Pregnant & Breastfeeding Women Who Get the COVID-19 Vaccine Are Protecting Their Infants, Research Suggests
Becky Cummings, who got vaccinated in December, snuggles her newborn, Clark, while he takes a nap.
Becky Cummings had multiple reasons to get vaccinated against COVID-19 while tending to her firstborn, Clark, who arrived in September 2020 at 27 weeks.
The 29-year-old intensive care unit nurse in Greensboro, North Carolina, had witnessed the devastation day in and day out as the virus took its toll on the young and old. But when she was offered the vaccine, she hesitated, skeptical of its rapid emergency use authorization.
Exclusion of pregnant and lactating mothers from clinical trials fueled her concerns. Ultimately, though, she concluded the benefits of vaccination outweighed the risks of contracting the potentially deadly virus.
"Long story short," Cummings says, in December "I got vaccinated to protect myself, my family, my patients, and the general public."
At the time, Cummings remained on the fence about breastfeeding, citing a lack of evidence to support its safety after vaccination, so she pumped and stashed breast milk in the freezer. Her son is adjusting to life as a preemie, requiring mother's milk to be thickened with formula, but she's becoming comfortable with the idea of breastfeeding as more research suggests it's safe.
"If I could pop him on the boob," she says, "I would do it in a heartbeat."
Now, a study recently published in the Journal of the American Medical Association found "robust secretion" of specific antibodies in the breast milk of mothers who received a COVID-19 vaccine, indicating a potentially protective effect against infection in their infants.
The presence of antibodies in the breast milk, detectable as early as two weeks after vaccination, lasted for six weeks after the second dose of the Pfizer-BioNTech vaccine.
"We believe antibody secretion into breast milk will persist for much longer than six weeks, but we first wanted to prove any secretion at all after vaccination," says Ilan Youngster, the study's corresponding author and head of pediatric infectious diseases at Shamir Medical Center in Zerifin, Israel.
That's why the research team performed a preliminary analysis at six weeks. "We are still collecting samples from participants and hope to soon be able to comment about the duration of secretion."
As with other respiratory illnesses, such as influenza and pertussis, secretion of antibodies in breast milk confers protection from infection in infants. The researchers expect a similar immune response from the COVID-19 vaccine and are expecting the findings to spur an increase in vaccine acceptance among pregnant and lactating women.
A COVID-19 outbreak struck three families the research team followed in the study, resulting in at least one non-breastfed sibling developing symptomatic infection; however, none of the breastfed babies became ill. "This is obviously not empirical proof," Youngster acknowledges, "but still a nice anecdote."
Leaps.org inquired whether infants who derive antibodies only through breast milk are likely to have a lower immunity than infants whose mothers were vaccinated while they were in utero. In other words, is maternal transmission of antibodies stronger during pregnancy than during breastfeeding, or about the same?
"This is a different kind of transmission," Youngster explains. "When a woman is infected or vaccinated during pregnancy, some antibodies will be transferred through the placenta to the baby's bloodstream and be present for several months." But in the nursing mother, that protection occurs through local action. "We always recommend breastfeeding whenever possible, and, in this case, it might have added benefits."
A study published online in March found COVID-19 vaccination provided pregnant and lactating women with robust immune responses comparable to those experienced by their nonpregnant counterparts. The study, appearing in the American Journal of Obstetrics and Gynecology, documented the presence of vaccine-generated antibodies in umbilical cord blood and breast milk after mothers had been vaccinated.
Natali Aziz, a maternal-fetal medicine specialist at Stanford University School of Medicine, notes that it's too early to draw firm conclusions about the reduction in COVID-19 infection rates among newborns of vaccinated mothers. Citing the two aforementioned research studies, she says it's biologically plausible that antibodies passed through the placenta and breast milk impart protective benefits. While thousands of pregnant and lactating women have been vaccinated against COVID-19, without incurring adverse outcomes, many are still wondering whether it's safe to breastfeed afterward.
It's important to bear in mind that pregnant women may develop more severe COVID-19 complications, which could lead to intubation or admittance to the intensive care unit. "We, in our practice, are supporting pregnant and breastfeeding patients to be vaccinated," says Aziz, who is also director of perinatal infectious diseases at Stanford Children's Health, which has been vaccinating new mothers and other hospitalized patients at discharge since late April.
Earlier in April, Huntington Hospital in Long Island, New York, began offering the COVID-19 vaccine to women after they gave birth. The hospital chose the one-shot Johnson & Johnson vaccine for postpartum patients, so they wouldn't need to return for a second shot while acclimating to life with a newborn, says Mitchell Kramer, chairman of obstetrics and gynecology.
