Expecting her second child in August, Molly Davidson had a difficult decision to make. Should she get the coronavirus vaccine -- despite what she calls a “concerning” lack of data about its impact on pregnant women -- or risk becoming severely ill should she contract the disease?
“It’s been overwhelming,” the 39-year-old mother said. “It's so new and so much is unknown.”
At five months pregnant with an 18-month-old at home in Milton, Davidson consulted with Dr. Margaret Sullivan, an obstetrician and gynecologist at Tufts Medical Center. The inquiry has become routine for Sullivan and other local doctors, who field similar concerns from women about baseless rumors that the vaccine causes infertility.
“We're getting a lot of questions from women, both pregnant women and women planning families, about whether vaccines are safe for themselves, their pregnancies, their babies,” Sullivan said. “And in terms of fertility, there's lots of questions going on out there that I get in the office on a daily basis.”
Medical experts in Boston have been working behind the scenes to correct misinformation that has largely circulated on social media. Some reports have falsely asserted the vaccine raises antibodies against a protein involved in placental and pregnancy development because it resembles how the coronavirus behaves, according to Dr. Wendy Kuohung, director of Boston Medical Center’s Reproductive Endocrinology and Infertility Program.
“But it's simply not true,” Kuohung said, citing a study out of Yale Medical School that compared the proteins and determined that they are not similar. The rumors are particularly concerning, Kuohung said, because they are plausible.
“This fake news is the most harmful to women that I've heard in my 20 years of practice,” Kuohung said.
Not helping matters is a "vacuum" of data about how the vaccine impacts pregnant women, Kuohung added, created by the fact that they were excluded from initial clinical trials.
“If I wasn't pregnant, I would get the vaccine no questions asked,” Davidson said. “But not having data to support how, or if the vaccine affects the fetus -- that was most concerning to me.”
Pfizer-BioNTech launched a clinical trial for pregnant women last month, the first of its kind in the U.S.
Both Kuohung and Sullivan noted that no loss of fertility has been reported among trial participants or the millions of others who have been vaccinated since. They pointed to consensus statements from the American College of Obstetricians and Gynecologists as well as the American Society of Reproductive Medicine, among other medical organizations, that state the vaccine should not be withheld from pregnant women.
“Hopefully we learn our lesson in the future -- that these things also need to be tested in pregnant women,” Kuohung said.
Dispelling the COVID Fertility Myth
The easiest way to clear things up for patients is to explain the fundamentals of how vaccines work, according to experts. At its core, COVID vaccines send a message to the body to make a protein that resembles part of the coronavirus called the "spike protein," which stimulates the body to produce antibodies against it.
But it’s easy to get lost in clinical jargon, according to Dr. Mark Poznansky, director of Massachusetts General Hospital’s Vaccine and Immunotherapy Center, and overly complex explanations could fail to dispel preconceived notions people may have about fertility.
Broadly, there are two important factors people should consider when thinking about the vaccine and fertility, according to Poznansky, who heads a department involved in developing COVID-19 vaccine tests and new therapeutics.
The first is the modest amount of vaccine being given and the duration between doses, while the second is where it’s administered in the body.
“Vaccines are a quite unique type of medicine in the sense that they're only given in very, very small doses, maybe once or twice over a relatively long time in terms of medicines. Most medicines we take we take every single day, two to three times a day as advised by the health care workers, and obviously that's a much greater impact on your general health than these very small injections,” Poznansky said.
“The second thing is the doses are given into your arm because it's somewhat isolated from the rest of your body, which is obviously a long way -- both biologically and anatomically -- from either your reproductive organs or your pregnancy or anything that is involved in fertility.”
The immune response is generated directly in the arm, the site where the vaccine is given. That response is then delivered to parts of the body that would be challenged by the virus, including the nose, mouth and lungs.
While the physicians acknowledged the lack of information on the vaccine’s long-term impacts more broadly, they countered that the same can be said for COVID-19.
“We're not hearing a lot about the morbidity, which is long-term health consequences,” Sullivan said of the virus. “There's a lot of morbidity that's associated with people who survive COVID and so it's all about weighing the risks and benefits.”
There is, however, “substantial” proven risk for pregnant women who contract COVID-19, Kuohung noted, which is part of why Davidson ultimately decided to get the vaccine. She is due for her second dose this month.
“I weighed what the doctors and the scientific community know about how these types of vaccines work based on, you know, the science of it,” Davidson said. “I also weighed the worst case scenario should I get COVID and what the potential risks could be to me and also to my family. So that information combined helped me to make a decision that felt right to me.”
Particularly later in pregnancy, getting coronavirus increases risks including preterm birth, conditions that require a breathing tube and even death compared with non-pregnant women, according to Kuohung.
“Getting a vaccine is definitely a personal decision,” Kuohung said, “but fears about the vaccine causing infertility or miscarriage shouldn't factor into the decision whether or not to get the vaccine.”
Shira Stoll contributed to this report.