COVID-19 vaccines have been available to patients and the public for a few months, and questions regarding the administration of the available COVID-19 vaccines to pregnant and lactating women have arisen. Andrew Satin, M.D., director of gynecology and obstetrics, and Jeanne Sheffield, M.D., director of maternal-fetal medicine, provide information on this topic.
Is the COVID-19 vaccine available to pregnant women?
Yes, COVID-19 vaccines currently authorized by the Food and Drug Administration (FDA) should not be withheld from pregnant individuals who choose to receive the vaccine. It is suggested that women talk with their doctor to discuss all factors about the vaccine and their pregnancy.
- Symptomatic pregnant individuals who contract COVID-19 are at more risk of severe illness, complications and death than non-pregnant women. Many pregnant women have medical conditions that put them at increased risk.
- Pandemic level in the community is a factor.
- No study to date has specifically evaluated the coronavirus vaccine in pregnant and lactating women, but there have been a few pregnant women who were inadvertently included in the vaccine trials. Preliminary developmental and reproductive toxicity studies do not indicate any adverse effects on reproduction or fetal development.
- Thus, there are not any known safety concerns, but more data will be available in the weeks and months ahead from additional studies.
Johns Hopkins Medicine agrees with and supports the recommendations of the Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), even while acknowledging the unanswered questions about the vaccines for pregnant women. Below is the most current knowledge concerning pregnancy and breastfeeding.
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Routine testing and pregnancy
Routine testing for pregnancy before COVID-19 vaccination is not recommended. Women who are trying to become pregnant do not need to avoid pregnancy after receiving an mRNA COVID-19 vaccine.
Pregnant and Breastfeeding Women COVID-19 Vaccine Guidelines
mRNA vaccines do not contain the live virus that causes COVID-19 and, therefore, cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA because the mRNA does not enter the nucleus of the cell. Cells break down the mRNA quickly. Based on how mRNA vaccines are designed to work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and her fetus are still under review because these vaccines have not been studied in pregnant women.
The FDA’s emergency use authorization for the Pfizer-BioNTech COVID-19 mRNA vaccine states: “If you are pregnant or breastfeeding, discuss your options with your healthcare provider.”
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- Limited data are currently available from animal developmental and reproductive toxicity studies. No safety concerns were demonstrated in rats that received Moderna COVID-19 vaccine before or during pregnancy; studies of the Pfizer-BioNTech vaccine are ongoing.
- Researchers have studies planned in people who are pregnant.
- Both vaccine manufacturers are monitoring people in the clinical trials who became pregnant.
- ACOG and SMFM recommend that both COVID-19 vaccines authorized by the U.S. FDA should not be withheld from pregnant individuals who choose to receive the vaccine.
- A conversation between the patient and her clinical team may assist with decisions regarding the use of vaccines.
- The World Health Organization (WHO) states they do not have any reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women. Pregnant women at high risk of exposure to SARS-CoV-2 (for example, health workers) or who have comorbidities (health conditions that may contribute to death) that add to their risk of severe disease, may be vaccinated in consultation with their health care provider.
- You can review their recommendations here:
- ACOG: Vaccinating Pregnant and Lactating Patients Against COVID-19
- SMFM: Experts in High-Risk Pregnancy Respond to the FDA’s Decision to Offer the Newly Approved COVID-19 Vaccine to Pregnant and Lactating People
- SMFM Statement: SARS-CoV-2 Vaccination in Pregnancy
- WHO: The Moderna COVID-19 Vaccine: What You Need to Know
- ACOG and SMFM Joint Statement on WHO Recommendations Regarding COVID-19 Vaccines and Pregnant Individuals
People who are pregnant and part of a group recommended to receive COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. Pregnant patients and their clinicians should discuss and decide whether to get vaccinated with a vaccine that has been authorized for use under Emergency Use Authorization (EUA). While a discossion with a healthcare provider may be helpful, it is not a requirement to receive a vaccination.
