Every mom-to-be wants to have the healthiest pregnancy possible. During the COVID-19 pandemic, that has meant wearing a mask, avoiding crowds and social distancing — and now, getting the COVID-19 vaccine.
Health officials and experts from the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine are all urging pregnant women to get the COVID-19 vaccine, pointing to data that show the vaccines are safe and effective. On the other hand, there are serious risks to not getting vaccinated: Pregnant women and their babies have far greater risk of hospitalization and intubation, as well as preterm birth and other complications. Despite these risks, about three-quarters of pregnant women in the United States remain unvaccinated.
If you're feeling scared or anxious about getting vaccinated while you're pregnant (or thinking of getting pregnant, or breastfeeding), that's completely understandable — we've never experienced something like COVID-19 in our lifetimes, and every parent just wants what's best for their child. But that's why What to Expect creator Heidi Murkoff recently sat down with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, Chief Medical Advisor to the President, and a leader on the White House COVID-19 Response Team. Heidi peppered Dr. Fauci with the most pressing questions from parents in the What to Expect Community.
Here are some highlights from the interview:
- Is the COVID-19 vaccine safe during pregnancy? "[I]f you look at the literally — literally — tens and tens and tens of thousands of women who have been followed by the CDC who were vaccinated when they were pregnant, there's no indication whatsoever that there's any increase of any adverse issues in a pregnant woman who was vaccinated compared to a pregnant woman who wasn't vaccinated...It's really one of those things that's kind of not a close call. It really is pretty clear that pregnant women should get vaccinated."
- Can you continue breastfeeding after getting the COVID-19 vaccine? "[I]t is not only safe, but it's a good idea...you should know that you're doing something positive to protect the baby" (because you're passing antibodies through your breast milk).
- Will the COVID-19 vaccine impact your fertility? "[T]here have been hundreds and hundreds of millions of people now who've been vaccinated throughout the world. There's no indication whatsoever that the vaccine interferes with fertility in a woman or fertility in a man's ability to impregnate a woman. No evidence whatsoever."
Watch the full interview above, or read the full transcript below. (And go to vaccines.gov to find a COVID-19 vaccine near you.)
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Video transcript:
Heidi Murkoff: Hi everyone, I'm Heidi Murkoff and I am beyond excited to welcome to our What to Expect family someone who probably needs no introduction. He has been director of the National Institute of Allergy and Infectious Diseases for 37 years, serving under seven presidents, and he has been serving as our unofficial explainer-in-chief for all things COVID-19 over the last 19 months. It just seems like 19 years. He is a true public health hero and a personal hero for me, Dr. Anthony Fauci. Dr. Fauci, thank you so much for stopping by to answer our questions.
Dr. Anthony Fauci: Heidi, it's a pleasure to be with you, thank you for having me.
Heidi: Of course. Speaking of questions, we get tons of them on What to Expect, not surprisingly, about COVID-19 and the COVID-19 vaccines. Especially about safety during pregnancy. And the vaccine, as you know, is strongly recommended by the CDC, by ACOG, by the Society for Maternal Fetal Medicine for all pregnant women. And yet vaccine hesitancy has been especially high among pregnant women and the CDC has reported that vaccination rates are really low compared to the general population, among pregnant women. And of course we all understand pregnancy and worry go together, right? But I'm still hoping you can explain to concerned moms- and dads-to-be and, as a father yourself, why you are so confident that it the vaccine is safe and effective to get when you're pregnant and why should moms not worry so much.
Dr. Fauci: Well, even though this is an issue and a problem that all of us, including myself— When my wife was pregnant with my three daughters I got nervous about everything.
Heidi: I'm sure you did. [both laughing]
Dr. Fauci: You know, even as an informed physician, I was always concerned about anything that could have a deleterious effect on my pregnant wife, as well as on our soon-to-be-born baby. So that's totally understandable. But the best way to explain that is to look at the facts that are really well known and to balance these facts about risk versus benefit. The overwhelming balance of risk-benefit is in favor of pregnant women getting vaccinated against COVID-19, and the reason for that is, look at what we know for sure. What we know for sure is that if a pregnant woman gets infected and gets COVID-19 there are serious consequences for the pregnant woman herself, for the pregnancy and for the fetus. If you look at it, preterm births, all kinds of complications that are exacerbated in a pregnant woman.
Then you asked the question, well, are the vaccines safe? And if you look at the literally — literally — tens and tens and tens of thousands of women who have been followed by the CDC who were vaccinated when they were pregnant, there's no indication whatsoever that there's any increase of any adverse issues in a pregnant woman who was vaccinated compared to a pregnant woman who wasn't vaccinated. And we all know that pregnancy, there is always a risk of a spontaneous miscarriage. There's always the situation, there's always situations when women get illness, there could be preeclampsia, things like that. However, when you look at the unvaccinated versus the vaccinated, there is absolutely no increased risk of that. So because of that, the CDC and the ACOG, the American College of Obstetrics and [Gynecologists], who used to say it is okay for them, for pregnant women to get vaccinated, to change now and say it is recommended that pregnant women get vaccinated. It's really one of those things that's kind of not a close call. It really is pretty clear that pregnant women should get vaccinated.
