In December of 2020, about a week before Christmas, Valerie Gotie, N.P., had a decision to make. Unlike the classic questions at this time of year – like what food to serve or which last-minute gifts to buy – this was a weightier worry. Valerie was three months pregnant…should she get the COVID vaccine?
In pregnancy, timing is important. It is no surprise that the question of when to get vaccinated is top-of-mind for pregnant people, who want to do what is best for their unborn baby.
Valerie, a nurse practitioner who works in Orthopaedics and the Wilmot Cancer Institute at the University of Rochester Medical Center, made her decision without much hesitation. After conducting her own research and talking with her husband, she told her doctor she planned to get vaccinated. Her obstetrician agreed it was the right thing for Valerie to do, and she got her shot before Christmas.
“Some of my coworkers, who weren’t pregnant, questioned why I did it so soon,” said Valerie, who was eligible for the vaccine earlier than most, given her role as a health care provider. “When you are pregnant, your immune system is automatically compromised. I wanted to protect myself and my baby as best I could, because I’ve seen firsthand the devastating effects of viruses like COVID. Respiratory distress and respiratory failure are beyond frightening.”
Valerie had a tender arm after her first shot, and felt fatigued after her second. The rest of her pregnancy was normal, and she delivered a healthy baby boy last summer.
“There were no consequences or side effects for my baby; he is doing great,” noted Valerie. “I’m glad I got the vaccine when I did. If I had gotten COVID, my outcome could have been very different.”
Pregnancy experts like Eva Pressman, M.D., chair of the department of Obstetrics and Gynecology at URMC, urge their patients to get the COVID vaccine as soon as possible. As we head into flu season, they also recommend pregnant people get the flu shot. Pressman answers common questions about COVID vaccines, flu shots and vaccine side effects:
Q: When is it recommended to get the vaccine in pregnancy?
A: As soon as possible! Whenever you can get it, it is safe and effective. The sooner you get the vaccine, the less likely you are to get a severe infection with COVID and that is most important in pregnancy as well as outside of pregnancy.
Q: I had side effects from the first vaccine dose, should I proceed with the second dose?
A: Generally, yes. Even in cases of a severe allergic reaction, we can pre-treat and give the vaccine in a more controlled setting for the second dose. If the reaction to the first dose was fever, or fatigue, or aches, those are typical and it’s safe to give the second dose without pre-treatment.
Q: Is it safe to also get a flu shot while I’m getting the COVID vaccine?
A: The most recent data shows that there is no need to wait in between vaccines so, yes, you can get the vaccines together if you need to.
Q: Why do you have to wait until the 12th week of pregnancy to get a flu shot but it’s OK to get the COVID vaccine early in pregnancy?
A: In general, we like to avoid exposures of anything in the first trimester of pregnancy and that is why there’s been a general recommendation to wait until 12 weeks to get a flu shot. There’s actually no data to say that getting vaccinated for flu is dangerous in those 12 weeks and we actually have much more data on the COVID vaccine in that timeframe—thanks to all the health care workers who got the vaccine when it was first available who happened to be in their first 12 weeks of pregnancy. So there is no impact on pregnancy from the COVID vaccine in the first, second or third trimesters or the immediate post-partum period. The vaccine is safe at all of those times and there is no reason to wait.
The only reason that you might choose a certain time is that, we know within the first few days of getting it you might feel poorly. If you’re about to have a medical procedure, or a surgery, or have your baby in those next few days, it will be hard to tell whether those symptoms, such as fever, are a complication of your medical procedure or from the vaccine. In general, we like to separate those by at least a few days.
Q: Is it advisable to spread out the time between first and second doses (1-2 months) due to existing pregnancy complications?
A: No, the vaccine doses should be given on schedule as recommended because that’s how they are the most effective. There are certain vaccines (like pertussis) that are recommended at certain times. The pertussis vaccine is recommended during the third trimester so your antibody levels are highest around the time that you deliver.
Q: I had and recovered from COVID; do I have immunities since I was exposed? Do I still need the vaccine?
A: Having had COVID provides some protection, but it turns out, not as good of protection as you get from the vaccine. So, even people who have had the disease should get the vaccine. Everyone should get the vaccine, whether they have had COVID or not.
Q: Does having recovered from COVID increase your chances for side effects from the COVID vaccine?
A: There is no data that says getting the vaccine after COVID gives you more symptoms.
Q: What about blood clots?
A: We know that having COVID increases your risks of blood clots. We also know there is a small risk of people getting blood clots who have had the Johnson & Johnson vaccine (though we don’t know if those are related). If you have a history of blood clots, the J&J is probably not the best vaccine for you.
Q: How can anyone keep pushing a vaccine without data on long-term side effects?
A: This is challenging, and we don’t have a crystal ball telling us what long-term side effects might be. We do know the risk of getting COVID is very, very high. We already know that the long-term side effects of COVID (or “long COVID”) are impacting people who had COVID over a year ago. It can be devastating to your heart, lungs and neurological system. I don’t know what the long-term side effects of the vaccine are, but you have to balance those risks for yourself. We really have no choice.
Q: Do we know about long-term effects of other similar vaccines?
A: We don’t know of any vaccines, other than those that have live virus in them, that are not recommended to be given during pregnancy. For example, the Rubella vaccine has an attenuated level of live Rubella in it, and we don’t want to give pregnant women that vaccine. But any vaccine that doesn’t have live virus has been shown to be safe in pregnancy, for decades.