Pregnant Ohioans Can Now Get The Vaccine, But Should They?

Ohio Gov. Mike DeWine announced Monday that pregnant  women are eligible to receive the COVID-19 vaccine starting Thursday.

Dr. Oluwatosin Goje, who works in obstetrics and gynecology (OB/GYN) at the Cleveland Clinic, says this is the best news she’s heard all week, along with the FDA's emergency use authorization of the Johnson & Johnson vaccine. 

“Now we have three effective vaccines that can be administered, not just to the general population, but even to pregnant patients,” she said.

According to the U.S. Centers for Disease Control and Prevention, pregnant women have a higher risk of severe forms of COVID-19, which is one of the reasons why Goje is relieved her patients can now start receiving the vaccine.

She said studies show pregnant women with symptomatic COVID-19 are more likely to be hospitalized and more likely to end up in the Intensive Care Unit or on a ventilator than patients who are not pregnant.

“So if we have something that can prevent our pregnant patients from getting to that level, it is welcomed,” Goje said.

Dr. Kavita Arora, an OB/GYN from MetroHealth, agrees.

“I think in general, OB/GYNs are very excited that pregnant women are finally being prioritized for the vaccine,” she said. “For us, in OB/GYN, we’ve seen the dangers of COVID in pregnancy and feel strongly that pregnant women should be prioritized in its allocation.”

Pregnant women were not involved in the initial testing of the COVID-19 vaccines, but Goje said research still shows it is safe.

According to the CDC, there were no reproductive safety concerns in animal testing of the vaccines.

Some pregnant women in the United States have already received the vaccine, said Goje, because they are part of another eligible group, such as health care workers, or because they live in a state where the vaccine was already made available to them.

“And we’ve not heard about any alarming side effects, so that is really reassuring,” she said.

Infectious disease specialist Dr. Amy Edwards of University Hospitals said there’s a lot of reluctance to include pregnant women in early clinical trials.

“Unfortunately, pregnant women often get left out of a lot of research, which, for a lot of us in the medical community, we think it’s very unfortunate because it leaves them in a place where they don’t have as much science to do their own medical care,” she said.

While the two OB/GYNs were confident in the safety of the COVID-19 vaccine for pregnant women, Edwards expressed more hesitancy.

“My recommendation, as an infectious disease doctor, is if a woman is in their second or third trimester, and their obstetrician feels that their pregnancy is going well and that it’s safe for them, that they should get vaccinated,” she said. “But I would hesitate to do it in my first trimester unless I was in an extremely high-risk situation where I felt like not getting the vaccine could be very harmful to me.”

Edwards said that it’s best if the patient talks to her obstetrician directly to decide whether to get vaccinated. 

Arora recommends the vaccine at any stage of pregnancy because of the risks of contracting COVID-19 in the first trimester. She said any potential risks of the vaccine have not been substantiated by data. 

The American College of Obstetricians and Gynecologists is also recommending the vaccine in any trimester, along with other organizations in the OB/GYN medical community, Arora said.

“It’s very understandable to be risk-averse in pregnancy and be cautious,” she said. “Women are understandably concerned about the impact in the first trimester or the risk of infertility. However, myself and all the major medical associations dealing with pregnancy in the United States feel that the benefits outweigh the risks.”

All of the doctors agree that the risks of getting COVID-19 during pregnancy outweighs the risk posed by the vaccine.

One of Goje’s patients became infected with COVID-19 when she was 22 weeks pregnant, and she ended up in the ICU.

“Despite all the multidisciplinary treatment, she ended up having an emergency Cesarean section of a very premature baby,” Goje said. “Despite everything, the baby died, I think before the end of the first 24 hours. So that’s why it’s important that we protect these patients.”

Other Eligible Conditions

Pregnancy isn’t the only new condition on Ohio’s vaccine eligibility list.

Gov. DeWine announced people with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, are now eligible, as well as those who have had bone marrow transplants and people living with Type 1 diabetes.

Those conditions join a list of medical conditions like Down syndrome, sickle cell anemia, cystic fibrosis, and others.

But there are some conditions left off the list, likeType 2 diabetes, which Edwards said surprised her.

“I thought that was a glaring omission,” she said. “I would have included all diabetics, Type 1 and Type 2. I wouldn’t have differentiated them.”

Edwards said diabetes is a risk factor for COVID-19, so she’s glad to see at least Type 1 diabetes on the eligibility list. She isn't sure why the state left Type 2 diabetes off the list.

Ohio Department of Health officials did not respond to an email request asking why Type 1 was included, while Type 2 was not. 

Edwards estimated the vaccine will become more widely available by the end of March or April. Because demand is greater than supply now, some will have to wait.

“They’re probably doing the best they can, but there’s always going to be gaps,” she said. “Choices have to be made, and that’s unfortunately the place that we’re in when you have a limited resource. Until there’s more vaccine available, it just is the way that is, as frustrating as that is.”