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Why COVID-19 vaccines are not widely recommended for pregnant and breastfeeding Canadians, for now

TORONTO — As the first doses of COVID-19 vaccines are distributed across the country, those who are pregnant or breastfeeding will have to weigh their individual risks when it comes to getting the shot.

Because there’s currently no data on the safety of COVID-19 vaccines during pregnancy, the National Advisory Committee on Immunization (NACI) says the vaccine should not be routinely offered to those who are pregnant or breastfeeding. However, the NACI, which advises the Public Health Agency of Canada, says that if the benefits of vaccine outweigh the potential risks for the individual and “if informed consent includes discussion about the insufficient evidence in this population,” people in that group may get the shot.

Currently, neither Pfizer-BioNTech nor Moderna – the makers of COVID-19 vaccines approved for use in Canada so far — have conclusive evidence on whether the vaccines pose any harm to pregnant or breastfeeding people, since those groups were excluded in clinical trials.

Infectious disease specialist Dr. Isaac Bogoch told CTVNews.ca that despite the lack of data, he believes women should make their own decisions based on their individual circumstances and most up-to-date information available.

“We know that pregnant women can be at risk for more severe illness and more severe outcomes with COVID-19 and based on that I think we can empower women to make informed decisions for themselves,” said Bogoch.

“Having a nuanced discussion with an individual’s health-care provider might clarify if the pros outweigh the cons, then it could be acceptable,” he said.

The U.K. currently excludes pregnant and breastfeeding women from receiving the vaccine because of the lack of data available. The general advice in the U.S. is that individuals should make their own informed decisions based on potential risk factors.

“Pregnant patients who decline vaccination should be supported in their decision. Regardless of their decision to receive or not receive the vaccine, these conversations provide an opportunity to remind patients about the importance of other prevention measures,” according the American College of Obstetricians and Gynecologists.

Canadian doctors echo their American counterparts in considering whether pregnant or breastfeeding women should receive the vaccine.

“We recommend that pregnant and breastfeeding individuals who are eligible for the COVID-19 vaccine due to exposure risk, medical status, or other circumstances should be able to make an informed decision by having access to up-to-date information about the safety and efficacy of the vaccine (including clear information about the data that is not yet available) and information about the risks of COVID-19 infection for them,” says the Society of Obstetricians and Gynecologists of Canada.

Before deciding whether to receive a COVID-19 vaccine, Canadians should consider their own current health status and individual risk of exposure to the virus, according to Bogoch.

“I’m all for empowering people to make their own decisions over their own bodies after having a nuanced discussion about what we know, and what we don’t know about these vaccines,” he said.

Pregnant women are historically excluded from vaccine clinical trials because of potential complications and ethical concerns that need to be considered, such as possible harm to the fetus and milk production.

“There are lots of vaccines pregnant women get, and there’s some that they don’t get. But I think the real question is are they included in clinical trials? And the answer to that is no,” said Bogoch.

“It’s an issue – but there’s a huge push to enroll pregnant women and women who are breastfeeding in clinical trials so we actually have the data.”

Bogoch expects that there will be more data available to pregnant and breastfeeding women in the weeks ahead because of individuals around the world who may have become pregnant after receiving the COVID-19 vaccine.

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