Heidi: And it's not even at this point, go talk to your doctor, I mean you should definitely go talk to your doctor, but it's not ambiguous.
Dr. Fauci: No, it really isn't.
Heidi: It's really important to get vaccinated.
Dr. Fauci: In all transparency, Heidi, in the very beginning we didn't really know what the effect of the disease was on pregnancy and we didn't have enough experience of pregnant women getting vaccinated. But now that, you said, we're 19 months into this outbreak, we know a lot about what the effect of the disease is on pregnancy and we now have tons of experience with pregnant women who've been vaccinated, and it's just like I mentioned to you a moment ago, this is an easy call.
Heidi: And pregnant women, if they do get infected with COVID-19 and they're not vaccinated, their risks of being hospitalized, intubated, having all kinds of complications are much higher than a woman who's not pregnant, so.
Dr. Fauci: Absolutely, absolutely, yeah, that's why I said, this is an easy one.
Heidi: It is. I hope it is for all the moms out there. And then, of course, there's another potential benefit which I'd like to ask you about and that is the antibodies that might be passed through the placenta to an unborn baby. How much evidence do we have of that and I mean, if it's true, it's a nice perk, but we don't know how long it would last if there is some form of protection.
Dr. Fauci: Okay, so you have to give — and again I will always be completely honest about what the data are. This is an extrapolation, Heidi, let me explain. So there are two ways in which a mother can protect the fetus and then the baby after birth regarding immune response. There's passage of antibodies through the placenta during the pregnancy, and then after birth mothers can transfer antibodies to the baby by breastfeeding. Those are the two ways that antibodies go from a mother to either a fetus or a baby after he's born. Now we haven't done, or we couldn't because there's not enough data to do it, to say that antibodies against COVID-19, again, SARS-COV-2 either from the placenta or through breast milk, absolutely protect the baby against SARS-COV-2, but we have decades and decades of experience with other diseases that make it very clear that when a mother has antibodies, they could protect the fetus during the pregnancy and when they have antibodies after, those antibodies last for a few months after pregnancy, and it isn't as if once you're born the antibodies are gone. The antibodies that go from the mother through the placenta last in the baby for a while, you know for a matter of a couple of months, then if you continue to do that with breastfeeding, it lasts as long as you breastfeed.
So we know that from other diseases. We don't specifically know it for SARS-COV-2 because there's not enough data to say that, but there's no reason to believe that COVID-19 is going to be any different from any other infectious disease and that you will get protection of the baby with breastfeeding and trans-placentally to the fetus.
Heidi: And we should put in a plug now for for flu vaccines, also for pregnant women since we're coming up on on flu season and that's somewhere else where they can pass those antibodies and protect their babies to some extent. TDAP as well.
Dr Fauci: Absolutely. It's for any infectious disease. See, that's the beauty of the physiology of motherhood.
Heidi: Yeah — among many!
Dr. Fauci: In the evolution of our species, you know, it evolved that way because fetuses and babies are very, very vulnerable. So, if nature was going to figure out a way, how do you protect fetuses and babies during that vulnerable period, from an immunological infectious disease standpoint, there it is. Antibodies through the placenta protects the baby for a period of time after birth and in utero, and then for breastfeeding, it's the same thing.
Heidi: And so Mother Nature has your back, but also science.
Dr. Fauci: Mother Nature knows science.
Heidi: And so, to go back to breastfeeding, it is safe to breastfeed after getting the vaccination, and in fact it's even safe to breastfeed if you are infected with COVID with the proper precautions.
Dr. Fauci: Oh yeah, absolutely, and you know, it is not only safe but it's a good idea. Now, not every mother either chooses to or is able to breastfeed. We know that.
Heidi: Of course. Yes.
Dr. Fauci: But if you are, and your decision is to breastfeed, you should know that you're doing something positive to protect the baby.
Heidi: Exactly. That's why we need to support breastfeeding moms better. So there's a lot of misinformation — well, I don't have to tell you this, especially circulating about the mRNA vaccine and how it works and that somehow it impacts fertility. This is something we hear a lot on What to Expect. Just please clarify, is there any way that getting the Pfizer or Moderna vaccine could possibly impact your chances of getting pregnant?
Dr. Fauci: So, Heidi, there's two answers to that and they're both or what you want to hear.
Heidi Murkoff: Good! Yay! I love when that works out.
Dr. Fauci: And both of them, it's not a problem for the following reasons. There is no evidence — now remember, there have been hundreds and hundreds of millions of people now who've been vaccinated throughout the world. There's no indication whatsoever that the vaccine interferes with fertility in a woman or fertility in a man's ability to impregnate a woman. No evidence whatsoever.
