Author Topic: Covid vaccine during pregnancy?  (Read 2869 times)

Radagast

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Covid vaccine during pregnancy?
« on: February 02, 2021, 07:25:47 PM »
Hello Mustachian Friends, I have an odd question whose answer is not clear based on information I have seen. Perhaps there is someone on the site who is more current with research and literature.

Is the COVID-19 vaccine something that you would recommend during pregnancy? We will be having our first kid in about 6 weeks, and my wife is a nurse and hence eligible for the vaccine. However we have not been able to decide if the benefits outweigh the risks. DW has a family history of diabetes and is carefully watching her blood sugar, which is a complicating factor. However she works from home and we have been pretty good about face coverings and keeping our distance.

I see three possible options:
Get the vaccine early. There is a 100% chance of getting it, but the likelihood and severity of side effects is reduced compared to what the disease may cause. However there may be an unknown factor.
Get the vaccine after. The odds of getting the virus is low (10%?) but the likelihood and severity of symptoms is higher.
Get 1 shot before and 1 after. Supposedly the second is most likely to produce strong side effects.

We are at an impasse. Any (knowledgeable) input would be appreciated.

Adventine

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Re: Covid vaccine during pregnancy?
« Reply #1 on: February 02, 2021, 07:34:32 PM »
There are a few doctors on this site, and hopefully they should chime in soon.

However, this is really a question you and your wife should be asking your ob-gyn.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #2 on: February 02, 2021, 07:50:25 PM »
Certainly :). However those ob-gyn people are keen to avoid responsibility in case something goes wrong either way and inevitably say something along the lines of "I don't really know it is up to you." So I thought I would ask some nonresponsible internet people, and there seem to be people on MMM who might have some insight :).

Adventine

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Re: Covid vaccine during pregnancy?
« Reply #3 on: February 02, 2021, 08:00:25 PM »
True, lots of knowledgeable people here, who may be able to help you make an informed decision.

Now, if any of them are able to give you a concrete yes or no answer about this medical concern... we'll see. I'm interested in reading the reponses too.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #4 on: February 02, 2021, 08:09:03 PM »
I am not even really looking for a concrete answer TBH. A link to a very recent study would be great as well.

Mariposa

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Re: Covid vaccine during pregnancy?
« Reply #5 on: February 02, 2021, 08:17:27 PM »
If I were your wife, 33 weeks pregnant nurse with work exposure to covid, I'd get the vaccine now. There's also evidence that antibodies cross the placenta & will protect your newborn:
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775944

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #6 on: February 02, 2021, 10:01:16 PM »
If I were your wife, 33 weeks pregnant nurse with work exposure to covid, I'd get the vaccine now. There's also evidence that antibodies cross the placenta & will protect your newborn:
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775944
Thank you Mariposa that link was quite useful. However, one thing I noticed in the link was that it takes about 6 weeks from the first vaccine dose to developing peak "efficacy" following the second vaccine dose. So in this case it appears too late for much affect in the baby.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #7 on: February 02, 2021, 10:19:27 PM »
An ironic thing is that may wife has been on light duty working from home answering her hospital's Employee Covid Hotline, meaning it is her day job to interview doctors and nurses with Covid symptoms or who have side effects from receiving the vaccine, and track them in one big spreadsheet. You would think she would be one of the top 0.1% most knowledgeable people right? Anyhow she still really wanted my to research on my own, and google only takes me so far. But I explained to her that she was about the most knowledgeable person around and gleaned a few insights.

-Daily hospital (hers specifically, no info on others) employee cases have fallen 90% from their peak as of today, so there is limited chance of getting it from them at this point
-But about 1/7 have already tested positive, which to me indicates about 30% have had it including asymptomatic cases
-All of the pregnant providers (NP/PA/DO/MD) she has talked to got the vaccine (but tiny sample size)
-None of the pregnant nurses she knows got the vaccine, stunning reversal from above
-She is not aware of any of the pregnant Covid-positive-testing healthcare women being among those with the most severe symptoms
-However she reports that they were by far the most scared group (no surprise!)
-She is not aware of any complications in pregnant women from either the virus or the vaccine.
Yay for anecdata! And yay for the existence of the word anecdata!

Mariposa

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Re: Covid vaccine during pregnancy?
« Reply #8 on: February 03, 2021, 08:39:32 AM »
How soon could she get the vaccine? That JAMA article quoted a study that was done earlier in the pandemic, on women who got infected by covid. There's a large variation in antibody levels in people with natural immunity. Vaccines, on the other hand, produce consistently high titers of antibodies in just about everyone.

The immunogenicity data on people from Moderna's phase I trial show that antibodies (and their ability to neutralize virus) peaked ~day 36-43 after the first shot & remained high for at least 119 days:
https://www.nejm.org/doi/full/10.1056/NEJMc2032195

The Moderna data doesn't distinguish between IgM and IgG, however, and only IgG crosses the placenta. Here's a study on people with covid infection showing IgG becomes detectable ~1 week after onset of symptoms, and peaks ~3 weeks after:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202656/

The JAMA article notes that since antibody transfer across the placenta begins at 17 weeks, it's probably optimal to vaccinate early in the second trimester. But, looking at the data, there still could be some significant benefit at 33 weeks. Plus, antibody transfer could still continue through breast milk.

Since your wife currently doesn't have any work exposure, and the numbers in your community are low-ish, the risk-benefit assessment is a little different. If it were me, I'd probably still get it.

In my experience I've also found that every (non-pregnant) doctor & PA I've asked have gotten the vaccine; a number of the nurses have not.

delegatedoptimist

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Re: Covid vaccine during pregnancy?
« Reply #9 on: February 03, 2021, 03:06:08 PM »
My wife is a pregnant PA and so did a lot of research and asked not only our OBGYN but also a variety of doctors that she respects (they all said they would get it if they were in her shoes). Then she researched it more on her own. She ultimately decided to get the vaccine. A big factor for her was that a high fever is known to be risky for babies and, in the off chance she got a bad case of COVID, she would be putting the baby at risk. To her this seemed more likely than the vaccine negatively affecting our baby (which granted, odds of either seem pretty low).

