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Vaccine Hesitancy Among Pregnant Patients

Vaccination during pregnancy is always a topic that is met with hesitation among moms-to-be. Always wanting what is best for their babies, but concerned about what they read on their friend's Facebook page or what she heard about the friend-of-a-friend cousin's problems after a vaccine, many expectant mothers are driven into a shroud of doubts that sometimes never gets cleared despite their discussion with their doctor or their google search.

Now, let me start by stating something clearly: complications from vaccines are real, they do exist and for the most part, are very well documented. Here, I will cover the vaccines we recommend during pregnancy (TDaP, flu and COVID-19), so we can review common complications for them.

The most novel and spoken about is the vaccine against COVID-19. Common side effects are malaise, low grade fever, body aches and injection site discomfort. Severe, life-threatening allergic reactions are very uncommon, being documented at 11 cases per million doses. For comparison, the odds of being strike by lightning in a given year are 2 in a million. The other concerning complication, Guillain-Barré syndrome (GBS), has been observed in 1 out of 702 people who were previously diagnosed with Guillain-Barre syndrome. Increased rates of GBS have not been observed in the general population. The vaccine, given its mechanism of action, does not have the capacity to reach the developing baby.

The complications for seasonal flu vaccine are similar. Allergic reactions are mostly seen in people with severe egg allergies (more than hives/rash) or those who have already developed a severe allergic reaction to a previous flu vaccine. According to the available data, GBS may be increased very slightly by since the introduction of the flu vaccine (1-2 additional cases per million doses of vaccine) which does not change much the overall rate in the United States of about 3000 to 6000 cases. More importantly, getting the flu does increase your personal risk of developing GBS when recovering. Finally, multi-dose flu vaccines contain Thimerosal, a mercury-containing preservative that prevents growth of fungus and bacteria and whose safety has been thoroughly documented. Pre-filled syringes and nasal spray flu vaccines do not contain Thimerosal.

The TDaP vaccine has been used commonly over the past few decades, and severe side effects are quite rare. Common complaints like site soreness and malaise are not very common, and the rate of severe allergic reaction and GBS are as low as with the flu vaccine.

As you can see, these potential complications are real, however, they are very unlikely to happen to any given patient. The benefits we can provide to the expectant mother and her unborn child are, however, quite real and significant.

For the COVID-19 vaccine, for example, pregnancy increases dramatically (50%) your chance of hospitalization and severe illness, including the need for intubation and the risk of death. It also appears to increase the risk for long-term COVID complications, ranging from taste/smell problems to sleep problems, tiredness and difficulty breathing. Receiving the COVID-19 during pregnancy not only decreases the risks for these problems and complications, but could also prevent another aspect of COVID-19 infection unique to the expectant mother, and that is having active COVID-19 at the time of delivery. For the patients that I have taken care during those times, I can relate to additional stress produced from the fact that instead of being able to share your experience with a special someone, women have to deliver in isolation, and many times remain that way for some time. Not only this, but receiving the COVID-19 vaccine has the potential of transferring the antibodies that the mother produces to the baby before he or she is born.

With regards to the flu vaccine, it has been a long-standing recommendation for pregnant patient to get their seasonal flu vaccine when it becomes available. The reason for this is due to the well documented increased risk for severe flu in the pregnant population, including increased mortality. In a similar and confirmed fashion, seasonal flu vaccination also can help protect newborn babies by the transference of antibodies during pregnancy. The overall safety record of the flu vaccine on the pregnant population goes back many years, and this is true during any trimester.

Finally, for the TDaP vaccine, the current recommendation to get it during pregnancy between weeks 27 and 36 of pregnancy, stems directly from the transferred immunity towards the infant and the protection it will bring the baby during their early life, while they are waiting to be old enough to receive it themselves. This holds true even when the mother was recently vaccinated with the TDaP vaccine. This recommendation extends to all household members, as Pertussis is a potentially mortal disease during early life, and when the whole household is protected against Pertussis, the likelihood of the newborn acquiring it diminishes dramatically.

In summary, the recommended vaccines during pregnancy, COVID-19, seasonal flu and TDaP, are exceptionally safe for mother and baby. Risks do exist, but these are extremely infrequent, to the point that they do not pose any reasonable contraindication against receiving them, with exception of documented severe allergic reaction against that same vaccine. The benefits of receiving these vaccines considerably outweigh the risks, and for this reason, I do recommend all of my pregnant patients to get them. If you have any questions, please reach out to our office and we can schedule an appointment for you.

Please see here a TV interview I did regarding COVID-19 vaccination.

Dr. Helard Ballon, MD, FACOG Dr. Helard Ballón Dr. Ballón is a medical doctor, specialized in Obstetrics and Gynecology. He practices at the Desert Hills Care Center, a branch of Women's Health Associates of Southern Nevada. He provides prenatal care for low- and high-risk pregnancies, as well gynecological care for an array of female problems, from routine check-ups to contraception, endometriosis, abnormal bleeding, uterine fibroids, ovarian cysts and minimally invasive surgery with robotic assistance.

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