Medical experts are saying pregnant and breastfeeding women should not be routinely offered COVID-19 vaccines until more data is gathered, but the same experts are saying it is ethically justified to offer the vaccines to those who want it.
The recommendation is part of a commentary recently published by the Canadian Medical Association Journal (CMAJ) and said vaccines can be considered in certain scenarios where the benefits are deemed to outweigh the risks.
"Core principles of medical ethics hold that medical decisions or interventions should respect individuals’ autonomy, be just, be beneficial (beneficence) and not cause harm (nonmaleficence)," said the article.
"Canadian guidance has recommended that the vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should not be routinely offered to individuals who are pregnant or breastfeeding until further evidence is available; however, it is ethically justified to offer individuals who are pregnant, trying to conceive or breastfeeding the option to receive the vaccine," said the article.
The article is written by Jonathan S. Zipursky MD, University of Toronto; Rebecca A. Greenberg RN PhD, Sunnybrook Health Sciences Centre; Cynthia Maxwell MD, Sinai Health; and Tali Bogler MD MScCH, St. Michael’s Hospital in Toronto.
The article also examined a woman's right to make decisions about her own body even if such decisions might conflict with the well-being of the fetus. It also noted that breastfeeding women can pass the benefits of the vaccine into the bodies of their children.
"A recent statement from the Academy of Breastfeeding Medicine does not recommend cessation of breastfeeding in individuals who are vaccinated against SARS-CoV-2, as antibodies and T-cells stimulated by the vaccine might transfer into breast milk, thereby protecting the infant from SARS-CoV-2 infection," said the article. “Until evidence emerges showing that harms outweigh benefits, we propose that all individuals who are pregnant or breastfeeding should be given the option of receiving the SARS-CoV-2 vaccine.
"Other options should also be presented as part of a shared decision-making approach, including delaying vaccination until further safety data are available, or forgoing vaccination altogether and continuing to follow public health measures to minimize the risk of SARS-CoV-2 infection," the article continued.
It also stated that shared decision-making is a process where clinicians partner with patients to reach informed, value-laden medical decisions.
The overall position is also endorsed by the American College of Obstetricians and Gynecologists.
"After an explicit, evidence-based review of all available data, the Advisory Committee on Immunization Practices (ACIP) issued interim recommendations for use of the Pfizer-BioNTech “COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19 (CDC 2020) and the use of the Moderna-1273 COVID-19 vaccine in persons aged ≥ 18 years (CDC 2020).
ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups.
“COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP.
"Discussions about the safety of the vaccine for individuals who are pregnant or breastfeeding will evolve over time as new safety data emerge. In some regions, these individuals can enrol in registries after receiving the vaccine and are expected to be included in additional vaccine trials in early 2021," the article concluded.
Len Gillis is a Local Journalism Initiative reporter at Sudbury.com, covering health care in Northern Ontario. The Local Journalism Initiative is funded by the federal government.