Also, the WHO now recommends pregnant people to get the vaccine: https://www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know

ChpBstrd

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Re: Covid vaccine during pregnancy?
« Reply #10 on: February 04, 2021, 08:15:01 AM »
Get the vaccine.

You're not going to find research on the vaccine and pregnancy because it doesn't yet exist. However, we do know that pregnancy is a complication that puts your wife and her fetus at risk if she gets COVID. Plus we know that even surviving COVID is not going to be a good thing for the fetus. So it's an easy choice between a clear and present danger now (COVID) versus a "what if" that we might not know about for another 2 years (unknown vaccine risks specific to pregnancy). So far what we know is that some people who take the vaccine get a sore arm, a mild fever, and a little fatigue - normal immune response symptoms like pregnant women have had throughout history. COVID on the other hand will kill one's ass dead and has been proven to damage the lungs and kidneys of even asymptomatic people. This is an unfortunate time to be pregnant, but the vaccine is an easy call IMO.

startingsmall

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Re: Covid vaccine during pregnancy?
« Reply #11 on: February 04, 2021, 08:19:58 AM »
Veterinarian here, with a public health obsession that leads me to compulsively follow COVID-related info/studies/discussions/etc.

I'd get the vaccine.

PMG

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Re: Covid vaccine during pregnancy?
« Reply #12 on: February 04, 2021, 08:32:53 AM »
Not pregnant but thinking of getting pregnant so Iíve been following this a bit. The vaccine side effects, second dose especially can  include fever which is risky, especially in early pregnancy. Of course thatís still much better than getting covid, but timing of that second dose and itís possible side effects might be something to think about.

For me I decided to avoid vaccination in early pregnancy when fever is especially dangerous but I would consider it later in pregnancy.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #13 on: February 04, 2021, 08:39:10 AM »
There is not enough data yet to tell you if it's safe or not.  So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.

The WHO doesn't currently recommend routine vaccination for pregnant women due to lack of data:  https://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19--vaccine#:~:text=Pregnant%20and%20breastfeeding%20women,pregnant%20women%20at%20this%20time..
« Last Edit: February 04, 2021, 08:42:33 AM by GuitarStv »

RetiredAt63

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Re: Covid vaccine during pregnancy?
« Reply #14 on: February 04, 2021, 09:25:13 AM »
Forget where I saw it, but pregnant women were more likely to be sicker and hospitalized than otherwise similar non-pregnant women.  My DD is pregnant and she would love to get the vaccine.

FindingFI

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Re: Covid vaccine during pregnancy?
« Reply #15 on: February 04, 2021, 09:39:40 AM »
I'm around 14 weeks right now and asked my OBGYN about the vaccine. He recommended it with the logic that the known effects of a covid infection presents greater risk than the unknown potential effects of the vaccine.  I don't yet qualify for the vaccine, but I think I will get it when it's my turn. 

jeromedawg

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Re: Covid vaccine during pregnancy?
« Reply #16 on: February 04, 2021, 11:15:44 AM »
Not pregnant but thinking of getting pregnant so I’ve been following this a bit. The vaccine side effects, second dose especially can  include fever which is risky, especially in early pregnancy. Of course that’s still much better than getting covid, but timing of that second dose and it’s possible side effects might be something to think about.

For me I decided to avoid vaccination in early pregnancy when fever is especially dangerous but I would consider it later in pregnancy.

Very good point. I've been hearing the same about the side-effects. My extended family, many of whom are healthcare workers/providers (pharmacists, doctors, dentists), have all reported back saying the second dose hit hard and some of them were laid up in bed for a full day or more from feeling fatigued and tired. Headaches and fever as well.

I was curious about the timing of the second dose and if the efficacy is less effective the longer you wait. I know there's a minimum waiting period before you get it (somewhere around a month) but is it OK to push the second dose out say 6 months or longer from the first dose? I guess the risk is that you'd still be some % exposed to the virus in that in-between period but I figure if you're still practicing social distancing and masking (versus feeling like you can go back to normal pre-covid life 100%), you will still be fine.
« Last Edit: February 04, 2021, 11:18:37 AM by jeromedawg »

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #17 on: February 04, 2021, 11:32:42 AM »
Not pregnant but thinking of getting pregnant so Iíve been following this a bit. The vaccine side effects, second dose especially can  include fever which is risky, especially in early pregnancy. Of course thatís still much better than getting covid, but timing of that second dose and itís possible side effects might be something to think about.

For me I decided to avoid vaccination in early pregnancy when fever is especially dangerous but I would consider it later in pregnancy.

Very good point. I've been hearing the same about the side-effects. My extended family, many of whom are healthcare workers/providers (pharmacists, doctors, dentists), have all reported back saying the second dose hit hard and some of them were laid up in bed for a full day or more from feeling fatigued and tired. Headaches and fever as well.

I was curious about the timing of the second dose and if the efficacy is less effective the longer you wait. I know there's a minimum waiting period before you get it (somewhere around a month) but is it OK to push the second dose out say 6 months or longer from the first dose? I guess the risk is that you'd still be some % exposed to the virus in that in-between period but I figure if you're still practicing social distancing and masking (versus feeling like you can go back to normal pre-covid life 100%), you will still be fine.

Even fully vaccinated, you should not be going back to normal pre-covid life until herd immunity has been achieved.  The vaccine is not 100% protective, and people who have been fully vaccinated with a two week waiting period after receiving both shots can carry the virus.

ChpBstrd

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Re: Covid vaccine during pregnancy?
« Reply #18 on: February 04, 2021, 12:02:25 PM »
Not pregnant but thinking of getting pregnant so Iíve been following this a bit. The vaccine side effects, second dose especially can  include fever which is risky, especially in early pregnancy. Of course thatís still much better than getting covid, but timing of that second dose and itís possible side effects might be something to think about.

