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SALT LAKE CITY — Dr. Hannah Imlay did not feel hesitant about the COVID-19 vaccine until she found out she was pregnant.
She had unknowingly been pregnant when she got the first dose, but now that she knew she was pregnant, the choice to get her second dose gave her pause as she wanted the best for her unborn child.
The pause didn't last long. At the time, there wasn't much data because pregnant women weren't included in clinical trials for the vaccines, but as an assistant professor of infectious diseases at the University of Utah, she also knew how to evaluate the data that did exist, and it seemed safe.
Imlay knew that the COVID-19 vaccines are not live virus vaccines, which is the only kind of vaccine pregnant women are advised against because of potential harm to the fetus. Pregnant women are, however, advised to get a flu shot and a tetanus, diphtheria and pertussis (Tdap) shot during pregnancy and can pass helpful antibodies to the fetus.
"I want to protect my child. Is getting a vaccine giving my child the best chance?" Imlay said. "From an infectious disease perspective, the bad effects of being pregnant and not getting vaccine were much worse."
After evaluating what she did know, it was clear. Imlay decided to receive the second dose of the COVID-19 vaccine.
The only side effect she experienced was a sore arm and a little fatigue. Shortly afterward, more data came out. Several people in the Moderna and Pfizer trials were in the same situation she had been in. They found out they were pregnant after already starting the trials. The outcomes showed that there was no harm to the fetus, but pregnant women who received the placebo had poor outcomes both for the fetus and the mother upon contracting COVID-19.
According to research published earlier this year by University of Utah Health, some of these outcomes can include preterm birth, cesarean delivery and high blood pressure in pregnancy. Mothers who choose not to be vaccinated and become severely ill with COVID-19 have to make "heartbreaking decisions" between their health and their fetus', Imlay said, like whether to deliver early and risk the baby's health, whether to use medications to treat COVID-19 that haven't been tested on pregnant women yet, and whether to be intubated or hooked up to life support.
Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered, though, some developed severe COVID-19.
During pregnancy, a person's immune system changes, meaning they become more susceptible to infections and viruses. They can also get sicker than people who are not pregnant. According to the Centers for Disease Control and Prevention, pregnant women who contract COVID-19 are at a higher risk of becoming severely ill, potentially requiring hospitalization, intensive care and ventilation.
These risks are higher if the mother has certain underlying medical conditions, is older than 25, lives or works in a community with high numbers of COVID-19 cases or lives or works in a community with low levels of COVID-19 vaccination.
"Subsequently, the CDC and the FDA have done a very good job monitoring issues and immunogenicity. Both organizations have given us really rewarding and good news. The vaccine works well in pregnant women. It looks great and very safe for the baby. We don't know the long-term effects, but previously similar vaccines have had a great track record of safety," Imlay said.
"And — now more than ever — we have good data that yes, the vaccine is safe."
In fact, a study earlier this year showed that not only are fetuses not damaged by their mothers receiving the vaccine, they actually benefit from it.
Researchers at Massachusetts General Hospital and its Ragon Institute, Brigham and Women's Hospital, MIT and Harvard have demonstrated that mothers who receive the vaccines can pass antibodies to newborns through the placenta while pregnant and through breast milk while nursing. Because infants and toddlers cannot yet be vaccinated against the novel coronavirus, this is one of the only ways to induce immunity to protect them.
Experts at the CDC recently joined the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine — the two leading organizations representing specialists in obstetric care — in recommending that all pregnant women be vaccinated. The statement explained that current data did not find an increased risk of miscarriage among 2,500 pregnant people who received the COVID-19 vaccine in the first 20 weeks of pregnancy.
"CDC encourages all pregnant people or people who are thinking about becoming pregnant and those breastfeeding to get vaccinated to protect themselves from COVID-19," said CDC Director Dr. Rochelle Walensky. "The vaccines are safe and effective, and it has never been more urgent to increase vaccinations as we face the highly transmissible delta variant and see severe outcomes from COVID-19 among unvaccinated pregnant people."
There is also no evidence to suggest that COVID-19 vaccines have any effect on fertility among the millions of individuals who have so far received the vaccine, the statement added.
However, in spite of all of the recommendations from experts, the CDC reports that only 23% of pregnant women in the U.S. had been vaccinated as of the end of July. Myths and misinformation about how the vaccines have affected pregnant women have severely impacted vaccination rates as the delta variant has spread faster among all people — including pregnant people — in the past several weeks.
"The increased circulation of the highly contagious delta variant, the low vaccine uptake among pregnant people, and the increased risk of severe illness and pregnancy complications related to COVID-19 infection among pregnant people make vaccination for this population more urgent than ever," the CDC statement reads.
If you have more questions about getting vaccinated while you're pregnant or breastfeeding, you can use MotherToBaby, a free and confidential service available in both English and Spanish by phone or chat, available Monday through Friday, 8 a.m. to 5 p.m.