The Bottom Line

January 22, 2022: There are currently no pregnancy-specific data regarding the newest identified variant, Omicron (B.1.1.529), and pregnancy outcomes after infection. However, current data indicate mRNA vaccination remains effective against severe Omicron infection during pregnancy, and this is likely enhanced after a booster dose. Read more below.

As of January 2022, current data indicate COVID-19 vaccination is safe and effective while trying to conceive, during pregnancy, and while breastfeeding, and the benefits of vaccination outweigh the serious potential risks of infection. Further, there is currently no evidence vaccination adversely impacts fertility and published preliminary data indicate there are no strong links to menstruation disturbances.

Side effects of COVID-19 vaccination while pregnant and breastfeeding are similar to the general population and adverse pregnancy outcomes (miscarriage, birth defects, preterm delivery, etc.) are occurring at the same rate or below the rates of these same events in controls (unvaccinated pregnant individuals).

However, COVID-19 infection can cause adverse outcomes in pregnancy and numerous international obstetric organizations recommend vaccination during pregnancy, which can also pass antibodies to the fetus for possible protection after delivery.

Pregnant individuals should have an open discussion with their health care provider regarding any concerns they may have regarding COVID-19 vaccination.

For detailed information related to COVID-19 infection during pregnancy, click here and visit the U.S. Centers for Disease Control website for additional information.

Jump to:
Share on:
updated

Latest Updates

January 2, 2022: Although neutralizing capability is reduced, mRNA vaccination (initial two dose series) remains effective at preventing severe infection during pregnancy from the Omicron variant.

December 28, 2021: Study analyzed data from 1,359 vaccinated pregnant women, including 20 women who received a booster dose, and 1,362 umbilical cord samples. Vaccination against COVID-19 before and throughout pregnancy was associated with detectable maternal anti-spike IgG levels at delivery. A complete vaccination course, prior history of SARS-CoV-2 infection, and a third-trimester booster dose were associated with the highest maternal and umbilical cord antibody levels.

December 23, 2021: Study assessed possible protection to the infant after COVID-19 vaccination during pregnancy or while breastfeeding. Researchers studied 22 mother/baby pairs: 10 received mRNA vaccination during pregnancy; 12 received mRNA vaccination after delivery. Researchers assessed maternal blood, breast milk, infant blood, infant nose, and infant stool samples.

  • Breastfed infants in the pregnancy group had COVID-19-specific IgG in their blood and noses.

  • Half of the infants in the pregnancy group had high titer COVID-19-specific IgA in the nose that exceeded titers found in breast milk.

  • Data suggest that vaccination during pregnancy followed by breastfeeding provides the most reliable source of systemic and mucosal antibodies against COVID-19 for infants. Breastfed infants only acquired systemic antibodies if their mothers were vaccinated during pregnancy.

  • However, breastfeeding is still expected to provide temporary protection at an infant's mucosal membranes (mouth, throat, intestinal tract), but likely needs to be replenished often (continually breastfed) to keep some level of sustained protection.

December 22, 2021: Study assessed second trimester COVID-19 mRNA vaccination and antibody transfer to the fetus and infant. Newborn antibody levels "were approximately 2.6 times higher than maternal titers, representing 100% placental antibody transfer." No correlation was found between maternal and neonatal antibody titers and the presence of adverse effects after vaccination. More below under "Pregnancy".

December 18, 2021: There are currently no pregnancy-specific data on the Omicron variant after infection. It will likely take an additional few weeks or longer to determine if Omicron will be more severe than, or similar to, prior COVID-19 variants during pregnancy.

Although information is currently limited, in the general population, Omicron appears to be highly contagious compared to previously identified variants (e.g. Delta), but a booster vaccination can help decrease the risk of severe infection.

December 13, 2021 (pre-print): Laboratory study found no evidence of mRNA vaccine products in maternal blood, placenta tissue, or cord blood at delivery. The study did find evidence of antibody transfer that remained in early infancy.

December 5, 2021: Pre-print found that for lactating individuals, COVID-19 spike-specific T-cell (type of immune cell) receptors were more frequent in breastmilk compared to maternal blood and expanded in breast milk following a third mRNA vaccine dose.