For me I decided to avoid vaccination in early pregnancy when fever is especially dangerous but I would consider it later in pregnancy.

^ +1

Very good point. I've been hearing the same about the side-effects. My extended family, many of whom are healthcare workers/providers (pharmacists, doctors, dentists), have all reported back saying the second dose hit hard and some of them were laid up in bed for a full day or more from feeling fatigued and tired. Headaches and fever as well.

I was curious about the timing of the second dose and if the efficacy is less effective the longer you wait. I know there's a minimum waiting period before you get it (somewhere around a month) but is it OK to push the second dose out say 6 months or longer from the first dose? I guess the risk is that you'd still be some % exposed to the virus in that in-between period but I figure if you're still practicing social distancing and masking (versus feeling like you can go back to normal pre-covid life 100%), you will still be fine.

Even fully vaccinated, you should not be going back to normal pre-covid life until herd immunity has been achieved.  The vaccine is not 100% protective, and people who have been fully vaccinated with a two week waiting period after receiving both shots can carry the virus.

jeromedawg

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Re: Covid vaccine during pregnancy?
« Reply #19 on: February 04, 2021, 12:10:46 PM »
Not pregnant but thinking of getting pregnant so Iíve been following this a bit. The vaccine side effects, second dose especially can  include fever which is risky, especially in early pregnancy. Of course thatís still much better than getting covid, but timing of that second dose and itís possible side effects might be something to think about.

For me I decided to avoid vaccination in early pregnancy when fever is especially dangerous but I would consider it later in pregnancy.

Very good point. I've been hearing the same about the side-effects. My extended family, many of whom are healthcare workers/providers (pharmacists, doctors, dentists), have all reported back saying the second dose hit hard and some of them were laid up in bed for a full day or more from feeling fatigued and tired. Headaches and fever as well.

I was curious about the timing of the second dose and if the efficacy is less effective the longer you wait. I know there's a minimum waiting period before you get it (somewhere around a month) but is it OK to push the second dose out say 6 months or longer from the first dose? I guess the risk is that you'd still be some % exposed to the virus in that in-between period but I figure if you're still practicing social distancing and masking (versus feeling like you can go back to normal pre-covid life 100%), you will still be fine.

Even fully vaccinated, you should not be going back to normal pre-covid life until herd immunity has been achieved.  The vaccine is not 100% protective, and people who have been fully vaccinated with a two week waiting period after receiving both shots can carry the virus.

Makes sense. I hope all the non-healthcare getting the 2nd dose soon aren't thinking that they can go back to "pre-COVID life" after getting it. My mom was almost talking this way the other day...smh

PMG

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Re: Covid vaccine during pregnancy?
« Reply #20 on: February 04, 2021, 03:01:55 PM »
Are you check recent CDC updates?  IIRC they recommend getting the second dose within 42 days. So there is wiggle room but not six months. You should read all their guidance before asking us. ;)
https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html  They also recently updated the guidance on pregnancy and vaccinations. I just assumed youíd already read it. It doesnít say much but doesnít advise against vaccinating.

use2betrix

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Re: Covid vaccine during pregnancy?
« Reply #21 on: February 04, 2021, 07:10:12 PM »
My wife is pregnant. While sheís not a special case that is a candidate for the vaccine, I would have a hard time encouraging her to get a vaccine that has not been thoroughly tested on pregnant women with documented evidence of whether or not it can cause birth defects.

We are both taking COVID precautions very seriously and are young, healthy, low risk people otherwise.

jeromedawg

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Re: Covid vaccine during pregnancy?
« Reply #22 on: February 04, 2021, 10:46:47 PM »
Are you check recent CDC updates?  IIRC they recommend getting the second dose within 42 days. So there is wiggle room but not six months. You should read all their guidance before asking us. ;)
https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html  They also recently updated the guidance on pregnancy and vaccinations. I just assumed you’d already read it. It doesn’t say much but doesn’t advise against vaccinating.

Good point. Wasn't even thinking about the vaccine for ourselves really because we're not eligible either way, so I hadn't even thought of checking CDC as I'm not planning to get it anytime soon. Was just throwing the question out there while perusing and seeing this thread pop-up. One of my friends who works for a biotech company and has a background in public health/clinical research mentioned that it might be better, in some cases, to wait it out for the second dose although he didn't go into detail and I didn't ask.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #23 on: February 04, 2021, 10:51:04 PM »
I think the appropriate way to look at it is by probabilities. Let's say the odds of getting Covid are 5% per month, which means 0.95*0.95...*0.95 gives a 45% chance after a year. However after 2 months the odds are 0.95*0.95= a 90% chance of not catching Covid, or a 10% chance of getting it. Compare this to a 100% chance of getting a vaccine.

Now we need odds of severe side effects affecting the pregnancy for both options. I don't know those, but let's guess they are 1% for Covid and 0.1% for a vaccine.

Multiply 0.001*1 (vaccine) and 0.01*0.1 (Covid) and you get the same result, eg. the decision to get the vaccine is a wash using my own ignorant information and a two month horizon. This is where official channels would do very well to get more information out, even if it is preliminary. Of course you would also need to take individual risk factors into account, but unfortunately we have no clear framework to do this.

For a lifetime of exposure your odds of contracting Covid approach 100%, and vaccination is the easy choice, and sooner is better. However there is good reason to be skeptical of the vaccine during pregnancy largely because of the time factor. That said I expect that the vaccines are actually better than a factor of 10 improvement over Covid, probably more like a factor of 100. So it may be a slam dunk decision, but not on the knowledge I have.

