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Should Pregnant People Get a Covid Booster? Should You Get a Covid Booster if You Are Pregnant?
(about 3 hours later)
Last December, I cried into my mask on the subway home after getting the only holiday gift I wanted: the Pfizer vaccine. As a gastroenterologist treating hospitalized Covid patients, it brought back a flood of difficult memories from the past year. Among the most haunting were the pregnant people with severe liver injury I cared for in the intensive care unit who couldn’t see their newborns.Last December, I cried into my mask on the subway home after getting the only holiday gift I wanted: the Pfizer vaccine. As a gastroenterologist treating hospitalized Covid patients, it brought back a flood of difficult memories from the past year. Among the most haunting were the pregnant people with severe liver injury I cared for in the intensive care unit who couldn’t see their newborns.
Two months later, I became pregnant myself.Two months later, I became pregnant myself.
The pandemic has transformed pregnancy, an already stressful life event, into a unique minefield. Pregnant people faced early bans on hospital visitors during labor, exclusion from the original vaccination studies and disproportionate devastation from the Delta variant, which in August cost 22 lives — the highest number of Covid-19 deaths in a single month among pregnant people since the pandemic started.The pandemic has transformed pregnancy, an already stressful life event, into a unique minefield. Pregnant people faced early bans on hospital visitors during labor, exclusion from the original vaccination studies and disproportionate devastation from the Delta variant, which in August cost 22 lives — the highest number of Covid-19 deaths in a single month among pregnant people since the pandemic started.
Since January 2020, at least 180 pregnant people have died from Covid-19. The recent pleas from federal health officials for all pregnant people to get vaccinated as soon as possible has provided the kind of no-nonsense clarity that expecting parents might have been waiting for. But what does that mean for boosters?Since January 2020, at least 180 pregnant people have died from Covid-19. The recent pleas from federal health officials for all pregnant people to get vaccinated as soon as possible has provided the kind of no-nonsense clarity that expecting parents might have been waiting for. But what does that mean for boosters?
The Centers for Disease Control and Prevention lists pregnancy as a medical condition that would make someone eligible for a Covid-19 booster. Official guidelines firmly declare that you “should” get a booster if you meet certain criteria — for instance if you work in a high-exposure field, like as a nurse or teacher (both professions that incidentally make up the two most common occupations for pregnant workers in the United States). But the guidelines recommend that people who fall into other high risk categories, including those who are pregnant, weigh the individual risks and benefits of the booster.The Centers for Disease Control and Prevention lists pregnancy as a medical condition that would make someone eligible for a Covid-19 booster. Official guidelines firmly declare that you “should” get a booster if you meet certain criteria — for instance if you work in a high-exposure field, like as a nurse or teacher (both professions that incidentally make up the two most common occupations for pregnant workers in the United States). But the guidelines recommend that people who fall into other high risk categories, including those who are pregnant, weigh the individual risks and benefits of the booster.
This can leave many pregnant people like myself wondering if they should rush to get a third shot. Dr. Dana Meaney-Delman, the lead scientist for maternal Covid-19 immunization at the C.D.C., has been considering these questions carefully. “There’s nothing to suggest boosters are a safety issue. We have great confidence in these vaccines,” she said, adding that anyone who is pregnant, postpartum, considering pregnancy or who might be pregnant in the future should get the vaccine. “That’s the most urgent message,” she said.This can leave many pregnant people like myself wondering if they should rush to get a third shot. Dr. Dana Meaney-Delman, the lead scientist for maternal Covid-19 immunization at the C.D.C., has been considering these questions carefully. “There’s nothing to suggest boosters are a safety issue. We have great confidence in these vaccines,” she said, adding that anyone who is pregnant, postpartum, considering pregnancy or who might be pregnant in the future should get the vaccine. “That’s the most urgent message,” she said.
She noted that, as an OB-GYN herself, she encourages a third dose for her pregnant patients. “From a biological plausibility perspective, there’s really no reason not to recommend a booster,” she said.She noted that, as an OB-GYN herself, she encourages a third dose for her pregnant patients. “From a biological plausibility perspective, there’s really no reason not to recommend a booster,” she said.
The American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine, also did not mince words in the advisories they updated on Oct. 1: Yes, pregnant people who completed the Pfizer-BioNTech vaccine series at least six months ago should get the booster shot. (Other vaccines will likely soon be authorized as boosters.)The American College of Obstetricians and Gynecologists, as well as the Society for Maternal-Fetal Medicine, also did not mince words in the advisories they updated on Oct. 1: Yes, pregnant people who completed the Pfizer-BioNTech vaccine series at least six months ago should get the booster shot. (Other vaccines will likely soon be authorized as boosters.)
Their recommendations underscore the risks of severe consequences from Covid-19 during pregnancy, as well as evidence of waning immunity.Their recommendations underscore the risks of severe consequences from Covid-19 during pregnancy, as well as evidence of waning immunity.
Many experts suggest that pregnant people are not so much immunocompromised, as once believed, but that their immune systems change in unique ways during each stage of pregnancy, opening windows of vulnerability to Covid-19. Besides these changes, the physical demands of pregnancy — the growing fetus’ strain on the diaphragm and lungs, the increased strain on the cardiovascular system — put pregnant people at higher risk of being hospitalized and dying from Covid-19 without the vaccine.Many experts suggest that pregnant people are not so much immunocompromised, as once believed, but that their immune systems change in unique ways during each stage of pregnancy, opening windows of vulnerability to Covid-19. Besides these changes, the physical demands of pregnancy — the growing fetus’ strain on the diaphragm and lungs, the increased strain on the cardiovascular system — put pregnant people at higher risk of being hospitalized and dying from Covid-19 without the vaccine.