November 27, 2021: Studies added regarding the effect of COVID-19 vaccination on menstruation (see below under "Menstruation and Fertility").

Key Findings

  • There is currently no evidence that COVID-19 vaccination has any adverse impact on female or male fertility. There is also no evidence vaccination adversely impacts pregnancy outcomes or causes adverse effects while breastfeeding (to include in breastfed infants/children).

  • Pregnant and breastfeeding individuals may choose to be vaccinated and/or boosted when eligible and should have a risks and benefits discussion with their health care provider.

  • As of January 17, 2022, more than 187,931 pregnant individuals have been vaccinated in the U.S. and entered into CDC's v-safe registry. Side effects of these vaccines during pregnancy are similar to those expected among the non-pregnant population. Side effects are generally short-lived; no adverse effects to fetuses have been identified. Fever following vaccination can be treated with acetaminophen to decrease adverse-fever associations risks (talk with health care provider).

  • Recent reports show that individuals who received mRNA COVID-19 vaccines during pregnancy and/or while breastfeeding have passed antibodies to their fetuses. These antibodies could help protect infants/children, but more information is necessary to determine effectiveness of these antibodies and how long they may last.

  • There is currently no evidence or mechanism of action in which vaccinated individuals "shed" and/or could cause infertility in other individuals by simply being around them. There is no scientific basis for this as the COVID-19 mRNA vaccines do not replicate and they are not live-attenuated (not a live virus).

  • Fully vaccinated individuals have lower risk of passing infection, including to a newborn. Based on May 13 CDC guidelines, individuals do not need to wear a mask when meeting a baby unless they want to [or at parent request]; talk to pediatrician with any concerns.

Photo by Juli Kosolapova on Unsplash

Background

There are currently three COVID-19 vaccines authorized for use in the U.S.: Two are mRNA vaccines, Pfizer-BioNTech (Comirnaty) [fully approved] and Moderna (SpikeVax), and one is an adenoviral-vector vaccine (Janssen) of Johnson & Johnson. Second doses of Pfizer and Moderna vaccines are given 21 days and 28 days after the first dose, respectively (in the U.S.). The Johnson & Johnson vaccine is only one dose.

Participants in CDC V-safe COVID-19 Vaccine Pregnancy Registry:

  • V-safe: 187,931 (individuals pregnant at time of vaccination in U.S.)

  • Officially enrolled: 13,104

*As of January 17, 2022

Pregnant participants in the registry are contacted to answer questions about their pregnancy and medical history. This information will be evaluated and used to educate the public about how COVID-19 vaccination might affect pregnancy. For more information, see "Registries" section.

Menstruation and Fertility

Numerous international studies on the effect of COVID-19 vaccination on menstruation are underway, largely due to the significant number of anecdotal reports of menstrual changes following vaccination in country surveillance systems (VAERS, Yellow Card). However, current formal published data do not yet support a strong link, but more research is necessary:

Data published from the UK's Medicines and Healthcare Products Regulatory Agency (MHRA) on November 26 (data as of November 17) indicated the MHRA is reviewing reports of suspected side effects of menstrual disorders and unexpected vaginal bleeding following vaccination against COVID-19.

A total of 41,919 suspected reactions relating to a variety of menstrual disorders have been reported after all three of the COVID-19 vaccines including heavier than usual periods, delayed periods and unexpected vaginal bleeding. This is following approximately 50.1 million COVID-19 vaccine doses administered to women up to 17 November 2021.

The number of reports of menstrual disorders and vaginal bleeding is low in relation to both the number of people who have received COVID-19 vaccines to date and how common menstrual disorders are generally. Further, the menstrual changes reported are mostly transient in nature. "The rigorous evaluation completed to date does not support a link between changes to menstrual periods and related symptoms and COVID-19 vaccines."

A pre-print published in November 2021 retrospectively recruited 1273 people who had a record of their menstrual cycle and vaccination dates and used their reports to explore hypotheses about how COVID-19 vaccination and menstrual changes could be linked. Regarding this specific dataset, researchers were unable to detect strong signals to support the idea that COVID-19 vaccination is linked to menstrual changes. However, larger, prospectively recruited studies may be able to find associations that this study was not powered to detect.

