Here’s what Utah doctors are advising pregnant women about COVID-19 vaccines

Erin Merrill isn’t sure which will come first: her baby’s due date in June or an opportunity for her to get the COVID-19 vaccine.

“If I do get the chance, I’m definitely going to get it,” said the 27-year-old Bluffdale resident. She wants not only to protect herself and her family from the virus, she said, but to help stop its spread in the Beehive State.

As Utah leaders roll out their inoculation plan — which began with front-line health care workers and now includes teachers and residents age 70 and older — national experts recommend that women who are pregnant or breastfeeding be offered the vaccine. That advice is backed by the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

There’s limited information about how the vaccine may affect these women, specifically, since they weren’t included in early clinical trials. But based on what researchers know about how the Pfizer and Moderna vaccines work, “there is every reason to think that the vaccine is safe” for them, according to Dr. Sean Esplin, senior medical director for women’s health at Intermountain Healthcare.

Getting vaccinated is a personal choice for those who are expecting, according to the CDC, and people should ask their health care providers any questions they have to make an informed decision.

Katie Hansen, a labor and delivery nurse at Logan Regional Hospital who is eight months pregnant, knows she faces a risk of catching the virus despite the safety precautions she and other health care workers take. So, after considering the risks and benefits and consulting with her OB-GYN, she decided to get vaccinated, and she received her second dose earlier this month.

Seeing the effect COVID-19 has had on patients “has made me realize this is something if I have the option of not catching, ... I really don’t want to catch it,” the 30-year-old said. “Because you never know how you’re going to handle it.”

Factors to consider

The CDC recommends patients consider their possible exposure to COVID-19 and what could happen if they caught the virus.

“Pregnant people are at increased risk for severe illness from COVID-19,” according to the CDC, compared to women of reproductive age who are not pregnant. There also may be a higher likelihood of premature births and stillbirths from COVID-19, the agency said.

“Our research shows that serious pregnancy complications appear to occur in women who have severe or critical cases of COVID and not those who have mild or moderate cases,” said Dr. Torri D. Metz, a maternal-fetal medicine subspecialist and associate professor at the University of Utah Health.

Metz led a new study, which was presented Thursday at the Society for Maternal-Fetal Medicine’s annual meeting, that examined medical records of 1,219 pregnant women from 33 hospitals in 14 states between March and July last year. The patients with more severe cases of COVID-19 were older, had a higher body weight index and were more likely to have underlying medical conditions. The complications they experienced from the virus included cesarean section deliveries, heavy bleeding after giving birth, high blood pressure during pregnancy and preterm birth.

Four women (0.3%) in the study died due to COVID-19, which is higher than the death rate for pregnant women without the virus (17.4 deaths per 100,000 live births, according to the CDC).

If women have a lot of contact with people outside their home, or they work in an industry like the health care field, “it probably makes sense for you to take the vaccine,” Esplin said.

As a labor and delivery nurse, Hansen takes precautions and wears personal protective equipment. Mothers giving birth at the hospital are tested for COVID-19.

“My co-workers are really protective of any of us that are pregnant or have any high risk that would make it worse if we caught COVID,” Hansen said, and they care for coronavirus patients so she can focus on healthy patients. Getting vaccinated adds another protection for her, she said.

Even if pregnant women can stay home, wear a mask and practice social distancing, they should still think about the spread of COVID-19 in their communities, Esplin said. The vast majority of Utah’s 29 counties have a high level of transmission as of late January, the state Department of Health website shows.

There are other health conditions to consider, too, Esplin said, such as whether a person has a history of severe allergic reactions. Women who are overweight or have diabetes, high blood pressure or heart disease are at a greater risk of a more severe case of the virus. And Utah’s minority communities have experienced disproportionate effects from COVID-19.

“We are certainly supporting patients in whatever they decide,” Metz said.

What’s known about pregnancy and the vaccine

The two vaccines currently available are mRNA vaccines and do not contain live virus, according to the CDC, meaning they “cannot give someone COVID-19.” They also do not interact with a person’s DNA, and “we wouldn’t expect it to cross the placenta,” Esplin said.

“Based on the way the vaccine works, it’s anticipated that the safety and efficacy of the vaccine will be similar to what was seen in non-pregnant patients,” according to Intermountain’s website.

In the early COVID-19 trials, there were participants who became pregnant or weren’t aware they were pregnant when the studies began, according to University of Utah Health. They didn’t report any adverse side effects, and the CDC said both manufacturers continue to monitor this group. There also are studies planned looking at the vaccine and pregnant people, according the CDC.

Moderna tested the vaccine with pregnant rats, which “did not show any negative effects on fertility or fetal development,” according to Intermountain. And while different from the COVID-19 vaccines, there are other types of vaccinations that doctors say are safe for pregnant people to get, such as for the flu and pertussis, Esplin said.

It’s not surprising that pregnant volunteers weren’t specifically included in the initial COVID-19 vaccine trials, he said, because “it adds another variable to the picture.” It makes it tricky, though, for doctors to advise pregnant patients in situations like this, Metz said.

Right now, it’s important for Utahns to know that while doctors don’t have any reason to think the COVID-19 vaccines are unsafe for those who are pregnant or are breastfeeding, there isn’t conclusive data to know for certain yet, Metz said. If they do get vaccinated, she encouraged them to use the CDC’s v-safe mobile app to report any side effects.

Doctors also are recommending that “it’s perfectly safe to ... get pregnant after you’ve had the vaccine,” Esplin said.

Expecting during a pandemic

Being pregnant during the coronavirus pandemic has been “extraordinarily weird,” Merrill said. Both Merrill and Hansen are expecting their first child, so they said they don’t have another experience for comparison.

“I actually had a lot of guilt when I first got pregnant because I knew ... that the disease wasn’t going anywhere,” said Hansen, who lives in Smithfield.

But she and her husband were ready to have a child, she said. Plus, they had no idea how long they would have to put off starting a family before the virus was under control.

“I told my doctor, ‘At least this is the only kid I’ll have in a pandemic,’” Merrill laughed.

Jokes aside, there’s “been some grief in losing the pregnancy I’ve always envisioned,” Merrill said. Rather than running around, telling everybody and showing off her growing belly, Merrill said she’s stayed home as much as possible and taken precautions, including at her job as a librarian at Westminster College.

“My anxiety has also risen with the pandemic,” she said. She thinks about what would happen to her and her baby if she got COVID-19. And while she and her husband have stable jobs, she worries about their financial stability to support their baby in a pandemic that’s caused many people economic distress.

At the same time, Merrill said, her pregnancy has “also been exciting” and “gives us something to look forward to” in the uncertainty.

“It’s common and normal to be a little nervous when you’re pregnant because you want to be careful,” Esplin said. When it comes to the COVID-19 vaccine, he said, “getting information and “being comfortable with your choice is the right thing to do.”

Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.