My wife ended up getting the vaccine. I made the decision by using the random number generator on my phone to ask yes or no, and we decided that was good enough. Well, not exactly. There seems to be a pretty strong case that the bad reaction to the second dose is specifically caused by the Moderna vaccine. Apparently the Pfizer vaccine is much tamer in the side effects department. Not saying the Moderna is bad necessarily, but after getting the second dose many people subsequently decide to stay in bed for the next day or three and may become hotter to the touch than is normally the case. You are not supposed to have a choice right now, but as a result of her job DW had a good indication of when there was a high probability of the Pfizer vaccine being the serum d'jour and signed up for that time. Even then she decided to ask which it was in advance and drive off if it was Moderna. It ended up being Pfizer, so she got the first dose.


Radagast

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Re: Covid vaccine during pregnancy?
« Reply #24 on: February 04, 2021, 11:19:22 PM »
So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.
This to me was the most compelling argument and also one I made. Between the money grasping media and the straw grasping conspiracy theorists, surely even the slightest problem would be all over the internet by now if there was one to be found.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #25 on: February 05, 2021, 07:43:50 AM »
So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.
This to me was the most compelling argument and also one I made. Between the money grasping media and the straw grasping conspiracy theorists, surely even the slightest problem would be all over the internet by now if there was one to be found.

Not trying to pick on you here, but this information shouldn't be compelling at all.

We have very clear historical examples of this sort of reasoning causing tragedy.  Tens of thousands of people took Thalidomide.  Many thousands of women took thalidomide after their third trimester with no problems.  But the drug was not fully tested, and we didn't realize until it had impacted tens of thousands of people that the horrible birth defects being caused by the drug were actually caused by very specific conditions (pregnant woman, before third trimester).  At the time, the best science said it was safe for pregnant women.  That's the thing about science . . . theories change as new evidence is discovered.  Right now we're still in the discovery phase for these vaccines.

At the moment we have no real data about babies born from women in their first or second trimester who have taken a covid vaccine.

RetiredAt63

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Re: Covid vaccine during pregnancy?
« Reply #26 on: February 05, 2021, 11:38:14 AM »
My wife is pregnant. While sheís not a special case that is a candidate for the vaccine, I would have a hard time encouraging her to get a vaccine that has not been thoroughly tested on pregnant women with documented evidence of whether or not it can cause birth defects.

We are both taking COVID precautions very seriously and are young, healthy, low risk people otherwise.

Birth defects are mostly (all?) In the first 3 months.  I am guessing that once well into the second trimester that, and fever, would not be an issue.  Some of the vaccines are showing better efficacy if the second dose is delayed, the first dose does provide protection from severe cases.

SimpleCycle

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Re: Covid vaccine during pregnancy?
« Reply #27 on: February 05, 2021, 03:41:17 PM »
My wife is pregnant. While sheís not a special case that is a candidate for the vaccine, I would have a hard time encouraging her to get a vaccine that has not been thoroughly tested on pregnant women with documented evidence of whether or not it can cause birth defects.

We are both taking COVID precautions very seriously and are young, healthy, low risk people otherwise.

I think the relevant calculation is which presents a bigger risk to your wife and unborn child - the vaccine or getting COVID.  Getting COVID while pregnant presents an elevated risk to the pregnant person and possibly some elevated risk to the baby as well.  The risks of the vaccine are unknown, but we're not completely guessing either.  The general effects of the COVID vaccine - the pregnant person's body mounting an immune response to COVID - are almost certainly less risky than actually getting COVID.  But you also only have a chance of getting COVID, while getting the vaccine you're definitely taking on the risk of the vaccine.

This is important because 99% of medical treatments are not tested in pregnant women.  We are almost always making an educated guess when we recommend medical treatments to pregnant women.  The pervasive idea that we should take no unknown risks and instead take the known risk of not treating/vaccinating is not the right way to approach it in my opinion.  Instead, you want to maximize benefits while minimizing harms.  We see this calculation all the time when pregnant folks must weigh whether to take necessary medications in pregnancy - how can we maximize the benefits (to the pregnant person and the fetus) while minimizing the potential (but often unknown) harms.  Sometimes timing or dosages can be adjusted to achieve this.

@use2betrix, I also know your history and how much this baby is loved and wanted, so I totally understand not wanting to take any risk.  Unfortunately in a pandemic, you are taking a risk either way.

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Re: Covid vaccine during pregnancy?
« Reply #28 on: February 09, 2021, 11:31:54 AM »
I am about 18 weeks pregnant and discussed this with my ob a couple weeks ago and my friend who has a phd in this kind of stuff.  Similarly to the discussion above its about weighing the risks.  It is known that pregnancy is a risk for getting COVID bad, like a lot more likely to be hospitalized.  So far no "known" risks for the vaccine.  My dr and friend said they wouldn't get it in the first tri when the fetus is developing the most and a high fever from the vaccine could be a big deal.  My dr said he has other patients waiting until after 20 weeks when development is out of the critical stage.  I don't have the choice yet but expect to be in the next state grouping or ahead of others my age due to my employer.  I am currently leaning towards getting it as I will for sure be 20 weeks before even the 1st dose. 

I have had to take several medications that are Category B (untested in pregnant humans thus not approved as safe for pregnancy) in order to not be hospitalized this pregnancy due to dehydration and malnutrition... so yeah the vaccine is in the same boat.  Have to make the best choices for your personal situation and risks.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #29 on: March 01, 2021, 10:33:27 PM »
So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.
This to me was the most compelling argument and also one I made. Between the money grasping media and the straw grasping conspiracy theorists, surely even the slightest problem would be all over the internet by now if there was one to be found.

Not trying to pick on you here, but this information shouldn't be compelling at all.

We have very clear historical examples of this sort of reasoning causing tragedy.  Tens of thousands of people took Thalidomide.  Many thousands of women took thalidomide after their third trimester with no problems.  But the drug was not fully tested, and we didn't realize until it had impacted tens of thousands of people that the horrible birth defects being caused by the drug were actually caused by very specific conditions (pregnant woman, before third trimester).  At the time, the best science said it was safe for pregnant women.  That's the thing about science . . . theories change as new evidence is discovered.  Right now we're still in the discovery phase for these vaccines.