The hospital suspended the program when the Food and Drug Administration and the Centers for Disease Control and Prevention paused use of the J&J vaccine starting April 13, while investigating several reports of dangerous blood clots and low platelet counts among more than 7 million people in the United States who had received that vaccine.
In lifting the pause April 23, the agencies announced the vaccine's fact sheets will bear a warning of the heightened risk for a rare but serious blood clot disorder among women under age 50. As a result, Kramer says, "we will likely not be using the J&J vaccine for our postpartum population."
So, would it make sense to vaccinate infants when one for them eventually becomes available, not just their mothers? "In general, most of the time, infants do not have as good of an immune response to vaccines," says Jonathan Temte, associate dean for public health and community engagement at the University of Wisconsin School of Medicine and Public Health in Madison.
"Many of our vaccines are held until children are six months of age. For example, the influenza vaccine starts at age six months, the measles vaccine typically starts one year of age, as do rubella and mumps. Immune response is typically not very good for viral illnesses in young infants under the age of six months."
So far, the FDA has granted emergency use authorization of the Pfizer-BioNTech vaccine for children as young as 16 years old. The agency is considering data from Pfizer to lower that age limit to 12. Studies are also underway in children under age 12. Meanwhile, data from Moderna on 12-to 17-year-olds and from Pfizer on 12- to 15-year-olds have not been made public. (Pfizer announced at the end of March that its vaccine is 100 percent effective in preventing COVID-19 in the latter age group, and FDA authorization for this population is expected soon.)
"There will be step-wise progression to younger children, with infants and toddlers being the last ones tested," says James Campbell, a pediatric infectious diseases physician and head of maternal and child clinical studies at the University of Maryland School of Medicine Center for Vaccine Development.
"Once the data are analyzed for safety, tolerability, optimal dose and regimen, and immune responses," he adds, "they could be authorized and recommended and made available to American children." The data on younger children are not expected until the end of this year, with regulatory authorization possible in early 2022.
For now, Vonnie Cesar, a family nurse practitioner in Smyrna, Georgia, is aiming to persuade expectant and new mothers to get vaccinated. She has observed that patients in metro Atlanta seem more inclined than their rural counterparts.
To quell some of their skepticism and fears, Cesar, who also teaches nursing students, conceived a visual way to demonstrate the novel mechanism behind the COVID-19 vaccine technology. Holding a palm-size physical therapy ball outfitted with clear-colored push pins, she simulates the spiked protein of the coronavirus. Slime slathered at the gaps permeates areas around the spikes—a process similar to how our antibodies build immunity to the virus.
These conversations often lead hesitant patients to discuss vaccination with their husbands or partners. "The majority of people I'm speaking with," she says, "are coming to the conclusion that this is the right thing for me, this is the common good, and they want to make sure that they're here for their children."
CORRECTION: An earlier version of this article mistakenly stated that the COVID-19 vaccines were granted emergency "approval." They have been granted emergency use authorization, not full FDA approval. We regret the error.
Rooting for Your Ancestors Doesn’t Make You Racist
A group of people waving flags in a World Cup theme.
Editor's Note: This op/ed is in response to our Big Question of the month: "Should shared genetics play any role in encouraging sports fans to root for a certain team?"
A soccer fan can usually explain why he chose to love his team, but there is seldom any logic to it.
If it takes a mail-order DNA test to get you into the game, then swab your cheek and join the party.
Maybe he likes the colors, or maybe his mom grew up in the city where the team plays. Maybe a certain elegant Dutchman (Marc Overmars) played for a certain London club (Arsenal) during the most impressionable years (the late '90s, roughly) in the life of a young person (me), and that poor child continued to follow that poor club decade after losing decade, even though he lived in Florida, where games were only sometimes shown on TV and he missed most of them anyway, and, besides, this was long after the Dutchman had ceased being an employee of that club to which the young Floridian had absolutely no spiritual or economic connection.
I digress.
Maybe the fan simply picked the most dominant team at the moment he discovered the sport, thereby choosing Manchester United, which is just another way of saying he gets off on the suffering of others. Or maybe he took a mail-order DNA test, found out he was 1/12 French, and decided it would be Les Bleus or bust this summer at the World Cup.
A company called 23andMe hopes that millions of American fans, casting about for a team to support since their own failed to qualify for the World Cup, will take that last path. The TV spots hawking the service are already blanketing Fox Sports. And while I happen to think that soccer is a highly interesting sport for lots of better reasons, my position is that if it takes a mail-order DNA test to get you into the game, then swab your cheek and join the party.
