“Are you planning to get the COVID vaccine, doctor?” my patient inquired, her eyes wide above her mask. The announcement of vaccine sign-ups for healthcare workers at my hospital felt like a beacon of hope for returning to normalcy. I wanted to encourage her to get vaccinated, but I hesitated. I had a secret — I was in my first trimester of pregnancy. With pregnant individuals excluded from the COVID-19 vaccine trials, I was uncertain about receiving the vaccine. A quick online search yielded little clarity, and discussions on my pregnancy app were filled with uncertainty about the decision to vaccinate — clearly, I wasn’t alone in my confusion.
If I had been a “frontline” worker like my colleagues in the ER or ICU, the advantages of vaccination would have been clear-cut. They care for the most critically ill patients, exposing them to high risks. My situation as an outpatient physician placed me at moderate risk, similar to teachers and childcare workers who can’t maintain social distancing. I frequently encounter patients who test positive shortly after our visits. Despite wearing PPE, I often need to conduct hands-on examinations, and my office environment doesn’t allow for proper distancing during breaks. My toddler, who attends daycare and is too young to wear a mask, adds to my concerns, especially with rising infection rates in my city. Each day felt like a countdown to potential exposure to COVID-19.
It was unsurprising that pregnant women weren’t part of the trials; they have historically been excluded from medical research due to ethical considerations and potential risks to mother and fetus. This lack of data often leads pregnant women to hesitate in taking even necessary medications. I have witnessed many patients discontinue vital medications, mistakenly thinking that avoiding them is safer for their unborn child.
During my first pregnancy, I agonized over using a steroid ointment for my psoriasis. Despite consistent data supporting its safety when used correctly, I was anxious about potential risks. Ultimately, I followed my doctor’s advice and had a healthy baby.
With no data available, I sought guidance from experts. The American College of Obstetrics and Gynecology and the Society of Maternal-Fetal Medicine issued a joint statement advocating for pregnant individuals’ inclusion in clinical trials and their right to decide about immunization with their healthcare providers. After significant backlash, the WHO retracted its earlier recommendations against vaccination for pregnant individuals. It felt somewhat paternalistic that experts were allowing women the autonomy to discuss vaccination with their doctors.
I evaluated my decision similarly to how I would discuss routine vaccinations with my patients, weighing the risks and benefits of the vaccine against the dangers of the virus itself. My obstetrician strongly recommended the vaccine, emphasizing that the risks associated with COVID-19 far outweighed any potential vaccine risks. Data from the CDC indicates that pregnant women face significantly higher risks of severe outcomes than non-pregnant women, including ICU admission and death. Some studies have also linked COVID-19 to increased rates of preterm delivery and cesarean births.
To assess the vaccine’s risks, it’s essential to understand how mRNA vaccines function. Both the Moderna and Pfizer vaccines utilize mRNA to instruct our immune systems to produce the spike protein found on the coronavirus. This mRNA does not alter our genetic material and is quickly broken down after eliciting an immune response. The theoretical risk of fetal harm is minimal, and animal studies on the Moderna vaccine have not shown safety concerns for fetal development.
I would have liked to wait for more trial results, but the pandemic required timely decisions. In medicine, we often confront unprecedented situations, and science involves making informed inferences. For instance, while influenza vaccination is routinely recommended for pregnant individuals, the vaccine insert admits a lack of sufficient data to determine associated risks. Other pregnant physicians have shared their struggles with this decision, and I can empathize. I understand why avoiding a new vaccine might feel safer than risking exposure to COVID-19.
However, I couldn’t justify letting fear of the unknown dictate my choices, especially when COVID-19 poses known risks to my baby. I had read distressing accounts of patients and their obstetricians, and I worried about whether I could rationally prioritize my child’s health during a complicated delivery due to a preventable virus. Even with mild COVID-19 symptoms, the long-term effects could be daunting.
In the end, I chose to trust science and received both doses of the vaccine, experiencing only mild side effects. My obstetrician visits continue to show a reassuring heartbeat. The CDC has established V-safe, a monitoring program for vaccine side effects, which includes questions about pregnancy status. I also entered my information into a registry for COVID-19 vaccination during pregnancy and lactation. While I couldn’t participate in a clinical trial, it felt meaningful to contribute. I got vaccinated to protect myself, my family, my vulnerable patients, and for all pregnant women who may feel overlooked.
Although I’m still waiting to feel my baby kick, I often place my hands on my growing belly in the night, filled with both worry and hope — hope that my baby will be safeguarded by maternal antibodies and welcomed into a world where science prevails over politicization.
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In summary, as a pregnant physician, I faced a challenging decision about receiving the COVID-19 vaccine, weighing the known risks of the virus against the uncertainties surrounding the vaccine’s effects on pregnancy. Ultimately, I chose to trust scientific guidance and get vaccinated to safeguard my health and that of my unborn child.