At the moment we have no real data about babies born from women in their first or second trimester who have taken a covid vaccine.
Thalidomide is a great example of something which I felt we could rule out. Germany in 1952 was a bombed out husk with a standard of living no greater than in 1912, disorganized and demoralized. I doubt there was much in the way of science, regulation, data collection, or even communication, certainly by 2020/21 standards. They had no ultrasound, no gene sequencing, or a hundred other common technologies today. As a take on what "best science" said, the US banned it because even in 1952 it was apparent the drug was hazardous to anyone actually paying attention. To slip by the global scrutiny of the past 12 months would take something much more subtle.

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #30 on: March 01, 2021, 10:34:41 PM »
Anyhow, DW got the second dose last week. No issues of note, except a sore arm on the second day after the second dose. I am not aware of hearing any bad side effects to date.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #31 on: March 02, 2021, 07:49:21 AM »
So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.
This to me was the most compelling argument and also one I made. Between the money grasping media and the straw grasping conspiracy theorists, surely even the slightest problem would be all over the internet by now if there was one to be found.

Not trying to pick on you here, but this information shouldn't be compelling at all.

We have very clear historical examples of this sort of reasoning causing tragedy.  Tens of thousands of people took Thalidomide.  Many thousands of women took thalidomide after their third trimester with no problems.  But the drug was not fully tested, and we didn't realize until it had impacted tens of thousands of people that the horrible birth defects being caused by the drug were actually caused by very specific conditions (pregnant woman, before third trimester).  At the time, the best science said it was safe for pregnant women.  That's the thing about science . . . theories change as new evidence is discovered.  Right now we're still in the discovery phase for these vaccines.

At the moment we have no real data about babies born from women in their first or second trimester who have taken a covid vaccine.
Thalidomide is a great example of something which I felt we could rule out. Germany in 1952 was a bombed out husk with a standard of living no greater than in 1912, disorganized and demoralized. I doubt there was much in the way of science, regulation, data collection, or even communication, certainly by 2020/21 standards. They had no ultrasound, no gene sequencing, or a hundred other common technologies today. As a take on what "best science" said, the US banned it because even in 1952 it was apparent the drug was hazardous to anyone actually paying attention. To slip by the global scrutiny of the past 12 months would take something much more subtle.

Thalidomide was also approved for use in pregnant women in Canada, the UK, New Zealand, Australia, and forty odd other countries.  Certainly, not all of which had the same 'disorganized and demoralized' science/regulation/data collection problems that Germany did post WWII.  It was obviously not 'apparent the drug was hazardous to anyone actually paying attention' in 1952 . . . or none of these countries would have OK'd it.  The best science (based on understanding at the time) indicated that it should be safe.  But explicit testing of pregnant women had not been performed.

The triumph of the FDA in the 1960s was that they required proof of testing in pregnant women (as one of the common uses for the drug was a treatment for morning sickness) before allowing the drug to be marketed to them.  It was only in 1961 that the problems with the drug were really identified (not in the US . . . but by a German pediatrician, Widukind Lenz and also independently an Australian obstetrician, William McBride).

I strongly encourage people to read the history of this drug - not just a quick wikipedia skim.  It's an example of the (eventual) triumph of science, but also a warning for any time we attempt something that hasn't been done before and rely on what we think we know rather than real world testing.  If it's still hard to imagine that problems could have slipped through a rush developed new type of drug that has not received any longevity testing - then you haven't been paying attention.

cangelosibrown

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Re: Covid vaccine during pregnancy?
« Reply #32 on: March 02, 2021, 08:13:48 AM »
I think it's important to remember that while we may lack comprehensive data about these specific vaccines and pregnancies, we have enormous amounts of data on vaccines and pregnancies.  There's not a lot of new technology in these vaccines: one way or other they induce some cells in your body to produce a specific protein (or inject the protein directly, or inject a whole weakened virus, which has the protein attached). Your immune system then recognizes that protein and mounts a defense against it.  That's it. That's every vaccine ever produced by man. The only difference is what specific protein it is.

Now given that mechanism, I would have no idea if there were any chance of adverse affects to pregnant women or the baby they're carrying, but as far as I know, there has never been a vaccine that has been shown to have adverse affects on pregnant women, or on fetuses. As far as I know there has never been a vaccine that has any adverse affect on anyone -- with the exception of improperly made batches of vaccines, live virus vaccines, and a very occasional allergic reaction. Given the large number of vaccines that have been tested on pregnant women, and the fact that they're all basically the same, I think we can be extremely confident that there is no simply mechanism by which a vaccine or, any random protein floating around the bloodstream, can harm a fetus. And thus these new covid vaccines are likely extremely safe for pregnant women. I'm certainly not 100% sure, but my personal Bayesian estimate is well over 99%.

Also worth mentioning that the baby will likely inherit some amount of immunity if the vaccine is taken during pregnancy. Which has at least some value, given that it will probably be a while before anything is cleared for infants. (Although J&J did just announce infant trials).

All that said, my wife hasn't made her final decision on whether to get vaccinated when she becomes eligible (likely soon!). If she had any sort of risk of getting infected in daily life, she would get it for sure, but we're completely battened down here, so our risk is essentially zero.

GreenToTheCore

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Re: Covid vaccine during pregnancy?
« Reply #33 on: March 02, 2021, 09:34:25 AM »
I think it's important to remember that while we may lack comprehensive data about these specific vaccines and pregnancies, we have enormous amounts of data on vaccines and pregnancies.