Signing up for a booster shot might also help the unborn baby. Dr. Andrea Edlow, an OB-GYN and researcher at Massachusetts General Hospital, demonstrated that the immune response induced by Covid-19 mRNA vaccines in pregnant and lactating women was far greater than the response produced by a coronavirus infection. They also found that those antibodies were robustly passed to the fetus through the placenta, as well as through breast milk.Signing up for a booster shot might also help the unborn baby. Dr. Andrea Edlow, an OB-GYN and researcher at Massachusetts General Hospital, demonstrated that the immune response induced by Covid-19 mRNA vaccines in pregnant and lactating women was far greater than the response produced by a coronavirus infection. They also found that those antibodies were robustly passed to the fetus through the placenta, as well as through breast milk.
Although countries like Israel and most recently the United States have started giving booster shots to pregnant people, experts are still collecting data on their outcomes. It might be months, or more, before we have more information.Although countries like Israel and most recently the United States have started giving booster shots to pregnant people, experts are still collecting data on their outcomes. It might be months, or more, before we have more information.
Nonetheless, there is no reason to expect that the booster side effects in pregnant people will be different than those in the general population, according to Dr. Meaney-Delman, who led a C.D.C. study on vaccinations in pregnancy.Nonetheless, there is no reason to expect that the booster side effects in pregnant people will be different than those in the general population, according to Dr. Meaney-Delman, who led a C.D.C. study on vaccinations in pregnancy.
The study, which analyzed the self-reported side effects from more than 35,000 pregnant people, demonstrated that vaccine reactions were similar among pregnant women compared with nonpregnant women. Among the most common were pain at the injection site and fatigue.The study, which analyzed the self-reported side effects from more than 35,000 pregnant people, demonstrated that vaccine reactions were similar among pregnant women compared with nonpregnant women. Among the most common were pain at the injection site and fatigue.
Regarding timing, the sooner you get a booster during your pregnancy, the better, Dr. Edlow said. Not only does an earlier booster likely mean a lower chance of a breakthrough infection (which could increase the risk of preterm birth), but, as is the case with other recommended vaccines in pregnancy, an earlier shot could translate to more antibodies passed to the fetus.Regarding timing, the sooner you get a booster during your pregnancy, the better, Dr. Edlow said. Not only does an earlier booster likely mean a lower chance of a breakthrough infection (which could increase the risk of preterm birth), but, as is the case with other recommended vaccines in pregnancy, an earlier shot could translate to more antibodies passed to the fetus.
Waiting until just before delivery means you will have lower antibody levels, “and you don’t have as much time for the antibodies to transfer across the cord, so it’s just less effective,” Dr. Edlow said. “You’re going to give your baby the best protection if you do it earlier.”Waiting until just before delivery means you will have lower antibody levels, “and you don’t have as much time for the antibodies to transfer across the cord, so it’s just less effective,” Dr. Edlow said. “You’re going to give your baby the best protection if you do it earlier.”
Another reason eligible pregnant people shouldn’t wait to get a booster is that the types of antibodies that pass through the umbilical cord are different from those that pass through breast milk. The blood-borne antibodies that cross the umbilical cord are much longer lasting than those primarily passed through breast milk, Dr. Edlow said. By getting the booster during pregnancy, the baby gets the benefit of both.Another reason eligible pregnant people shouldn’t wait to get a booster is that the types of antibodies that pass through the umbilical cord are different from those that pass through breast milk. The blood-borne antibodies that cross the umbilical cord are much longer lasting than those primarily passed through breast milk, Dr. Edlow said. By getting the booster during pregnancy, the baby gets the benefit of both.
In the end, I decided to receive the booster shot two weeks ago at 33 weeks pregnant. I had some fatigue (and took a nap in the evening) as well as muscle aches the next day. By the following morning, I felt completely back to normal.In the end, I decided to receive the booster shot two weeks ago at 33 weeks pregnant. I had some fatigue (and took a nap in the evening) as well as muscle aches the next day. By the following morning, I felt completely back to normal.
“You shouldn’t think, ‘I need to get boosted or I’m going to die from Covid.’ That’s the rationale for the first vaccine doses,” Dr. Edlow said. The booster, however, can prevent pregnant people from symptomatic illness or from transferring the virus to young children at home in addition to providing protection to their newborns.“You shouldn’t think, ‘I need to get boosted or I’m going to die from Covid.’ That’s the rationale for the first vaccine doses,” Dr. Edlow said. The booster, however, can prevent pregnant people from symptomatic illness or from transferring the virus to young children at home in addition to providing protection to their newborns.
“I don’t think there are any special considerations. I think they should just go get the booster,” she said.“I don’t think there are any special considerations. I think they should just go get the booster,” she said.
Dr. Trisha Pasricha is a writer and physician at Massachusetts General Hospital. Her work has appeared in the Washington Post, the Los Angeles Times and The Atlantic.Dr. Trisha Pasricha is a writer and physician at Massachusetts General Hospital. Her work has appeared in the Washington Post, the Los Angeles Times and The Atlantic.