A separate pre-print published in November 2021 determined that 20% of 4989 pre-menopausal vaccinated individuals in the UK experienced some type of menstrual disturbance. Oestradiol-containing contraceptives was found to be a protective factor against adverse changes. Diverse experiences were reported, from a lack of menstrual bleeding to heavy menstrual bleeding.

There is currently no evidence that COVID-19 vaccination has any adverse impact on female or male fertility.

A study published in October 2021 analyzed pregnancies that occurred in four ongoing phase 1, phase 2, and phase 3 clinical trials of the AstraZeneca COVID-19 vaccine in three countries. Any pregnancies that occurred after vaccination were recorded and followed up until 3 months after birth. "We found no evidence of an association between reduced fertility and vaccination with [AZD1222]...Furthermore, compared with women who received the control vaccine, there was no increased risk of miscarriage and no instances of stillbirth in women vaccinated before pregnancy in global clinical trials of [AZD1222]."

A study published in August 2021 took serum and follicular fluid samples for analysis (after vaccination), as well as estrogen, progesterone and HSPG2 concentration, and the number and maturity of aspirated oocytes and previous estrogen and progesterone measurements. No differences were detected in any of the surrogate ovarian follicle quality reporting parameters.

A study published in June 2021 noted that seropositivity to the SARS-CoV-2 spike protein, whether from vaccination or infection, does not prevent embryo implantation or early pregnancy development.

A study published in May 2021 assessed thirty-six couples who resumed IVF treatment 7–85 days after receiving an mRNA SARS-CoV-2 vaccine. No in-between cycles differences were observed in ovarian stimulation and embryological variables before and after receiving mRNA SARS-CoV-2 vaccination. mRNA SARS-CoV-2 vaccine did not affect patients’ performance or ovarian reserve in their immediate subsequent IVF cycle.

Photo by MC PROJ on Unsplash

A separate study published in May 2021 identified no differences between the Intracytoplasmic Sperm Injection (ICSI) cycles that each patient underwent before and after vaccination. All the ICSI outcomes including the number of oocytes retrieved, the number of matured oocytes and the percentage of fertilized oocytes were similar in the pre- and post-vaccination groups. Moreover, the authors continued follow up for a few more days and assessed the quantity and quality of cleavage embryos and found no changes. Lastly, a subgroup from the sample showed that the pregnancy rate was also similar in the pre- and post-vaccination groups.

Data from the original clinical trials of all four major vaccines (Pfizer-BioNTech, Moderna, Janssen, and AstraZeneca) did not identify any fertility concerns in developmental and reproductive toxicity studies nor were there any concerns in clinical trial participants who became pregnant after vaccination (compared to controls).

Regarding male fertility, one study assessed sperm parameters before and after two doses of a COVID-19 mRNA vaccine; there were no significant decreases in any sperm parameter among this small cohort of healthy men.

A separate study also evaluated the impact of the BNT162b2 vaccine on sperm parameters and determined this vaccine appeared to have no impact on sperm parameters. The authors noted that "given that SARS-CoV-2 infection may impair male fertility, couples desiring to conceive should vaccinate, as vaccination does not affect sperm, whereas SARS-CoV-2 infection does impair sperm parameters."

updated

Pregnancy

Vaccines are effective at preventing infection during pregnancy, as well as related complications. According to a Mayo Clinic study, vaccinated pregnant patients were less likely to experience COVID-19 infection compared to unvaccinated pregnant patients in their cohort. In an Israeli study published in July 2021, mRNA vaccines were shown to be 78% effective at preventing infection in pregnancy (15,000+ participants). An additional study published in September 2021 determined the Pfizer vaccine to be 96% effective after two doses for preventing any documented infection in pregnancy (20,000+ participants). 

An additional study published in March 2021 found that COVID-19 vaccination may offer protection against maternal ICU admission, mechanical ventilation or ECMO, maternal death, and vertical transmission; vaccination may also help reduce preterm birth, cesarean section, stillbirth, mother-infant separation at birth, and possible interruption of breastfeeding (due to infection).