This is what I've come to understand.
@GuitarStv I usually feel like we're on the same page and your posts mirror my thoughts often. My mind also immediately went to the Thalidomide experience. Moving to the next step and looking into how similar the situations are, the more I learn that these vaccine scenarios aren't similar to or representative of the situation with Thalidomide. It's a completely different mechanism, the drug reporting system is much improved, and the risks are different (nausea aid vs disease prevention).
It's been quite interesting looking into this as we're mildly trying for a pregnancy. From the medical information and doctor perspectives that I've gathered, it's been a green light across the board.

Must add, I really appreciate this forum. We have some great conversations, I feel like they're generally respectful and polite regarding different perspectives. +1k points for including source references.

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Re: Covid vaccine during pregnancy?
« Reply #34 on: March 02, 2021, 01:29:42 PM »
Anyhow, DW got the second dose last week. No issues of note, except a sore arm on the second day after the second dose. I am not aware of hearing any bad side effects to date.

Good call!

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #35 on: March 02, 2021, 07:33:15 PM »
So far, about 10k pregnant women have been vaccinated for covid in the US and there don't appear to be any obvious immediate problems being reported.
This to me was the most compelling argument and also one I made. Between the money grasping media and the straw grasping conspiracy theorists, surely even the slightest problem would be all over the internet by now if there was one to be found.

Not trying to pick on you here, but this information shouldn't be compelling at all.

We have very clear historical examples of this sort of reasoning causing tragedy.  Tens of thousands of people took Thalidomide.  Many thousands of women took thalidomide after their third trimester with no problems.  But the drug was not fully tested, and we didn't realize until it had impacted tens of thousands of people that the horrible birth defects being caused by the drug were actually caused by very specific conditions (pregnant woman, before third trimester).  At the time, the best science said it was safe for pregnant women.  That's the thing about science . . . theories change as new evidence is discovered.  Right now we're still in the discovery phase for these vaccines.

At the moment we have no real data about babies born from women in their first or second trimester who have taken a covid vaccine.
Thalidomide is a great example of something which I felt we could rule out. Germany in 1952 was a bombed out husk with a standard of living no greater than in 1912, disorganized and demoralized. I doubt there was much in the way of science, regulation, data collection, or even communication, certainly by 2020/21 standards. They had no ultrasound, no gene sequencing, or a hundred other common technologies today. As a take on what "best science" said, the US banned it because even in 1952 it was apparent the drug was hazardous to anyone actually paying attention. To slip by the global scrutiny of the past 12 months would take something much more subtle.

Thalidomide was also approved for use in pregnant women in Canada, the UK, New Zealand, Australia, and forty odd other countries.  Certainly, not all of which had the same 'disorganized and demoralized' science/regulation/data collection problems that Germany did post WWII.  It was obviously not 'apparent the drug was hazardous to anyone actually paying attention' in 1952 . . . or none of these countries would have OK'd it.  The best science (based on understanding at the time) indicated that it should be safe.  But explicit testing of pregnant women had not been performed.

The triumph of the FDA in the 1960s was that they required proof of testing in pregnant women (as one of the common uses for the drug was a treatment for morning sickness) before allowing the drug to be marketed to them.  It was only in 1961 that the problems with the drug were really identified (not in the US . . . but by a German pediatrician, Widukind Lenz and also independently an Australian obstetrician, William McBride).

I strongly encourage people to read the history of this drug - not just a quick wikipedia skim.  It's an example of the (eventual) triumph of science, but also a warning for any time we attempt something that hasn't been done before and rely on what we think we know rather than real world testing.  If it's still hard to imagine that problems could have slipped through a rush developed new type of drug that has not received any longevity testing - then you haven't been paying attention.
So societies similar to modern day Lebanon, Republic of Georgia, and Mongolia, except without all the smartphones. Standard prenatal care in Canada may have frequently included a stethoscope. If the doctor was inclined to report a problem, it would mean writing a letter and hand delivering it to the post office for the slow train to the Ottawa bureaucracy. A horse may very well have been involved.

Human development has not sped up, and our capacity for ignorance and error is only fractionally reduced - though probably appreciably reduced in this particular case. However our medical instruments have improved by a factor of 10, the incentive to report problems by a factor of 100, the ease and speed of reporting by 1,000, and the network available to receive the report by another 100. Our society is at least a billion times more sensitive to problems with the coronavirus vaccine than it was to problems with Thalidomide. Even the slightest problem in this regard would become a global media crisis if it affected 1 in 10,000 pregnancies.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #36 on: March 03, 2021, 07:00:23 AM »
Even the slightest problem in this regard would become a global media crisis if it affected 1 in 10,000 pregnancies.

Agreed.  And when we've got the final data in on tens of thousands of pregnancies where the vaccine was applied, we'll know for sure.

ChpBstrd

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Re: Covid vaccine during pregnancy?
« Reply #37 on: March 03, 2021, 11:00:15 AM »
Even the slightest problem in this regard would become a global media crisis if it affected 1 in 10,000 pregnancies.

Agreed.  And when we've got the final data in on tens of thousands of pregnancies where the vaccine was applied, we'll know for sure.

Even then we won't know for sure, because any side effect / excess deaths from a vaccine mistake would have to be measured against the risk of side effect / excess deaths from COVID. I.e If ten million pregnant women decided NOT to be vaccinated, how many excess deaths, stillbirths, or birth defects would occur because of that decision? And if the side effect was an uptick in stillbirths, would that even be measured accurately? Most early-gestation natural abortions occur without the woman even knowing she was pregnant. We'll only get one side of the statistics when it's all said and done, because the complexity of reality is hard.

It's kind of like how cases of the flu are way down in the past 12 months. It's possible that our masking, social distancing, and facility closures for COVID saved tens of thousands of lives from the flu. The U.S. lost 61,000 people in 2016-17 for example, but this season will likely be only a few thousand. Should we subtract these lives saved from the 500k (so far) death toll from COVID? Kind of funny how a loss of life comparable to a significant war amounts to a debate over measurement error.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #38 on: March 03, 2021, 11:17:50 AM »
Who says the death count is 500k so far?  Everything that I've read indicates it's much higher than that in the US.

cangelosibrown

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Re: Covid vaccine during pregnancy?
« Reply #39 on: March 03, 2021, 11:44:39 AM »
Who says the death count is 500k so far?  Everything that I've read indicates it's much higher than that in the US.

