Navigating COVID-19 Vaccines with Pregnant Women

Current trial evidence is severely lacking for the at-risk group, but does clinical history suggest safety?

The topic of vaccination for coronavirus 2019 (COVID-19) in pregnant women is essentially a non-starter—largely due in fault to the fact that clinicians have no observed understanding of how currently regulated mRNA vaccines interact in the key patient group.

The group was largely excluded, or not at all recruited, for assessment in global, real-world trials which eventually generated the first available COVID-19 vaccines. That said, clinical history would indicate a likelihood of safety for expecting mothers and their newborns.

In the second segment of an interview with Contagion®, Eric Forman, MD, of the Columbia University Fertility Center, discussed why mRNA vaccines—limited in assessment among pregnant women—is theorized to be safe for the population.

“In general, we recommend avoiding live, attenuated vaccines, mostly from a theoretical concern due to the immunosuppressed state of pregnant women,” Forman said. “But even there, there are registries of women who inadvertently gotten MMR before realizing they were pregnant, and the safety was very good.”

As Forman noted, the significant transmissibility and effect of COVID-19, along with the makeup of vaccines, would lead to belief that the patient, her fetus and placenta would be safe. But supporting data is still lacking.

As such, Forman suggested pregnant be considered up-front in future COVID-19 vaccine trials.

“I don’t know if you’d have big enough numbers, but it would have been a start,” he said. “The pregnant state is different from the non-pregnant state, and it shouldn’t be excluded from studies.”