Vaccination during pregnancy also offers protection against COVID-19 variants, including Omicron. In a study published in May 2021, pregnant vaccinated individuals developed cross-reactive immune responses against COVID-19 variants of concern. Further, while pregnant individuals admitted to the hospital in the UK during the Delta period had an increased risk of pneumonia, no fully vaccinated pregnant patients were admitted between February 1, 2021 and July 11, 2021. A study published in January 2022 found that the initial two dose series of mRNA vaccination remained effective against severe infection from the Omicron variant (although neutralizing capability was decreased).

To date, vaccination in pregnancy is not associated with adverse maternal or fetal outcomes. Rates of adverse events such as miscarriage, preterm birth, stillbirth, birth defects, gestational diabetes, preeclampsia/gestational hypertension, eclampsia, intrauterine growth restriction, and neonatal deaths are less than or within expected background rates for the same events in non-vaccinated pregnant individuals.

A study published in September 2021 found that of 105,446 unique pregnancies, there were 13,160 miscarriages and 92,286 ongoing pregnancies. For those who experienced miscarriage, the odds of COVID-19 vaccine exposure were not increased in the prior 28 days compared with those with ongoing pregnancies.

United Kingdom (UK) reporting on vaccine safety from Yellow Card data published in August 2021 indicated that more than 55,000 pregnant individuals in the UK had been vaccinated against COVID-19. Data do not suggest an increase in miscarriage, stillbirth, birth defects, or birth complications.

A pre-print published on August 9, 2021 indicated that among 2,456 pregnant individuals who received an mRNA COVID-19 vaccine preconception or prior to 20 weeks’ gestation, the cumulative risk of pregnancy loss from 6–19 weeks’ gestation was 14.1%, similar to the background rate of pregnancy loss in an unvaccinated pregnant group. These data suggest receipt of an mRNA COVID-19 vaccine preconception or during pregnancy is not associated with an increased risk of pregnancy loss.

Side effects are similar to those experienced by the non-pregnant population. Side effects of dose one or dose two of either the Pfizer or Moderna vaccines are similar to the non-pregnant population and can include pain at the injection site, fatigue, headache, chills, nausea, muscle pain, and/or fever.

According to the CDC, most systemic post-vaccination symptoms are mild to moderate in severity, occur within the first three days of vaccination, and resolve within 1–2 days of onset. These symptoms are more frequent and severe following the second dose.

Note: Fever itself can cause concerns in pregnancy; acetaminophen is recommended to decrease adverse-fever associated risks (talk with health care provider first).

A study published in August 2021 assessed short-term reactions among pregnant and lactating individuals in the first wave of the COVID-19 vaccine rollout and determined average maximum temperature was 100.6 °F/ 38.1 °C after dose 1 and 100.7 °F/38.2 °C after dose 2 (including 1051 pregnant individuals).

However, at least one case study published in August 2021 documented that very rare side effects are possible. The case study indicated that a pregnant woman was diagnosed with immune thrombocytopenia (can lead to bleeding or bruising) in the first trimester, which occurred thirteen days after initiating the COVID-19 vaccination series. "High-dose oral corticosteroids were started, and she was discharged home with significant improvement in platelet count on her fourth day of hospitalization with no subsequent complications." 

The fetus does not get exposed to the spike protein. Study that assessed antibodies in babies after the mother was COVID-19 vaccinated during pregnancy shows evidence the vaccine itself does not cross the placenta, only the mother's antibodies (IgG). If the vaccine had crossed the placenta, researchers should have seen IgM antibodies, but none of the infants from vaccinated mothers had this type of antibody.

There are three main types of immunoglobins (antibodies; IgA, IgG, IgM). Placental transfer and breast milk transfer offer different types to a fetus/newborn.

IgM: body's first response to a new infection; short-lasting

IgG: produced during an initial infection; remains in the body long-term to prevent re-infection (basis of how vaccinations work)

IgG is the only immunoglobulin that can pass through the placenta and directly into the fetal bloodstream; provides protection to the fetus during pregnancy and to the infant for several months after delivery.