F*'ing seriously? People are on this thread trying to work through an actual important issue, and you're sitting there arguing in bad faith like a f*ing child. ChpBstrd, who I assume is an actual human being, made an actual point about how hard it is to ever know something like this for sure. We all got his point. Whether he had said 500k, or 500k+ or "a lot" or spent 4 hours trying to come up with the best possible estimate of how many covid deaths  the US has absolutely no relevance to the point he's making. This sort of "gotcha" ad hominem attack is in no way helpful to anyone. Go take this bs to a forum that's arguing about which Pokemon is best or which some similar BS. This is an actual issue actual human beings are trying to sort through and figure out.

I clicked on this thread this morning because I am trying to work through an extremely important health issue for me, my pregnant wife and my unborn child. As I saw there were new posts and I clicked I thought to myself "maybe someone has found a study that's out or thought of some relevant factor to consider." Nope, just GuitarStv arguing irrelevant details in someone else's post so he can feel like he's coming out on top of the argument. 

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #40 on: March 03, 2021, 11:59:01 AM »
I clicked on this thread this morning because I am trying to work through an extremely important health issue for me, my pregnant wife and my unborn child. As I saw there were new posts and I clicked I thought to myself "maybe someone has found a study that's out or thought of some relevant factor to consider."

Sorry that you're having such a hard time.  I'd suggest checking first with your doctor/pediatrician to find answers.  If you have to go with the internet, use the CDC and/or WHO webpages.  They're not going to philosophically argue that people can never know if a vaccine is safe or not - they'll give you a straight answer about whether or not we know enough to safely vaccinate based upon available data.

ChpBstrd

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Re: Covid vaccine during pregnancy?
« Reply #41 on: March 03, 2021, 12:01:12 PM »
Who says the death count is 500k so far?  Everything that I've read indicates it's much higher than that in the US.

F*'ing seriously? People are on this thread trying to work through an actual important issue, and you're sitting there arguing in bad faith like a f*ing child. ChpBstrd, who I assume is an actual human being, made an actual point about how hard it is to ever know something like this for sure. We all got his point. Whether he had said 500k, or 500k+ or "a lot" or spent 4 hours trying to come up with the best possible estimate of how many covid deaths  the US has absolutely no relevance to the point he's making. This sort of "gotcha" ad hominem attack is in no way helpful to anyone. Go take this bs to a forum that's arguing about which Pokemon is best or which some similar BS. This is an actual issue actual human beings are trying to sort through and figure out.

I clicked on this thread this morning because I am trying to work through an extremely important health issue for me, my pregnant wife and my unborn child. As I saw there were new posts and I clicked I thought to myself "maybe someone has found a study that's out or thought of some relevant factor to consider." Nope, just GuitarStv arguing irrelevant details in someone else's post so he can feel like he's coming out on top of the argument.

My impression of @GuitarStv 's post was that it was referring to the difference between official COVID deaths and the excess mortality the US has experienced in 2020-21. This is an example of a statistic (the 500k+ death count) not including all instances (the people whose deaths were categorized as something other, but were probably COVID). In this light, it's another example like my example of easily measurable vaccine-related reactions vs. not-easily-measurable extra losses from COVID due to people not getting vaccinated. S/He would be saying the death toll from COVID probably far exceeds 500k, rather than being one of those conspiracy theorists who think it's all made up.

Here's a good writeup on that topic.
https://ourworldindata.org/excess-mortality-covid
Quote
The raw death count helps give us a sense of scale: for example, the US suffered roughly 500,000 more deaths than the five-year average between 1 March and 27 December 2020, compared to 340,000 confirmed COVID-19 deaths during that period.

Admittedly, @GuitarStv did not clarify this detail, so thinking s/he meant less than 500k died is understandable too.

GuitarStv

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Re: Covid vaccine during pregnancy?
« Reply #42 on: March 03, 2021, 12:34:21 PM »
Yes, probably was not stated correctly . . . but the point I was trying to make was that the number of covid cases is being likely being far undercounted.  This undercounting renders the benefit from car crashes/flu avoidance moot . . . as is seen when you look at the surplus mortality totals.

dragoncar

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Re: Covid vaccine during pregnancy?
« Reply #43 on: April 07, 2021, 01:37:40 AM »
FWIW, my pregnant doctor wife got the vaccination (Pfizer) late last year after discussing with her professional network*.  There weren't long term studies, of course, that data didn't (doesn't) exist yet.  There were women who wound up pregnant in the trials with no acute issues and apparently healthy deliveries. 

For us it basically came down to the enhanced risk of contracting COVID while pregnant, her exposure level through employment (vs. someone who can totally isolate during pregnancy), and the far-fetched nature of hypothetical risks.  There has been evidence that newborns can have some antibodies conferred if the mother is vaccinated during pregnancy, which is great since it's unlikely the vaccine will be approved any time soon for infants.

Thinking of giving our toddler some of dat breast milk, too.

At this point, the calculation is different because you can free ride a bit on some kind of herd immunity.

*The American College of Obstetricians and Gynecologists has recommended that the vaccine should "not be withheld" from pregnant women.  It's possible they have the best summary of issues to consider here https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19

Radagast

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Re: Covid vaccine during pregnancy?
« Reply #44 on: October 02, 2021, 01:06:43 PM »
I'd like to update this thread. Mom and baby have been extremely healthy throughout. Baby was big and alert even on day of birth. DW just got her third shot.

Since this thread there has been mounting evidence that pregnancy increases comorbidities, such as tendency toward diabetes and strain on the heart and lungs, similarly to if that weight was fat. This probably should not have been a surprise. Plus as we have long known pregnancy suppresses the immune system. So it is actually turning out that vaccination while pregnant is even a better idea than it is for the population at large.

