to the menstrual cycle, is encouraged to report it to their health care provider so it can be added to the Vaccine Adverse Event Reporting system set up for the COVID-19 vaccines.

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