IgA: less common in number than IgG; found in saliva, tears, respiratory and gastric secretions, and breast milk

IgA provides protection against infection in mucosal areas of the body such as the respiratory and the gastrointestinal tracts. IgA transfers through breastmilk and helps protect the infant's respiratory/ gastrointestinal tracts from infection.

Sources: 1. Merck Manuals, "Immunoglobins", 2018. Accessed April 2, 2021. 2. Janeway et al. 2001.

Additionally, a separate laboratory study (pre-print) published on December 13, 2021 found no evidence of mRNA vaccine products in maternal blood, placenta tissue, or cord blood at delivery.

No placental antibody concerns have been identified. Among fifteen pregnant individuals who received at least one dose of Pfizer (including five breast-feeding women and two women vaccinated in early pregnancy), none had placental anti-syncytin-1 binding antibodies at either time-point following vaccination (May 2021). This means the vaccine did not cause antibodies toward a placental protein, adding further evidence to its safety in pregnancy. The study also determined that mRNA was not detected in breastmilk.

No placental harm has been identified. Study published in May 2021 found no evidence that mRNA COVID-19 vaccination during pregnancy harms the placenta (84 vaccinated individuals, 116 controls). "Placental examination [from pregnant individuals] with vaccination showed no increased incidence of decidual arteriopathy, fetal vascular malperfusion, low-grade chronic villitis, or chronic histiocytic intervillositis compared with those in the control group. Incidence of high-grade chronic villitis was higher in the control group than in the vaccinated group."

Vaccination produces COVID-19 antibody transfer to the fetus. Several studies have detected antibodies in umbilical cord blood, amniotic fluid, and in newborns after maternal vaccination. Further, this antibody transfer is assessed to be greater than antibody transfer after COVID-19 infection in pregnancy. More specifically:

A study published on December 22, 2021 assessed second trimester COVID-19 mRNA vaccination and antibody transfer to the fetus and infant. Newborn antibody levels "were approximately 2.6 times higher than maternal titers, representing 100% placental antibody transfer." No correlation was found between maternal and neonatal antibody titers and the presence of adverse effects after vaccination.

A study published in May 2021 found that mRNA-based COVID-19 vaccines in pregnant individuals lead to maternal antibody production as early as 5 days after the first vaccination dose, and passive immunity to the neonate as early as 16 days after the first vaccination dose. 

A pre-print published in November 2021 quantified anti-Spike IgG in ninety-two (92) 2-month and 6-month-old infants whose mothers were vaccinated in pregnancy, and in twelve (12) 6-month-old infants after maternal natural infection with COVID-19. In the vaccinated group, 94% (58/62) of infants had detectable anti-S IgG at 2 months, and 60% (18/30) had detectable antibody at 6 months. In contrast, 8% (1/12) of infants born to women infected with COVID-19 in pregnancy had detectable anti-S IgG at the 6-month timepoint.

Vaccination during pregnancy plus initiation of breastfeeding (prenatal antibodies + breastfeeding antibodies) is likely the most effective strategy, but both methods alone may offer an infant protection. The exact strength and length of that protection requires more research.

Photo by Alex Bodini on Unsplash

There is limited information on the most "ideal" timing for vaccination in pregnancy, but it is recommended pregnant individuals get vaccinated when they can. However, several studies indicate that vaccination late in the second trimester or early in the third trimester could provide more time for antibody transfer (vs. vaccination too close to delivery).

Placental transfer (during pregnancy) likely offers more protection (IgG; antibodies “more durable”) compared to vaccination while breastfeeding (IgA, some IgG; see box) but each method protects differently.

Placental transfer offers systemic protection (gets into blood; antibodies may last as long as 6 to 12 months); breastmilk transfer offers mucosal protection, but is not long lasting; however, being breastfed every few hours would offer some level of sustained [IgA, IgG] protection.