The point is, soccer is an exercise in the arbitrary. Your favorite player will probably miss the goal. The referee will probably make the wrong call. Your team will probably lose. You will probably get angry and then you will get sad and then, next week, you'll start the cycle again, over and over, ultimately infecting your offspring with the same illogical obsession so that you'll have someone else to be miserable with.
Choose misery with a chance of joy, I say. Choose empathy and random connection.
Maybe, because of a DNA test, you'll choose to care about the national soccer team of Egypt or Colombia or South Korea. The best that can happen is that you might plug in with a group of people who live far away in Egypt or Colombia or South Korea. You might, for a moment, share in their suffering and delight in their triumphs. You might empathize with strangers for no other reason than the fact that your great great great great great great great great great great grandmother was born in a crude hovel somewhere in the Nile Delta.
Whoa! Cool! That's the splendor of soccer… and advances in our understanding of the human genome, I suppose.
A leading bioethicist has suggested that 23andMe's campaign could inflame racial animosity, but that seems unlikely to me, because if we could alter the allegiances and behavioral patterns of actual soccer hooligans—for better or worse—by appealing to science and reason, they would already be extinct. No, the worst that could happen is that you'll waste a few hours of your life screaming at a TV show featuring two groups of men who are being paid millions of dollars to determine who is more proficient at placing a small orb between two sticks.
Choose misery with a chance of joy, I say. Choose empathy and random connection. Choose Iceland, even though it's unlikely you have any Icelandic ancestors, because it's the smallest country ever to qualify for the World Cup and what did Iceland ever do to you? Just don't choose Germany—they don't need your help.
[Ed. Note: To read the counter viewpoint, click here. Then visit leapsmag on social media to share your opinion: Who wins this debate?]
Soccer Fans, Don’t Root for a Team Based on Genetics
A soccer ball through glass.
Editor's Note: This op/ed is in response to our Big Question of the month: "Should shared genetics play any role in encouraging sports fans to root for a certain team?"
23andMe is taking a lot of heat as one of the DNA aggregators whose databases may not be secure from prying third-party eyes. That is a huge issue, but the company is engaging in even more troubling behavior—using genetics to sponsor racism.
The ad campaign urges that you choose to root for a team based on genetics—theirs and yours.
There is plenty to condemn when it comes to racism in international sports. Fans taunting black and minority athletes is a huge problem. No sport has been as beset by racial taunting as soccer. Which is why the current advertising campaign by the genetic testing company 23andMe and Fox sports is especially foul.
With the U.S. men's team eliminated from the 2018 FIFA World Cup in Russia, many potential American fans were left without a primary rooting interest in the upcoming summer tournament. And that would be a disaster for Fox, which will be carrying the games.
The network teamed up with 23andMe to urge American soccer fans not to tune out the World Cup. Instead the ad campaign urges that you choose to root for a team based on genetics—theirs and yours. Given the fact that ethnicity and race are mainly cultural and social constructs, not biological, this suggestion seems more 19th than 21st century in terms of its justification.
The ads say, "root for your roots." Send your spit off to 23andMe for a DNA test and you might discover most of your genes came from one of the countries that did qualify for the biggest event in soccer. Saudi Arabia, for example. Or Panama, Argentina, Serbia, Senegal or Iran. So if you and the team have the same genes - voila, you have someone and something to root for. Soccer hooligan bigots everywhere must be thrilled by this twaddle.
There is no correlation between genetics and who is a member of a nation's soccer team. People from many ethnic and racial backgrounds play for many nations. There is no Argentinian or Croatian team genotype. And why would information about your genetic ancestry lead you to root for a particular athlete or team? How about the team's skill, not their skin color or biological makeup?
What genetic difference is it that we are going to root for anyway—the immune system differences between Switzerland and Egypt?
And are there really genes to be found that determine with certainty that you or the team you are watching are really Panamanian? Hardly. Panama is a political entity that came into existence in 1903 not a biological species. And, do we really need an ad campaign telling us, falsely, that the nations of the Earth can be sorted out neatly into clear racial groups based on their heredity? What genetic difference is it that we are going to root for anyway—the immune system differences between Switzerland and Egypt? Markers for bone density between Argentinians and Russians?
The 'root for your roots' campaign comes at a horrible time, just when FIFA is trying to root the racism out of the World Cup. It is built on bogus science about the genetics of how we define nations and ethnic groups. It appeals to the racism in us to pick a team we can root for. And it reinforces racial and ethnic stereotypes about human behavior and nationhood that are rooted in history, culture, economics, colonialism and prejudice, not ancestry, genetics or biology. This is not the way to introduce the world to genetic testing.
[Ed. Note: To read the counter viewpoint, click here. Then visit leapsmag on social media to share your opinion: Who wins this debate?]