Key considerations pregnant patients can discuss with their healthcare provider include:
- The likelihood of exposure to SARS-CoV-2, the virus that causes COVID-19
- Risks of COVID-19 to them and potential risks to their fetuses
- What is known about the vaccine: how well it works to develop protection in the body, known side effects of the vaccine, and lack of data during pregnancy
Pregnant patients who decide to get vaccinated should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. This includes:
- Wearing a mask
- Staying at least six feet away from others
- Avoiding crowds
- Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
- Following CDC travel guidance
- Following quarantine guidance after exposure to COVID-19
- Following any applicable workplace guidance
CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and will closely monitor reports.
If I am breastfeeding can I get the COVID-19 vaccine?
There is no data on the safety of COVID-19 vaccines in lactating women nor on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant. Women who are breastfeeding and are part of a group recommended to receive a COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. Despite having no data, it appears safe to get the COVID-19 vaccine if you are nursing a baby, based upon available data. Although the vaccines have not been studied in nursing mothers, lactating women should be offered the COVID-19 vaccine. The vaccines do not contain live virus, so being vaccinated does not pose a risk to the baby. If you are vaccinated for the coronavirus, there is no need to delay or discontinue breastfeeding.
Is Fertility affected by the COVID-19 vaccine?
No, getting the COVID-19 vaccine will not affect your fertility. Women actively trying to conceive may be vaccinated with the current COVID-19 vaccines and there are no indications for delaying pregnancy after completing the vaccine series.
Confusion around this issue arose when a false report surfaced on social media, saying that the spike protein on this coronavirus was the same as another spike protein called syncitin-1 that is involved in the growth and attachment of the placenta during pregnancy. The false report said that getting the COVID-19 vaccine would cause a woman’s body to fight this different spike protein and affect her fertility. The two spike proteins are completely different, and getting the COVID-19 vaccine will not affect the fertility of women who are trying to become pregnant. This includes in vitro fertilization methods. During the Pfizer vaccine tests, 23 women volunteers involved in the study became pregnant, and the only one in the trial who suffered a pregnancy loss had not received the actual vaccine, but a placebo.
Can I contract the COVID-19 from the coronavirus vaccine?
No, you cannot get COVID-19 from the vaccines currently available. You may experience mild, temporary side effects, but side effects are the immune system's response to the vaccination, not COVID-19.
Learn more about COVID-19 vaccines, their safety and side effects, and what to expect if you choose to be vaccinated.
Can COVID-19 be severe in pregnant women?
Yes, the Centers for Disease Control and Prevention includes pregnant women as a high-risk group for severe COVID-19 illness. Consequently getting the COVID vaccine for the coronavirus is important for pregnant women to consider.
- Recent data indicate an increased risk of intensive care unit admission, mechanical ventilation and ventilator support needs , and death in pregnant women with symptomatic COVID-19.
- Health conditions that may contribute to death, or Co-morbidities, including racial and socioeconomic factors increase the risk of severe COVID-19.
- Lactating women are not considered at higher risk of developing severe illness when compared with the non-pregnant population.
People who are pregnant and part of a group recommended to receive COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated. A conversation between pregnant patients and their clinicians may help them decide whether to get vaccinated with a vaccine that has been authorized for use under Emergency Use Authorization (EUA). While a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.
Key considerations pregnant patients can discuss with their healthcare provider include:
- The likelihood of exposure to SARS-CoV-2, the virus that causes COVID-19
- Risks of COVID-19 to them and potential risks to their fetuses
- What is known about the vaccine: how well it works to develop protection in the body, known side effects of the vaccine, and lack of data during pregnancy
Pregnant patients who decide to get vaccinated should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. That means:
- Wearing a mask
- Staying at least six feet away from others
- Avoiding crowds
- Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
- Following CDC travel guidance
- Following quarantine guidance after exposure to COVID-19
- Following any applicable workplace guidance
Consult your obstetrician about health concerns specific to you.