Breastfeeding

At least two studies published in March and April 2021 found robust secretion of COVID-19 antibodies in breast milk. One study found these antibodies remained up to 6 weeks after vaccination and the second study determined they were present up to 80 days after vaccination. Antibodies found in breast milk showed strong neutralizing effects, suggesting a potential protective effect against infection in the infant.

A third study indicated that significantly elevated levels of specific IgG and IgA antibodies in human milk started approximately 7 days after the initial vaccine dose.

However, it is unclear if maternally transferred antibodies via breastmilk will offer protection against COVID-19. IgA antibodies produced in breastmilk after vaccination appear to resist an infant’s gastric phase of digestion but are degraded during the intestinal phase; IgG antibodies may be prone to degradation in both phases of digestion. More research is necessary to determine if the antibodies produced in breastmilk after vaccination are effective at preventing infant infection, and if they are, for how long.

More data are necessary, but breast milk IgA could prevent infection and transmission of infection at the mucosal surface (mouth, throat) for as long as breastfeeding continues.

A study published in August 2021 assessed antibodies in breastmilk after COVID-19 vaccination, include those lactating for two years or more. The study found that all vaccinated study participants ( n=94) who were breastfeeding had IgG antibodies and 89% of them had IgA antibodies against COVID-19 in their milk. Further, IgA and IgG antibody concentrations in the milk of mothers who were breastfeeding for 24 months or longer were significantly higher than in mothers with breastfeeding periods less than 23 months.

Milk Supply: At least two studies and one analytic report have indicated lactating individuals may experience temporary decreases in milk supply after vaccination (less than 24 to 72 hours) before returning to normal.

Infant side effects are rare, and may be coincidental. According to UK Yellow card data published in September 2021, there is no current evidence that COVID-19 vaccination while breastfeeding causes any harm to breastfed children or affects the ability to breastfeed. Of approximately 3,000 Yellow card reports, there were a small number of reports regarding symptoms in breastfed children. These included high temperature, rash, diarrhea, vomiting and general irritability. However, these are common conditions in children of this age, so determining whether the vaccine caused these effects is very difficult.

Long-Term Data

There are currently no data regarding long-term outcomes of infants whose mothers were vaccinated during pregnancy or while breastfeeding. However, researchers do have present data and decades of other research that indicate long-term unexpected adverse outcomes in infants are unlikely:

Currently, there are four large datasets from three countries that have not found higher rates of adverse birth outcomes after COVID-19 vaccination in pregnancy. Adverse outcomes detected are occurring at the same rate as unvaccinated pregnant individuals.

There is currently no evidence the vaccine itself (e.g. spike protein) crosses the placenta. IgM antibodies have not been detected in babies after maternal vaccination. IgM is made by the body when it is "infected"; it does not cross the placenta (see box, above). Therefore, if a newborn had IgM antibodies after maternal vaccination, that would indicate the vaccine itself crossed the placenta and "infected" the fetus for the fetus to have made its own IgM antibodies; this has not been detected after vaccination. Further, at least one laboratory study failed to find evidence of mRNVA vaccination products in maternal blood, placenta tissue, or cord blood at delivery.

Vaccine mRNA has not been detected in placenta or breastmilk (estimated half-life of 8 to 10 hours).

Lipid nanoparticles (LNP) are not expected to be a concern (prior drugs using LNPs were unable to cross placenta in animal studies).

Polyethylene glycol is not absorbed orally (no breastfeeding concerns).

There is no plausible mechanism for intact, complete, functional viral S proteins to be distributed into the milk.

updated

Boosters

Based on all current available data, researchers and scientists do not currently assess a third booster shot of any authorized vaccine will differ in safety from original doses in individuals trying to conceive, pregnant, or are currently breastfeeding.

Pregnancy or lactation-specific booster data (currently very limited):

December 28, 2021: An analysis of maternal and umbilical cord antibody levels at delivery, which included 20 pregnant women who received a vaccine booster, found that a booster dose in the third trimester was associated with maternal anti-spike IgG levels greater than third-trimester vaccination in women with or without a history of COVID-19 infection (booster provided higher antibody production than after two dose series).

December 5, 2021: Pre-print found that for lactating individuals, COVID-19 spike-specific T-cell (type of immune cell) receptors were more frequent in breastmilk compared to maternal blood and expanded in breastmilk following a third mRNA vaccine dose.

