Covid vaccine in pregnant women

[jpgoodie]

OB friends, has anyone noticed either via studies or anecdotally a rise in IUFD in pregnant women who get the Covid vaccine? Are you guys recommending it to pregnant women, regardless of which trimester they’re in? Has the Covid vaccine been shown to cause harm or any adverse effects on the fetus? I think CDC says there’s not much literature on it but animal studies so far are reassuring. Just wanted to get y’all’s hot take on it. Thanks!

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[anonperson]

OB friends, has anyone noticed either via studies or anecdotally a rise in IUFD in pregnant women who get the Covid vaccine? Are you guys recommending it to pregnant women, regardless of which trimester they’re in? Has the Covid vaccine been shown to cause harm or any adverse effects on the fetus? I think CDC says there’s not much literature on it but animal studies so far are reassuring. Just wanted to get y’all’s hot take on it. Thanks!

Straight from the American College of OBGYN.

"ACOG recommends that all eligible persons, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. Obstetrician-gynecologists and other women’s health care practitioners should lead by example by being vaccinated and encouraging eligible patients to be vaccinated as well."


They just recently changed their statement. It went from pregnant women can consider the vaccine to now the above statement.

I have several patients who are pregnant and received the vaccine. They are fine.

Conversely, we have had a healthy pregnant women die from Covid last year. And another stillbirth potentially attributed to the patient having recent Covid.

The disease itself is potentially pro thrombotic which can wreak havoc in a pregnant patient who is already at elevated risk.

The mrna vaccine isn't teratogenic.

The risk is minimal.

I tell patients it's very reasonable to get. With the new ACOG statement I can comfortably say they should get it.

 

[theshellyb]

Yes, let's please not start saying things like

has anyone noticed either via studies or anecdotally a rise in IUFD in pregnant women who get the Covid vaccine

Because, that is just patently false and doctors are the last people we need asking "hypothetical" questions like that.

You know what we DO know from studies? Pregnant women with covid are more likely to end up in the ICU and die than non pregnant women.

Vaccination works. And it saves lives. And it prevents my hospital from needing to reopen the OB-COVID floor for symptomatic COVID+ women in labor where I had years shaved off my life by women who couldn't take a deep breath to push during 2nd stage because they would desat to the 70s. AND it's the only reliable way to get antibodies to your infant. So.

 

[MOHS_01]

Yes, let's please not start saying things like



Because, that is just patently false and doctors are the last people we need asking "hypothetical" questions like that.

You know what we DO know from studies? Pregnant women with covid are more likely to end up in the ICU and die than non pregnant women.

Vaccination works. And it saves lives. And it prevents my hospital from needing to reopen the OB-COVID floor for symptomatic COVID+ women in labor where I had years shaved off my life by women who couldn't take a deep breath to push during 2nd stage because they would desat to the 70s. AND it's the only reliable way to get antibodies to your infant. So.

Not playing devil's advocate and not taking sides as OB is not my thing (although I'm married to one) -- but I would caution against this reasoning for it poses more danger than offers a solution. You specifically should be asking these questions -- it is your duty; what is not your duty is to necessarily cast these questions into the open ether in a manner such as to invoke fear or doubt. It's not a trivial distinction.... and defaulting to consensus statements from boards of authority may serve you well in a court of law for reasons beyond this discussion, but they are not sufficient for the actual performance of our jobs and duties -- and you want this to be the case else we have little to offer beyond the NP, PA, or midwife who can follow the recipe / algorithm as dictated on high as well as you or I can.

 

[anonperson]

Not playing devil's advocate and not taking sides as OB is not my thing (although I'm married to one) -- but I would caution against this reasoning for it poses more danger than offers a solution. You specifically should be asking these questions -- it is your duty; what is not your duty is to necessarily cast these questions into the open ether in a manner such as to invoke fear or doubt. It's not a trivial distinction.... and defaulting to consensus statements from boards of authority may serve you well in a court of law for reasons beyond this discussion, but they are not sufficient for the actual performance of our jobs and duties -- and you want this to be the case else we have little to offer beyond the NP, PA, or midwife who can follow the recipe / algorithm as dictated on high as well as you or I can.

