Are COVID-19 vaccines safe in pregnancy?

If only the medical advice were clearer, Anja W., a 35-year-old woman in the 25th week of pregnancy, would want to get vaccinated against COVID-19.

She's a doctor, and she knows her way around all the issues.

"If the German Society for Gynecology and Obstetrics and the Standing Committee on Vaccination would clearly recommend vaccination for pregnant women, and if a COVID-19 vaccination was deemed a lower risk than an infection with the virus itself, I would get vaccinated. I've been watching the advice in other countries. In the US, they've been vaccinating pregnant people for months," said Anja W.

In addition to the US, other countries, such as the United Kingdom, Israel and Belgium have recommended that pregnant people get vaccinated. In fact, they are to be treated as priority cases.

But the Standing Committee on Vaccination (STIKO) has yet to recommend it in Germany, either during pregnancy or for those people breastfeeding newborn babies.

Delay due to lack of data

In April 2021, STIKO recommended against vaccinating people during pregnancy.

It said that only those who had preexisting conditions resulting in a higher risk of a severe COVID-19 infection should be considered for vaccination, but only after a risk-benefit-analysis and after the person had been fully informed.

Basically, that's vaccination only in individual, exceptional cases, and at the person's own risk.

STIKO said it lacked sufficient data to make a general recommendation in favor of vaccinating pregnant people because they only rarely take part in clinical trials.

So, it's not necessarily that the committee has spoken out against vaccinations for mothers-to-be, it just says it can't recommend it for everyone who is pregnant.

It's a case of not for and not against. But it's precisely that stance that expectant mothers find confusing.

Gynecologists want rapid vaccination

Intensive care professionals and gynecologists are stepping up the pressure. A group of 11 expert organizations in Germany have published a "position paper" (link in German), arguing that pregnant women are at higher risk of severe COVID-19 and that there is now enough reliable data on the safety of mRNA vaccines.

Stefan Kluge sees it the same way. Kluge heads the University Hospital at Hamburg-Eppendorf (UKE).

He said they are seeing a growing number of COVID cases among pregnant women in intensive care. He told the dpa news agency there were five such cases in the past two weeks alone.

"These cases are especially dramatic. We must start vaccinating pregnant women in Germany," said Kluge.

More severe cases during pregnancy

We've known that pregnant women are a high-risk group since September 2020.

A meta-study, published in the British Medical Journal reviewed the data from 190 studies, involving 68,000 women.

The results were unambiguous: About five times as many cases among pregnant women were asymptomatic, but the risk that they would need intensive care or artificial respiration after an infection was twice as high.

The risk of death due to a COVID-19 infection was equally high, at two in every 10,000 cases.

Preexisting conditions such as diabetes or obesity, or indeed being over the age of 35, could increase the risk further.

On average, pregnant women are about as at risk as people aged 70 to 84 years.

More worries than before

Anja W. said that if pregnant women were now to be considered as risk patients, protecting them should be a top priority. As a working doctor, and pregnant at the same time, she feels especially vulnerable.

"I'm living through this pregnancy feeling more worried than I was during my first pregnancy," she said. "I'm still working at the hospital and trying, as best as I can, to protect myself against a SARS-CoV-2 infection."

"I would have welcomed better advice from the German Society for Gynecology and the Robert Koch Institute [Germany's government agency responsible for disease control and prevention — Editor's note] for pregnant people in the workplace," she said.       

Expert organizations for gynecology in Germany, who want to see vaccinations for pregnant and breastfeeding women, cite the V-safe COVID-19 Vaccine Pregnancy Registry at the US Centers for Disease Control and Prevention (CDC).

The CDC says there are no indications that a COVID-19 vaccine would cause complications for pregnant women. It says there are also no concerns regarding the production of antibodies or people's tolerance of a vaccine.

mRNA vaccines preferred

Pregnant women are advised, however, to give preference to mRNA vaccines. So, that's the BioNTech/Pfizer and Moderna vaccines.

Pregnant doctor Anja W. would prefer a mRNA vaccine herself. "Pregnant women have a higher risk of thrombosis as it is, and I would want to reduce the risk of sinus thrombosis, so I would prefer a mRNA vaccine," she said.

Difficult risk-benefit analysis

But many people — pregnant and willing to be vaccinated — are still not getting a jab, because doctors are said to be shying away from the risks.

It's left to pregnant women to decide whether the risks are greater of a COVID-19 infection or as a result of a vaccination.

Anja W. hopes there will soon be clearer advice in Germany for pregnant women. "Only by then," she said, "my second child will already have arrived."

This article was adapted from German.