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Dr. Anthony Fauci privately discussed concerns about COVID-19 mRNA vaccines for pregnant women in January 2021, including questions about fever after a second dose and a theoretical risk of miscarriage during the first trimester, according to newly released text messages.The exchange involved Fauci, then-Centers for Disease Control and Prevention Director Dr. Rochelle Walensky and Dr. Vivek Murthy, who would later become former President Joe Biden’s surgeon general. Fauci said, because many people experience significant cytokine-related symptoms and fever after a second dose, that reaction “theoretically could be associated with miscarriage in the 1st trimester,” according to the messages shown on page two of documents released Monday by Sens. Ron Johnson, R-Wis., and Rand Paul, R-Ky.Murthy initially asked whether there was any reason to favor vaccination earlier or later in pregnancy and whether officials had seen evidence of adverse outcomes among pregnant women who had already been vaccinated.Fauci responded that there were “no data or theoretical reason” to believe vaccination earlier in pregnancy should be preferred over later vaccination. He also said concerns that an mRNA vaccine could alter a person’s genes were a misconception. Later that evening, however, Fauci mentioned the evidence of issues with the second shot for pregnant women.Walensky replied that it was “definitely a good point, esp after dose two.” Murthy then wrote that he had been hearing concerns about mRNA causing mutations in a developing fetus and said Fauci’s point about a cytokine response after the second dose was “a really good point.”The following day, after Murthy flagged a World Health Organization recommendation at the time advising against use of Moderna’s vaccine in pregnant women because of limited data, Fauci emphasized that officials had to weigh the potential risks of vaccination against the risks posed by COVID-19 itself. He wrote that more than 10,000 pregnant women had already been vaccinated with “no issues” reported, that Food and Drug Administration, Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists guidance allowed pregnant women to choose vaccination, and that animal toxicology studies had not raised red flags.Murthy responded that the WHO recommendation surprised him and warned that a strong recommendation against vaccination based on a lack of data could be “potentially quite damaging to public confidence among pregnant women.” Walensky agreed and said she would flag the issue for an upcoming ACIP meeting.