Last week, Ontario became the only Canadian province to announce they were prioritizing all pregnant people for the coronavirus vaccine, adding pregnancy to the list of conditions that could make you eligible for a vaccine in Phase 2, before the rest of the general population. During that phase—which is currently expected to begin in April and conclude by July at the latest—people with some health conditions will be vaccinated, from highest-risk conditions on down. Since pregnancy is classified as an “at-risk” condition (which is below the “highest risk” and “high risk” categories), pregnant people will have the option of being vaccinated near the end of Phase 2, after those with higher-risk health issues, such as multiple sclerosis, kidney disease or obesity. (You can see the full list here).
Constance Nasello, president of the Ontario Society of Obstetricians and Gynaecologists, has said she’s happy the province is offering the shot to pregnant women. “I’m hoping that other provinces will follow Ontario. I think it’s only reasonable that all pregnant women in Canada should be given the opportunity to get the vaccine,” she says.
Two other provinces have made similar moves. Saskatchewan has included pregnant women with significant heart disease in its Phase 2 rollout, and Manitoba announced it will include pregnant people who have additional risk factors—those who are 35 or older, have a BMI over 29, and have pre-existing diabetes, pre-existing hypertension, cardiac or pulmonary disease—in priority list 1 for the AstraZeneca vaccine.
All pregnant people who are considering getting any of the COVID vaccines are advised to have a conversation with their health-care providers first, since it’s all about balancing your risk factors, the likelihood of COVID exposure for you and your family, and looking at your individual health and lifestyle. (Examples: Do you work from home, or in an office? Do you have older children attending daycare? Do you have any other health conditions?)
Here’s what you need to know.
“Pregnancy is emerging as a risk factor for complications with COVID,” says Vanessa Poliquin, an OB/GYN based out of Winnipeg and co-chair of The Society of Obstetricians and Gynaecologists of Canada’s infectious diseases committee. A systematic review and meta-analysis published in The BMJ found that people who had COVID-19 and were pregnant were more likely to need hospitalization, ICU care, and be put on a ventilator than people with the disease who weren’t pregnant. Their babies were also more likely to be born preterm.
The risks are higher for pregnant people who are also older than 35, or who have asthma, obesity, preexisting diabetes, or preexisting hypertension and heart disease. And they’re obviously higher for those who are pregnant and have other conditions that are known to increase the risk for coronavirus, like cardiac or kidney disease, as well.
An interim report from a Canadian research project at the University of British Columbia found similar results. They looked at Canadian data—pregnant women in Ontario, Alberta and BC—and found that of the 353 cases available to analyze, 11 percent of pregnant women were hospitalized for COVID-19, while only 1.7 percent of women aged 18 to 45 were. It also found 2.4 percent were sent to the ICU, while only 0.3 percent of women in the comparable group were, and that 15 percent of the babies were born prematurely—twice as many as the national average.
At the same time, all the initial clinical trials on coronavirus vaccines have excluded pregnant and breastfeeding women, so there isn’t as much solid evidence that the vaccines are safe for them, like there is for the general population. But more data is coming: Pfizer is currently running a vaccine trial that includes 4,000 pregnant women who are between 24 and 34 weeks pregnant, to see how effective the vaccine is, and how safe. The results are expected to be available by June or July.
In the meantime, there are a few sources of information that suggest it is, in fact, safe. First, the way the vaccines work suggests they shouldn’t be dangerous, says Poliquin. “We have lots of experience using non-live vaccines in pregnancy, like influenza vaccines and the pertussis (or whooping cough) vaccine."
Second, a few dozen women did become pregnant during the Pfizer and Moderna clinical trials, and those women haven’t had any adverse effects from the vaccines.
And finally, information released in mid-February by the US Centers for Disease Control and Prevention's V-safe registry—a tool that allows people to report side effects after receiving vaccines—offers more reassurance. It found that of the 55 million Pfizer-BioNtech and Moderna doses that had been given out in the US by that date, more than 30,000 shots went to pregnant people, and there were no increases in adverse outcomes such as miscarriages or birth defects.
All this has left pregnant people wondering, Should I get the shot?
“I literally have been getting this question every single day,” says Tali Bogler, a family doctor and obstetrics provider at St. Michael’s Hospital in Toronto, and co-founder of the Pandemic Pregnancy Guide, which has been sharing up-to-date information on COVID-19 in pregnancy and newborns.
Since data from clinical trials is still lacking, the government is advising pregnant women to talk to their doctors before deciding whether to get a COVID vaccine—it’s a personal choice. You may want to consider your risk of exposure, as well as whether you have any pre-existing conditions that might qualify you as even higher risk.
“When you look at the group of women in general, it still remains that most pregnant women had mild to moderate symptoms from COVID, and the vast majority of babies are going to be born at term and very healthy,” says Poliquin. It’s a clearer decision if the woman has risk factors, or is at high risk of being exposed to COVID, than it is for low-risk people who are able to avoid exposure, she explains.
She adds that all the shots seem equally safe, whether it’s an mRNA vaccine or not, so she advises women who choose to get vaccinated to take whichever vaccine is available to them.
There’s even less information about what trimester might be best. “There’s some data suggesting that the longer the interval between a COVID infection to delivery the better, because there’s more time for the mom to mount a good immune response, and potentially confer more protection for the baby,” says Bogler. Under this logic, administering a COVID vaccine earlier would also allow the mother's body more time to create antibodies and pass protection to the fetus.
Another consideration is a study published in JAMA (the Journal of the American Medical Association), which found that almost 90 percent of women who were infected during pregnancy passed antibodies on to their unborn children.
But some women and providers like to take a “hands-off” approach to the first trimester (in general) to be cautious, and the Pfizer study is looking at only women in their second and third trimesters.
"That's not to say that pregnant women should avoid getting the vaccine in the first trimester if they are at high risk of exposure or illness, and there is nothing to suggest that the vaccine, nor COVID-19 infection itself, causes congenital malformation," adds Bogler. "But I would understand if my patients wanted to hold off in the first trimester and wait until the second."
Whether or not low-risk pregnant people should get the shot can be a difficult decision, Bogler says. “From what we know thus far, we believe that it’s safe, and I would feel very comfortable with my pregnant patients getting the vaccine. But I acknowledge that there still is a gap in the data around this.”