Now, in addition, you used the word mechanism. There's no mechanistic reason to figure out how that would even occur. I mean, I can't even make up a reason how if you give an mRNA vaccine, all of a sudden that's going to interfere with fertility. There's no way. And then there is this misperception that, since the letters "RNA" are in there, that, ah! It's somehow getting into your genes and it'll do... No. It molecularly can't happen. You can't have messenger RNA all of a sudden go back and become something that does to your genes. It just doesn't happen.
Heidi: So don't kill the messenger. And I feel like this is a good time to say that if you are a couple planning to get pregnant that you should plan to get vaccinated before you get busy. Just saying.
Dr. Fauci: Exactly. You know, well, it goes beyond pregnancy, Heidi. If you are, if you're even thinking about vaccination, go get vaccinated now.
Heidi: Exactly.
Dr. Fauci: And if you're not thinking about vaccination, you should be thinking about vaccination because, beyond the scope of pregnant women, it is so clear, the beneficial effect. This is really one of a number of vaccines whose effectiveness is high. It's extremely high. And the vaccine is really quite safe.
Heidi: A lot of people are concerned about breakthrough cases if they are vaccinated, but I think the reassuring thing is that if you're pregnant and you're vaccinated...I just heard from mom who is concerned because she teaches in a kindergarten that serves kids who possibly might not keep their masks on and she was very concerned. So can you talk her off the ledge?
Dr. Fauci: Yeah. I mean, if she's vaccinated, but still kids are not wearing masks... There are breakthrough infections, particularly with the delta variant. The delta variant is a bad actor, it really is, it spreads extremely efficiently from person to person. But you look at the gradation of diminishing risks so the fact that she's vaccinated, even though there are unmasked kids in the class, the chances are of her even getting infected are dramatically lower than if she were not vaccinated. Now, if she does get infected as a breakthrough infection — when you wind up getting in fact that even though you're vaccinated that's referred to as a breakthrough infection — when you look at breakthrough infections overwhelmingly they are less serious than infections of a person who is unvaccinated. So even if she does, the chances are she's either going to have an asymptomatic or a mildly symptomatic infection compared to if she was unvaccinated. So right away, nothing's 100%, but you've diminished the risk dramatically.
Heidi: Right. And that's what I told her, but I think she'll be even more reassured hearing the same thing from you. So pregnant women were not included in the COVID-19 vaccine trials. They're not included in any trials. So that sort of sets up a scenario where where people are questioning, even with full FDA approval now of the Pfizer vaccine, how do we convince parents that the vaccine has been studied sufficiently in pregnant women? Or can, at some point, in in this process in the future, can we include pregnant women in trials voluntarily, so we can clear up that kind of confusion, from the outset?
Dr. Fauci: Okay, so you could include women now after the fact. But to be honest with you it's not necessary and I'll explain to you why. The reason pregnant women are excluded from clinical trials is because pregnant women is something you know very well, because pregnant women are among the vulnerable in society as are little children. Which is the reason why, when you first have a clinical trial, you want to show it safe and effective in a non-pregnant female population. Once you do, what happened with COVID-19, is that so many women wanted to get vaccinated because many of them were in the health care profession, and they were being exposed to people with COVID-19. A lot of pregnant physicians...
Heidi: Nurses.
Dr. Fauci: ...and respiratory therapists said, hey I want to get vaccinated right away. They wanted to see if they could protect themselves and it turned out, they did get vaccinated, tens of thousands of them, and now, we have real world effectiveness to know what I should I mentioned to you a few minutes ago. Of the tens and tens and tens of thousands, maybe hundreds of thousands of pregnant women throughout the world who've gotten vaccinated, there is no safety signal that one sees. And as we get more experience with COVID-19, we know how difficult and bad and dangerous it is for pregnant women to get COVID-19. So, yes, we could do a trial in pregnant women, but the real-world evidence has already almost superseded a trial, because so many women have been vaccinated when they're pregnant.
Heidi: So there there's a question all parents and grandparents, I think, are asking right now, and I know you can't answer it: When will little ones under the age of 12 be able to get vaccinated so we can stop worrying about them? I know you can't necessarily answer that — however, how can we keep keep babies and children safe in the meantime?
Dr. Fauci: A good question. You do that by surrounding babies and children and kids in school from 11 and younger with people who are fully vaccinated. You protect the child by surrounding the child with people who have very unlikely that they will be infected. Not impossible, but unlikely. And as the CDC guidelines and recommendations are, when you're in a school setting, wear a mask. That's the reason why masks should be mandated in schools in session right now.
Heidi: Could not agree more. One last thing: will we have hugs again?
Dr. Fauci: Oh for sure.
Heidi Murkoff: Okay, good. So you'll be you'll be on my list for hugs post-pandemic.
Dr. Fauci: I'll take you up on that.
Heidi: I hope it's soon.
Dr. Fauci: Thank you. Take care.
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