I don't know the OP but the original question seemed to be a bit disingenuous but I am willing to give them the benefit of the doubt.

Where are there any indications in the news etc/general media that the COVID vaccine is even remotely related to fetal demise? I don't think I have heard anything even from the extreme anti vaccine crowd.

There are plenty of stories of pregnant women dying or experiencing significant morbidity from COVID-19.

I would also disagree about your issue with consensus statements.

When the American College of OB GYN and the Society of Maternal Fetal Medicine make a consensus statement promoting something like a vaccine in the midst of a pandemic with a reasonable amount of data indicating safety and efficacy, one will look like a charlatan by trying to be the dissenting voice with NO data to back you up. Not even anecdotal patient experiences.

 

[MOHS_01]

I don't know the OP but the original question seemed to be a bit disingenuous but I am willing to give them the benefit of the doubt.

Where are there any indications in the news etc/general media that the COVID vaccine is even remotely related to fetal demise? I don't think I have heard anything even from the extreme anti vaccine crowd.

There are plenty of stories of pregnant women dying or experiencing significant morbidity from COVID-19.

I would also disagree about your issue with consensus statements.

When the American College of OB GYN and the Society of Maternal Fetal Medicine make a consensus statement promoting something like a vaccine in the midst of a pandemic with a reasonable amount of data indicating safety and efficacy, one will look like a charlatan by trying to be the dissenting voice with NO data to back you up. Not even anecdotal patient experiences.

We should always try to start with the most generous take and then allow the person asking to walk your generosity back (which sadly happens quite often).

I'm not arguing the merits of any assumption of validity -- and I certainly do not believe that we should be taking our medical directives from the evening news -- but at the same time that does not mean the question is beyond reproach for it most certainly is not. It's a question that we used to consider at the top of the list prior to the past year and some change -- has it been studied and is it safe -- and anyone asking those questions should not be chastised for going against the current religion.

No one is arguing that covid is not serious or infections impacting pregnant women; in fact, that is not even part of the discussion. The question asked, as best I could tell, was if anyone was aware of any safety data on IUFD in vaccinated individuals. The proper response would have gone something like this: Not that I have read or am aware of; here is UpToDate link on the topic. What we do know, however, is that vaccines have thus far demonstrated good efficacy at preventing serious disease and that vaccinations historically have proved to be generally safe in this population. We have to weigh the risk of the known (infection morbidity and mortality) with the unknown (new vaccine risks) and, for now, that math favors vaccination.

Lastly, on the disagreement about consensus statements -- that is, at best, a very weak form of argument. I understand why we do it, the ease and convenience it represents -- but remember that consensuses not only frequently change, they frequently reverse themselves and are found to be completely wrong. There's also different degrees of validity for consensus statements and I understand that many times that may well be the best, most practical evidence we can get -- particularly in a field such as OB where studies are quite difficult to do. At the same time, consensus based upon limited data is limited and we would probably be served by recognizing and acknowledging that fact with the caveat of "well, we don't really know as it is so new but so far here is what we believe...". As an aside, I believe the failure to do this -- and the faulty belief that they needed to speak authoritatively to a degree beyond their knowledge or understanding -- is a major contributing factor to the loss of trust currently experienced by the public health community.

...and it has been discussed and is being studied, btw, precisely because they don't know.

https://www.cdc.gov/vaccinesafety/pdf/VSD-COVID-Vaccine-SAB-SB-Protocol-508.pdf

 

[anonperson]

We should always try to start with the most generous take and then allow the person asking to walk your generosity back (which sadly happens quite often).

I'm not arguing the merits of any assumption of validity -- and I certainly do not believe that we should be taking our medical directives from the evening news -- but at the same time that does not mean the question is beyond reproach for it most certainly is not. It's a question that we used to consider at the top of the list prior to the past year and some change -- has it been studied and is it safe -- and anyone asking those questions should not be chastised for going against the current religion.