Background: As of December 2021, according to the CDC, everyone ages 18 and older should get a COVID-19 booster vaccination. If you received Pfizer or Moderna, it is recommended you receive a booster at least six months after completing your primary series. Any booster authorized in the U.S. may be selected for your third dose ("mix and match" is authorized). If you received Johnson & Johnson's Janssen vaccine, it is recommended you receive your booster two months after completing your primary vaccination. Any vaccine authorized in the U.S. may be selected for your booster (second dose).

Photo by Arteida MjESHTRI on Unsplash
updated

Organizational Recommendations

The latest organizations recommendations regarding pregnancy and COVID-19 vaccination from:

  • U.S. Centers for Disease Control and Prevention

  • American College of Obstetricians and Gynecologists

  • Society for Maternal-Fetal Medicine

  • UK Royal College of Obstetricians and Gynaecologists

  • The Society of Obstetricians and Gynaecologists of Canada

  • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

CDC (updated December 6, 2021): The U.S. Centers for Disease Control and Prevention (CDC) formally announced new guidance to officially recommend COVID-19 vaccination for all people aged 5 years of age and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Booster doses were also approved and recommended for pregnant individuals and recently pregnant individuals (six weeks postpartum). CDC further added:

  • "If you got pregnant after receiving your first shot of a COVID-19 vaccine that requires two doses (i.e., Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine), you should get your second shot to get as much protection as possible. If you experience fever following vaccination, you should take acetaminophen (Tylenol) because fever—for any reason—has been associated with adverse pregnancy outcomes."

  • "COVID-19 vaccines cannot cause COVID-19 infection in anyone, including the mother or the baby, and vaccines are effective at preventing COVID-19 in people who are breastfeeding. Recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breastmilk, which could help protect their babies. More data are needed to determine what level of protection these antibodies may provide to the baby."

Photo by Brian Asare on Unsplash

American College of Obstetricians and Gynecologists (ACOG):

  • December 3, 2021: ACOG recommends that all eligible persons greater than age 12 years, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. 

  • COVID-19 vaccines may be administered simultaneously with other vaccines. This includes vaccines routinely administered during pregnancy, such as influenza and Tdap.

  • Moderately to severely immunocompromised people should receive a third dose of the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines at least 28 days after the completion of the initial mRNA COVID-19 vaccine series. Currently, there is insufficient data to determine whether immunocompromised people who received J&J/Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

  • ACOG recommends that pregnant and recently pregnant people up to 6 weeks postpartum, including pregnant and recently pregnant health care workers, receive a booster dose of COVID-19 vaccine following the completion of their initial COVID-19 vaccine or vaccine series.

  • All individuals aged 18 years and older, including pregnant and recently pregnant people, who received the J&J/Janssen vaccine as their initial COVID-19 vaccine should receive a single booster dose at least 2 months after their initial vaccine. 

  • Individuals qualifying for a COVID-19 booster may receive any vaccine product available to them; they do not have to receive the same product as their initial vaccine or vaccine series.

Society for Maternal-Fetal Medicine (SMFM):

  • December 20, 2021: "SMFM, the CDC, and other organizations representing maternal and public health professionals recommend that pregnant, postpartum, and lactating people and those considering pregnancy receive the COVID-19 vaccination. Vaccination is the best method to reduce maternal and fetal complications of SARS-CoV-2 infection. Counseling to support the recommendation for vaccination should include available data on vaccine efficacy, as well as data on vaccine safety during pregnancy and lactation."

  • "SMFM and ACOG recommend that pregnant people receive a COVID-19 booster shot at least 6 months after their primary series for mRNA-based vaccines (ie, Pfizer or Moderna) and at least 2 months after their primary vaccination for the Janssen vaccination. As with the primary series, the booster dose should be given at any stage during pregnancy and postpartum."

UK Royal College of Obstetricians and Gynaecologists (RCOG): 

  • September 16, 2021: The UK Royal College of Obstetricians and Gynaecologists released a statement urging "all pregnant [individuals] eligible for the COVID-19 booster vaccine to take up the offer."

