Should pregnant women get a third COVID-19 vaccination? According to several experts, the answer is yes.
Israel is the first country to offer a booster shot to vast sectors of its general population – anyone as young as 20, plus healthcare workers and teachers of all ages.
When the Health Ministry extended the eligibility of the booster to people over 40 on Thursday, it also issued a recommendation for pregnant women to get the shot as well.
While millions of women all over the world have been vaccinated against COVID with the Pfizer vaccine used in Israel, virtually no one had received the third shot when the ministry suggested getting it.
However, several experts said that there is no reason to believe that the new inoculation presents more danger than the previous ones, while pregnant women who get infected are a higher risk of developing serious symptoms.
“In my opinion, women should be encouraged to get the third vaccine, because I don’t think that there is any possible bad consequence or difference between the first two shots and the booster,” said Dr. Misgav Rottenstreich, a senior physician in the Department of Obstetrics and Gynecology at Shaare Zedek Medical Center, Jerusalem. “We see all the time how pregnant women are more at risk, because their immune system is weaker. I believe that the third shot is very important for everyone, and especially for populations at risk. If a woman got inoculated over five months ago, her antibodies are probably low.”
Together with Prof. Sorina Grisaru, director of the Wilf Women and Infant Center, Rottenstreich led a study in the past few months about pregnancy-related complications that might result from vaccination, analyzing data from almost 3,000 women who gave birth at Shaare Zedek, which between its two campuses accounts for about 15% of all births in Israel.
The study – which has not yet been published – found no significant difference regarding pregnancies between women who were inoculated and women who didn’t in pregnancies reaching full-term, birth weights, nature of delivery or fetal development. The experts also compared the outcomes with those of women who contracted COVID.
For example, while both vaccinated and unvaccinated women – whose data were drawn by a previous study – had a 2.8% chance of premature labor, among those who contracted COVID, the chance went up to 3.4%.
In addition, some 5.2% of babies born from women recovered from COVID needed neonatal intensive care, compared to 4.5% of those born from unvaccinated mothers and 4.1% of those born from vaccinated ones.
In all the other parameters checked, the rate of complications among vaccinated women was very similar or lower than the other two groups.
Rottenstreich said that in the past two weeks they have seen more COVID infections among pregnant women, and that even when the cases are not serious, the disease still adds a layer of stress and complications to the delivery.
“While now we are better prepared than in the past, in order to intervene we need to wear the special protective gear, and this slows down our reaction,” he said. “Also, the relationship with the midwife cannot be the same.”
DURING THE third wave last winter, several pregnant women developed very severe forms of COVID, resulting in several deaths.
After those tragic events, most women got vaccinated, recalled Prof. Yoav Yinon, head of Fetal Medicine Unit, Obstetrics and Gynecology at the Sheba Medical Center, and chair of Israeli Maternal Fetal Medicine Society. He added that he believes that this time most women will be ready to take the vaccine.
“The reason the Health Ministry recommends a third vaccine is the assumption that after five months, the antibody level goes down,” Yinon said. “Specifically in pregnancy, there are two things we have to remember. First of all, there are good data showing that the vaccine is safe in pregnancy, both from Israel and from the US. The vaccine is not associated with any pregnancy complication. Secondly, COVID itself causes a more severe disease during pregnancy.”
Based on these two factors, the professor stressed that the third shot is advisable, and there is no reason to believe it would be any different than the other two.
In addition, while he acknowledged there are no data on long-term effects on children, there is no reason to assume that there would be any consequence “based on data on other vaccines and on the fact that the mRNA deteriorates quickly.”
Prof. Roni Maimon, director of the Obstetrics and Gynecology Division at Shamir Medical Center, and chairman of Israel Society of Obstetrics and Gynecology, also recommended all pregnant women to get inoculated with the booster.
“I don’t see much difference between the first, the second and the third shot,” he said. “The fraction of the molecule in the vaccine is very small. It deteriorates quickly, which is also why we need a booster.”
“The danger for pregnant women in not getting vaccinated or in having a low level of antibodies is much higher,” he added. “The disease is more frightening than a small molecule that deteriorates quickly.”
At the beginning of the vaccination drive, many experts recommended getting vaccinated only after the first trimester, mainly to avoid the public thinking that possible problems – including miscarriages, which are common in the first weeks – were associated with the vaccine. However, Maimon said, there is now enough information to suggest pregnant women should get inoculated at any stage of the pregnancy.
Asked about the lack of information on long-term effects of the vaccine, he said that based on how the mRNA technology and other vaccines work, there should not be any.
“We also have to remember that we live in a world of risks,” he said. “Now we are dealing with this pandemic and I believe this is a reasonable chance to take.”