No one is arguing that covid is not serious or infections impacting pregnant women; in fact, that is not even part of the discussion. The question asked, as best I could tell, was if anyone was aware of any safety data on IUFD in vaccinated individuals. The proper response would have gone something like this: Not that I have read or am aware of; here is UpToDate link on the topic. What we do know, however, is that vaccines have thus far demonstrated good efficacy at preventing serious disease and that vaccinations historically have proved to be generally safe in this population. We have to weigh the risk of the known (infection morbidity and mortality) with the unknown (new vaccine risks) and, for now, that math favors vaccination.

Lastly, on the disagreement about consensus statements -- that is, at best, a very weak form of argument. I understand why we do it, the ease and convenience it represents -- but remember that consensuses not only frequently change, they frequently reverse themselves and are found to be completely wrong. There's also different degrees of validity for consensus statements and I understand that many times that may well be the best, most practical evidence we can get -- particularly in a field such as OB where studies are quite difficult to do. At the same time, consensus based upon limited data is limited and we would probably be served by recognizing and acknowledging that fact with the caveat of "well, we don't really know as it is so new but so far here is what we believe...". As an aside, I believe the failure to do this -- and the faulty belief that they needed to speak authoritatively to a degree beyond their knowledge or understanding -- is a major contributing factor to the loss of trust currently experienced by the public health community.

...and it has been discussed and is being studied, btw, precisely because they don't know.

https://www.cdc.gov/vaccinesafety/pdf/VSD-COVID-Vaccine-SAB-SB-Protocol-508.pdf

The proper response is to go to Uptodate but question consensus statements national organizations?


Lol.

Ok. Uptodate is fine but they are just articles written by some random physicians. Some of them are well regarded but a decent number are by people I have never heard of (within my specialty).

And I will give ACOG credit this time for making a measured response. Up until 7/30/21, they had indicated the vaccine was an option. It's just now that they have recommended the vaccine.

 

[Matthew9Thirtyfive]

...and it has been discussed and is being studied, btw, precisely because they don't know.

Yes, and preliminary data show that it is likely to be safe.

https://www.nejm.org/doi/full/10.1056/nejmoa2104983

 

[MOHS_01]

Yes, and preliminary data show that it is likely to be safe.

https://www.nejm.org/doi/full/10.1056/nejmoa2104983

I don't believe anyone has argued this was not the case -- I just believe that an acknowledgement of the very real limitations of our certainty is not unreasonable.

 

[MOHS_01]

The proper response is to go to Uptodate but question consensus statements national organizations?


Lol.

Ok. Uptodate is fine but they are just articles written by some random physicians. Some of them are well regarded but a decent number are by people I have never heard of (within my specialty).

And I will give ACOG credit this time for making a measured response. Up until 7/30/21, they had indicated the vaccine was an option. It's just now that they have recommended the vaccine.

No - the proper response is to acknowledge the concern and offer back the knowledge as it exists and is available; UpToDate was used because it is freely available and contained links and citations to the actual information as it exists currently — that is the value of it — a provision of the data from which conclusions are being derived — which is in direct contrast to an appeal to some authority’s proclamation on the data. I happen to agree with ACOG’s measured approach here, merely pointing out (once again) that it is in absolutely no way unreasonable to ask the question.

This is why discussion on religion and politics are not very fruitful — people do not read to understand, they read with the intent to respond… and matters of faith are particularly problematic.

 

[Matthew9Thirtyfive]

I don't believe anyone has argued this was not the case -- I just believe that an acknowledgement of the very real limitations of our certainty is not unreasonable.

I don’t think anyone is saying we shouldn’t be asking if it’s safe and what the data show. What people are saying is that a loaded question like who here has noticed anecdotal increases in IUFD with the covid vaccine is a dangerous question that isn’t asking in good faith, but rather with an ulterior motive, especially given the prelim data and Acog statement. Not saying that was OP’s intent, but it comes across that way a bit.

 

[MOHS_01]

I don’t think anyone is saying we shouldn’t be asking if it’s safe and what the data show. What people are saying is that a loaded question like who here has noticed anecdotal increases in IUFD with the covid vaccine is a dangerous question that isn’t asking in good faith, but rather with an ulterior motive, especially given the prelim data and Acog statement. Not saying that was OP’s intent, but it comes across that way a bit.