  • July 22, 2021: RCOG released the following statement: "Health chiefs are encouraging more pregnant women to come forward for their COVID-19 vaccine, as new data from Public Health England (PHE) show for the first time that 51,724 pregnant women in England have received at least one dose...On 16 April 2021, the Joint Committee on Vaccination and Immunisation (JCVI) advised that pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, based on their age and clinical risk group."

The Society of Obstetricians and Gynaecologists of Canada (SOGC): On November 15, 2021, SOGC revised and reaffirmed their original guidance from December 2020:

  • COVID-19 vaccination is recommended during pregnancy in any trimester and while breastfeeding

  • All available COVID-19 vaccines approved in Canada can be used during pregnancy and breastfeeding, but the SOGC recommends following provincial and territorial guidelines on type of vaccine to prioritize for pregnant and breastfeeding individuals.

  • Individuals should not be precluded from vaccination based on pregnancy status or breastfeeding.

  • Given that pregnant people are at increased risk of morbidity from COVID-19 infection, all pregnant persons should be prioritized to receive a COVID-19 vaccination.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG): On November 5, 2021, RANZCOG released the following statement:

  • "A booster dose can be considered if you are 18 years, or older, and had your initial COVID-19 vaccine course (called the primary course) ≥ 6 months ago. Pfizer is the preferred brand for booster doses for all people, including in pregnancy, regardless of the brand used initially."

  • "mRNA vaccines are safe and effective for those trying to conceive, pregnant and breastfeeding women. Booster doses have not yet been studied in those who are pregnant, but have been shown to be safe and effective in non-pregnant adults.  We do know that COVID-19 infection in pregnancy poses a significant risk for mothers and their babies, RANZCOG recommends that pregnant women receive booster vaccinations in line with the recommendations for the non-pregnant adult population."

Registries

V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccine. Through v-safe, you can quickly tell CDC if you have any side effects after getting a COVID-19 vaccine. Depending on your answers to the web surveys, someone from CDC may call to check on you and get more information. V-safe will also remind you to get your second COVID-19 vaccine dose if you need one.

V-safe COVID-19 Vaccine Pregnancy RegistryThe registry is collecting health information from people who received COVID-19 vaccination in the periconception period (within 30 days before last menstrual period) or during pregnancy. The information is critical to helping people and their healthcare providers make informed decisions about COVID-19 vaccination. Participation is voluntary, and participants may opt out at any time.

Vaccine Adverse Event Reporting System (VAERS): VAERS is a U.S. early warning system to detect possible safety problems in U.S.-licensed vaccines. VAERS is co-managed by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). VAERS accepts and analyzes reports of adverse events (possible side effects) after a person has received a vaccination. Anyone can report an adverse event to VAERS.

COVID-19 Vaccines International Pregnancy Exposure Registry: The C-VIPER is open to any woman who is 18 years of age or older, pregnant, and vaccinated against COVID-19 during pregnancy.

Action

Pregnant individuals or those trying to conceive should have an open discussion with their health care provider regarding any concerns they have regarding COVID-19 vaccination, to include possible adverse reactions and/or side effects. See the resources below for additional information.

Resources

Considerations for counselling pregnant persons regarding COVID-19 vaccination; pregnancy data on thirteen global COVID-19 vaccines (Dr. Liona Poon, academic specialist in Obstetrics and Maternal Fetal Medicine)

Explainer on COVID-19 vaccination, fertility, pregnancy and breastfeeding (Victoria Male, Lecturer in Reproductive Immunology at Imperial College London)

COVID-19 Vaccination of Pregnant or Lactating People (U.S. Centers for Disease Control and Prevention)

Provider Considerations for Engaging in COVID-19 Vaccine Counseling With Pregnant and Lactating Patients (Society for Maternal-Fetal Medicine)

How Do We Know the COVID-19 Vaccines Are Safe and Effective? One Expert Explains. (American College of Obstetricians and Gynecologists; December 2020)

References

Test ToolTip

    Sign up to read 3 pages for free or subscribe now for full site access.