Why there's no blanket recommendation on COVID-19 vaccination in pregnancy

Those who are pregnant or breastfeeding will have to weigh their own risks when deciding whether to be vaccinated to protect against COVID-19 because it hasn't beenstudied in clinical trials, Canadian doctors say.

Without data on the safety of the vaccines during pregnancy and breastfeeding, there's a grey area for people looking for answers to how the risk of COVID-19 compares with that of the immunizations.

It's an especially pressing decision right now for health-care workers who are among the priority groups to be immunized given the risks of exposure to the virus they face on the job.

Dr. Sarah Lai, a pediatric surgeon and Canadian in Denver, Colo., is wrestling with the choice. She is seven months pregnant, wants to be vaccinated and is looking for more information.

"If I were to get it while I'm pregnant, is it going to induce labour earlier?" she asked. "I don't know if it's safe for me to have this vaccine."

Dr. Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax, said there were some women who received coronavirus vaccines during the clinical trials who got pregnant immediately afterwards and haven't yet delivered.

"We will have pretty soon babies being born to those women and we expect them to be perfectly normal but we don't know that yet," MacDonald said.

Pregnancy changes COVID-19 risks

Meanwhile, research has shown that pregnant women are at higher risk of severe outcomes if they do get COVID-19.

When U.S. researchers analyzed data from about 400,000 women aged 15 to 44 in the U.S. with COVID-19, they found the absolute risks of the infection during pregnancy were low.

But pregnant women with COVID-19 were more likely to suffer severe outcomes such as being admitted to intensive care, being put on a ventilator and dying than non-pregnant women with COVID-19, the team found.

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The COVID-19 vaccines are not recommended for pregnant women, because initial clinical trials did not include pregnant women. However, for some front-line workers, the vaccine benefits may outweigh the unknown risks.

The study's authors recommended counseling pregnant women about the risk for severe COVID-19-associated illness and emphasizing measures to prevent infection.

Weighing benefits and risks

While the U.K. currently advises those who are pregnant against having Pfizer-BioNtech's vaccine, authorities in Canada and the U.S. take a different approach.

The National Advisory Committee on Immunization or NACI that independently advises the Public Health Agency of Canada about immunization questions concluded that if a risk assessment finds the "benefits of vaccine outweigh the potential risks for the individual" then authorized COVID-19 vaccines may be offered.

Dr. Daniel Flanders, a pediatrician in Toronto, said he's fielding questions from women who are breastfeeding about whether to receive the vaccine while lactating.

Flanders agrees with NACI's advice.

"I don't think it's appropriate in a situation like this to have a blanket, across the board recommendation to do it or not to do it," Flanders said.

Personal circumstances at play

Everyone who is pregnant or lactating has a unique set of circumstances and the vaccination decision is a personal one to make after a health-care provider gives information, he said.

"If a pregnant or a lactating person lives in a community where the COVID-19 disease burden is really high and if that person has a job, for example, in health care, and is exposed to patients with COVID-19 all the time, you know that person may choose to get the vaccine because the risk of getting COVID-19 may be much higher than the risks of the unknown of taking the vaccine itself," Flanders said.

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Early research shows pregnant women are at a higher risk of being hospitalized with COVID-19 than non-pregnant women in the same age group, but doctors note the risk is still low.

Lai is still weighing those factors deciding whether to get the vaccine after she's given birth.

"The biggest question is, do I sacrifice the amount of time that I want to breastfeed to get the shot knowing that it hasn't been tested?" Lai said.

Lai is waiting for more data about the coronavirus vaccines for herself, her two-year-old and the fetus. In the meantime, she plans to continue to take precautions, such as wearing a mask and visor at work.