Two weeks ago DW (who is now back as a nurse in the hospital) was caring for an 18-year old woman who had given birth by C-section a month or two early as a result of severe complications from COVID, most likely low oxygen. She was not especially fat beyond what may be expected for someone who had a C-section within the past couple days. She was in very poor condition, and transferred to ICU shortly. I think it goes without saying that both her and her baby would have been a lot happier and healthier and together if she had been vaccinated, despite apparently being in an otherwise low risk group. Instead they will be having a tough couple weeks apart in their respective ICUs.

So, vaccines during pregnancy now = resounding yes.

RetiredAt63

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Re: Covid vaccine during pregnancy?
« Reply #45 on: October 03, 2021, 06:11:53 AM »
My DD and SiL did both get vaccinated while DD was pregnant, and had their second dose after the delivery.  Mom and baby are fine. 

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Re: Covid vaccine during pregnancy?
« Reply #46 on: October 03, 2021, 08:58:26 AM »
Wonderful updates! Glad they are happy and healthy. I got mine both during first trimester and am lined up to get the third (booster) at probably 36 weeks.

I do public health research, and DH is a researcher in biotech, with literally past work history in emerging vaccine development, so we both know how to get past the media reporting and read the actual research and data, but I wonít lie it was a tough decision because there was just so little to go on at that point regarding pregnancy. But given what we know about how the vaccines work in the body, how vaccines generally affect pregnancy and their general risks (eg many live attenuated are no go), the risks of COVID, they vastly outweighed the known risks of the vaccine and the plausible but unknown risks of the vaccine (and the implausible risks were of course not likely). Looking back, I definitely made the right decision. I wouldnít fault anyone for not getting it while pregnant - such is the unfortunate state of research on literally anything during pregnancy. But it is heartening that we do now actually have data on pregnancy outcomes, antibody responses protecting baby as well, and antibodies can be passed in breast milk.

Now I just wish some researchers would contact me because I am SO willing to enroll in a trial to collect more data on this, FOR SCIENCE, and future pregnant people, but no one has. :(
« Last Edit: October 03, 2021, 10:39:45 AM by Britan »

RetiredAt63

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Re: Covid vaccine during pregnancy?
« Reply #47 on: October 03, 2021, 03:57:38 PM »
Wonderful updates! Glad they are happy and healthy. I got mine both during first trimester and am lined up to get the third (booster) at probably 36 weeks.

I do public health research, and DH is a researcher in biotech, with literally past work history in emerging vaccine development, so we both know how to get past the media reporting and read the actual research and data, but I wonít lie it was a tough decision because there was just so little to go on at that point regarding pregnancy. But given what we know about how the vaccines work in the body, how vaccines generally affect pregnancy and their general risks (eg many live attenuated are no go), the risks of COVID, they vastly outweighed the known risks of the vaccine and the plausible but unknown risks of the vaccine (and the implausible risks were of course not likely). Looking back, I definitely made the right decision. I wouldnít fault anyone for not getting it while pregnant - such is the unfortunate state of research on literally anything during pregnancy. But it is heartening that we do now actually have data on pregnancy outcomes, antibody responses protecting baby as well, and antibodies can be passed in breast milk.

Now I just wish some researchers would contact me because I am SO willing to enroll in a trial to collect more data on this, FOR SCIENCE, and future pregnant people, but no one has. :(

An Ob/gyn here was saying a disproportionate number of his patients needed to be hospitalized for Covid.  Seriously, a pregnant woman is highly unlikely to be in the classic high-risk groups (old, major comorbidities).  But the demands of pregnancy do put the same stresses on the body - more oxygen demand so more stress on the lungs (plus in later stages the poor lungs are getting compressed), more strain on the kidneys, more body weight, circulatory effects.   We were all thrilled when DD became eligible. Vaccinating her husband as well was approved, because they are in the same household and he could potentially bring it home.

20957

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Re: Covid vaccine during pregnancy?
« Reply #48 on: October 03, 2021, 03:58:20 PM »
It now seems like Covid increases the rate of stillbirth, so even beyond pregnancy making you higher risk for hospitalization and death, vaccination is a good idea to protect the baby.

Britan

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Re: Covid vaccine during pregnancy?
« Reply #49 on: October 03, 2021, 07:27:38 PM »
An Ob/gyn here was saying a disproportionate number of his patients needed to be hospitalized for Covid.  Seriously, a pregnant woman is highly unlikely to be in the classic high-risk groups (old, major comorbidities).  But the demands of pregnancy do put the same stresses on the body - more oxygen demand so more stress on the lungs (plus in later stages the poor lungs are getting compressed), more strain on the kidneys, more body weight, circulatory effects.   We were all thrilled when DD became eligible. Vaccinating her husband as well was approved, because they are in the same household and he could potentially bring it home.
Part of what sealed my decision to get it was remembering that, right at the start of the pandemic, my SIL was hospitalized for a pulmonary embolism a few days postpartum. Unclear if that was due to COVID (in retrospect, this was the time when COVID was circulating in the US but it was thought to be limited to a few spots, and it wasnít known yet that it was much wider) or just ďnormalĒ post pregnancy complication. But her recovery was rough, and it was scary. Just knowing the ďnormalĒ risk level of a pulmonary embolism and that this is a complication of COVID too, so the risk is higher, made the decision. Your whole circulatory system is already messed when pregnant, the last thing I wanted was to get COVID and make it worse.

Also tell me about it, I know all about those poor lungs getting compressed, i say, lying in bed winded at 34 weeks pregnant bc this baby kicking me in the diaphragm 😂

Anyways, back in like April, the OB was pretty agnostic about whether or not I got the vaccine, given the lack of data then. Now, it seems like they are more strongly encouraging women to get it. At least, they were able to be confidently affirmative in recommending the booster for me.