Pregnant health-care workers weigh COVID-19 vaccine risks given lack of research
'It’s still something that does weigh heavily on my mind'
As a public health nurse, Stephanie Pizzey knows better than most how COVID-19 vaccines work and how they were developed, and encourages people to take them when offered.
But Pizzey, who is 26 weeks pregnant, isn't getting immunized yet on the advice of her doctor.
"Initially, I was quite comfortable with getting it because I work a lot with vaccines," said Pizzey. "With this one — it's a little tricky because it hasn't been researched thoroughly in pregnancy or breastfeeding women."
Clinical trials for Pfizer-BioNTech and Moderna — the two types of vaccine available to Canadians — didn't include pregnant or breastfeeding people. While the vaccine was approved for use in other adults, there's not yet conclusive research about the safety and efficacy of the vaccines for either the mother or fetus.
Pfizer announced this month that it has started a global clinical trial to test the vaccine for pregnant people, and a dozen women who got the vaccine during its wider trial and later got pregnant are being monitored, with no adverse effects reported so far.
But simply opting to wait for research conclusions poses a dilemma for health-care workers like Pizzey.
- Ontario will now allow pregnant, breastfeeding people to access COVID-19 vaccine
- Ontario ob-gyns push back on policies advising against COVID-19 vaccine for pregnant or breastfeeding women
Evidence collected in Canada and internationally shows that pregnant people who get COVID-19 are at greater risk of more severe outcomes from the illness. The Society of Obstetricians and Gynaecologists of Canada recommends pregnant and breastfeeding women be offered the vaccine, as long as no contraindications exist.
"This decision is based on the women's personal values and an understanding that the risk of infection and/or morbidity from COVID-19 outweighs the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding," the society's statement reads.
It remains unclear when vaccine will be made widely available to Albertans. But for now, pregnant health-care workers have to weigh the risks and make their own decisions.
In addition to her job with public health, Pizzey sometimes works in the Red Deer Regional Hospital Centre's neonatal intensive care unit. She said if she spent more time in the hospital or working in a setting with a higher likelihood of COVID-19 positive cases, she would likely get the shots.
"It's still something that does weigh heavily on my mind," she said, adding that she's open to changing her mind if her doctor's advice changes, or if the obstetrician she is scheduled to meet with soon thinks she should get it now.
'Don't have to rely on other people'
Calgary recreation therapist Emily Chell is at the beginning of the third trimester of her pregnancy and plans to get the vaccine.
She works on a neuro-rehabilitation unit in a Calgary hospital, with patients who have suffered strokes, and brain and spinal cord injuries.
She said she didn't think she would be allowed to get the vaccine until an email inviting her to sign up landed in her inbox in January. She spoke to a friend who is a gynecological surgeon in another province who told her it was her choice.
"I was excited, I was stoked," she said. "I waited and talked to my doctor, and she basically backed that up. She said . . . 'if you want to get it, get it.'"
She said she researched mRna vaccines, and that made her feel more comfortable.
"So for me, the risk sounds very low. The more I looked into it, the more I read about it, the less anxious I was, for sure."
Chell has had a couple instances of close contacts to positive COVID-19 cases at work. Though she feels safe at work using PPE, physical distancing and other safety measures, she said, the biggest motivator for her was being able to take some control over protection against the virus.
"Knowing that I can get the shot myself and protect myself, and don't have to rely on other people was huge," she said.
Chell's appointment was cancelled when the province ran short on its supply of doses, and she hasn't been able to get another appointment booked yet.
A shared discussion
Pregnant people should weigh the likelihood of being exposed to COVID-19 and talk to their doctors, said Dr. Sue Chandra, a maternal fetal specialist and associate professor at University of Alberta's Faculty of Medicine.
"In the end it always comes down to the patient's autonomy," said Chandra, who sees patients at the Lois Hole Hospital for Women in Edmonton. "Our job as providers is to give them the best information so they can use that to guide their decision-making,"
She said the initial exclusion of pregnant and breastfeeding people from clinical trials — a longstanding concern in health research — puts practitioners in a challenging position.
"One of the considerations and challenges for us as prenatal providers is that we can't necessarily support the fact that administering this vaccine has been safe for pregnant women or even effective in terms of how much immunity it will convey compared to the effectiveness of the people in the trials," she said.
Though mRNA technology is new, Chandra is hopeful that pregnant and lactating people will have an effective response to the vaccines, in the same way they do to other immunizations offered during pregnancy such as pertussis and influenza.
An Alberta Health Services guidance document for practitioners states that experts believe it's unlikely that mRNA vaccine will pose a risk to pregnant or breastfeeding individuals, or to unborn babies or breastfed infants.
Chandra said that while most pregnant people won't suffer from severe outcomes if they get COVID-19, they are at a higher risk for ending up in hospital or in intensive care than other people of the same age.
She said observation during the pandemic has shown that pregnant people who are over 35, overweight, or who have underlying health conditions like high blood pressure, diabetes or pre-existing heart and lung problems are more at risk of severe outcomes.
As for risk to a fetus, Chandra said current information indicates the risk of a COVID-19 positive mother transmitting the virus to the baby is very low, and so far there is no evidence of a correlation with birth defects. However, she said COVID-19 does seem to increase the risk obstetrical complications, including increased risk of pre-term births and potential fetal growth restriction.
She said factors a pregnant person should consider as they weigh their decision on getting vaccinated include:
- Rates of COVID-19 infection in their community;
- Their personal likelihood of exposure (Do they work from home? With the public? In health care?);
- And other risk factors for pregnant people, including age, weight and underlying health conditions.
Chandra said it should be a shared discussion between a pregnant person their health-care provider.
Canadian research into COVID-19 and pregnancy
As of Feb. 17, Alberta had reported 898 cases of COVID-19 in pregnant women, according to the Canadian COVID-19 In Pregnancy Surveillance (CANCOVID-Preg), an ongoing initiative led by University of British Columbia researcher Dr. Deborah Money.
In a report compiling information from five provinces, the researchers made "crude" calculations of the rate at which pregnant people had contracted COVID-19, and as of Nov. 30, 2020, Alberta had reported the highest rate of COVID-19 infections per 1,000 pregnant individuals:
- 10.8 - Alberta
- 6.4 - British Columbia
- 6.4 - Manitoba
- 6.0 - Ontario
- 9.1 - Quebec
However, a spokesperson for the program noted that underreporting of COVID-19 among pregnant people in other provinces could be behind a seemingly increased infection rate in Alberta. She said updated data will be released in the next several days.