That's fair. I think too many people are far too quick to project motivations when it comes to this -- well, it's the case with any contentious topic I suppose -- and they respond to these projected motivations rather than to the question itself. It's a form of unenlightened behavior that has become far too common in anything that takes on a political bent (which is to say damn near everything these days) -- a hostility to inquiry that at best impedes true scientific thought and discourse and at worse represents a deliberate effort to shut it down. It's maddening to see it happen over and over again, from the arguments on therapeutics, to the origin story, to the relative risk profiles, to the benefits of certain social measures, on and on....

 

[anonperson]

No - the proper response is to acknowledge the concern and offer back the knowledge as it exists and is available; UpToDate was used because it is freely available and contained links and citations to the actual information as it exists currently — that is the value of it — a provision of the data from which conclusions are being derived — which is in direct contrast to an appeal to some authority’s proclamation on the data. I happen to agree with ACOG’s measured approach here, merely pointing out (once again) that it is in absolutely no way unreasonable to ask the question.

This is why discussion on religion and politics are not very fruitful — people do not read to understand, they read with the intent to respond… and matters of faith are particularly problematic.

Then I disagree with you completely.

Uptodate is not the appropriate fall back. It is not a systematic review. It is a single author who may or may not be an expert in the field who writes an article. Sure they cite articles but it is far from comprehensive.

My issue is that in one sentence you indicate we can't just call back on a consensus statement from nationally recognized organizations who have a fair amount of credibility while in another sentence indicating that going to Uptodate is somehow more reasonable.

So if the article on Uptodate disagrees with a national consensus statement , somehow the author of this one article has more credibility?

No one is arguing the data is limited regarding the Covid vaccine and pregnancy. That is known. But after a full year of dealing with Covid, anecdotally, myself and other OB GYNs already know the severe clinical morbidity it entails. With that in mind, I know anecdotally that the risk of the disease is greater than the risk of the vaccine.

I could be proven wrong but I am willing to take that bet.

 

[MOHS_01]

Then I disagree with you completely.

Uptodate is not the appropriate fall back. It is not a systematic review. It is a single author who may or may not be an expert in the field who writes an article. Sure they cite articles but it is far from comprehensive.

My issue is that in one sentence you indicate we can't just call back on a consensus statement from nationally recognized organizations who have a fair amount of credibility while in another sentence indicating that going to Uptodate is somehow more reasonable.

So if the article on Uptodate disagrees with a national consensus statement , somehow the author of this one article has more credibility?

No one is arguing the data is limited regarding the Covid vaccine and pregnancy. That is known. But after a full year of dealing with Covid, anecdotally, myself and other OB GYNs already know the severe clinical morbidity it entails. With that in mind, I know anecdotally that the risk of the disease is greater than the risk of the vaccine.

I could be proven wrong but I am willing to take that bet.

No, again, that's not it. Let's see how I can say this more clearly or even more simply: the UpToDate link was not an appeal to the authority of UpToDate -- it's that it provided a link to the data upon which the assessment is being made. A similarly proper argument could have been made by referring the person to ACOG's position statement if the position statement included links to the underlying data; it is only discounted as an appeal to authority when the underlying data is not divulged or under the assumption that one has to simply defer to the academics on high. That's the difference. If you take exception to the UTD, simply use links to the VAERS data, the CDC, the NEJM article, etc. UTD is merely an aggregating source -- much like ACOG -- and is irrelevant to the general construction of the argument.

I get the allure of outsourcing critical assessment to an authoritative agency; it makes life easier. That does not necessarily make it proper.

Either way, this horse is dead and flogging it further benefits no one. Feel free to have the close.

on edit -- we're probably more in agreement than this would suggest -- as the ACOG guidelines actually do cite the underlying data. I just want people to make proper arguments for proper reasons as this has been a problem over and over again throughout the pandemic, holding up statements by experts as gospel only to have these statements come back to bite the expert in the ass just a little while later as conditions change. I mostly don't like the chilling effect on inquiry or discussion and believe that the best disinfectant for bad ideas is an open and honest system of inquiry and discourse.

 

[MOHS_01]

In case I’ve given any notion that I believe people should be hesitant about vax in pregnancy, that’s absolutely not the case. Get your shot — infection represents a crazy risk given the precarious baseline that pregnant lungs and hemodynamics represent.