Now that COVID-19 vaccines are introduced, pregnant and breastfeeding people have many questions about the risks and benefits. Initially, many of those who receive vaccines in the United States will be healthcare workers, although eligibility circles expand.
The Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology (ACOG), and the Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines are offered to pregnant and lactating individuals who are eligible for vaccination.
Here are answers to some basic questions you may have about getting a COVID-19 vaccine if you’re pregnant or breastfeeding – or considering pregnancy. Remember that information moves quickly. Your obstetrician or medical team can provide more complete advice based on your personal health risks, exposure to the virus that causes COVID-19, and your preferences.
What do we know about how COVID-19 affects pregnant people?
COVID-19 is potentially dangerous for all people. Although the actual risk of serious illness and death in pregnant people is very small, it is higher compared to non-pregnant people of the same age group. Pregnant women are at higher risk of being hospitalized in an intensive care unit and require high levels of care, including breathing assistance on a machine. In this case, there is a higher risk of death.
Also, if you are pregnant you may wonder about the risks to the fetus if you get COVID-19. Research suggests that COVID-19 may increase the risk of premature birth, especially in those with severe illness. So far, studies have not identified any birth defects related to COVID-19. And while mother-to-baby transmission of the virus is possible during pregnancy, it appears to be a rare occurrence. Further information on pregnancy and COVID-19 can be found here.
What do we know about the safety of newly available mRNA COVID-19 vaccines in pregnant people?
The mRNA vaccine studies did not intentionally include pregnant or breastfeeding individuals, so our direct knowledge is currently limited. Some participants in the vaccine study accidentally became pregnant; 18 of these people received the vaccine. More information may be available in the coming months.
When examined during animal studies, the mRNA vaccines had no effect on fertility and did not cause problems with pregnancy. In humans, we know that other types of vaccines are generally safe for use in pregnancy – in fact, many are recommended.
It’s also important to know
- The mRNA vaccines do not contain any virus particles.
- Within hours or days, our bodies eliminate the mRNA particles used in the vaccine, so these particles are unlikely to reach or cross the placenta.
- The immunity a pregnant person creates through vaccination can cross the placenta and help keep the baby safe after birth.
What about side effects of the vaccine? A possible short-term side effect of mRNA vaccine trials (which occur within a day or two of vaccination) is fever. About 1% to 3% of people have a fever after the first dose of the mRNA vaccine and about 15% to 17% after the second dose. These fevers are generally low and can be treated with paracetamol, which is safe to take during pregnancy. In rare cases, high, persistent fevers during pregnancy can lead to birth defects.
For more information on common side effects of COVID vaccines, see here.
What to watch out for with COVID-19 vaccines if you are pregnant?
Eligibility for COVID vaccines varies from state to state. Health care workers with direct patient contact are usually in the first phase for vaccines, followed by others at high risk of COVID, such as those at high risk. B. First responders, key workers, residents of nursing homes, people over the age of 75, and people with certain health conditions.
Provided the mRNA vaccine is available to you during your pregnancy, you have several options to discuss this with your doctor.
- Get vaccinated as soon as the vaccine is available. You can choose to do so if you have additional risk factors for serious complications from COVID-19 (such as high blood pressure or obesity) and / or multiple potential COVID-19 exposures from your work, family, or community.
- Wait until you have the vaccine after giving birth. You can do this if pregnancy is your only risk factor for serious illness and you can control your exposure by limiting interactions with people outside your household and using protective measures (wearing masks, hand washing, and physical distancing).
- Think about how to change your exposure to COVID-19 and possibly postpone vaccination. Most people have some risk factors and some uncontrolled exposures. If this describes you, you still have options. You can change your exposure if possible and postpone vaccination until the second trimester if the natural risk of miscarriage is lower. Or you can postpone vaccination until after the baby is born.
- Wait for a traditional vaccine similar to the flu shot or the Tdap vaccines. These vaccines are under development but not yet approved in the United States. Experts know a lot more about the use of these types of vaccines in pregnant people. Depending on your exposure to COVID-19 and your risk of getting seriously ill if you become infected, it may be wisest to have an mRNA vaccine.
If you are considering postponing the vaccine, ask if it will be available to you at a later date. The answer may vary based on the COVID vaccine range and vaccination programs you live in.
What to watch out for with COVID-19 vaccines while breastfeeding?
Experts believe that getting an mRNA COVID-19 vaccine is most likely safe if you are breastfeeding. Although breastfeeding individuals were not included in the vaccine studies, the mechanism of mRNA vaccines and experience with other vaccines suggest that this is the case.
It is important to know:
- There is no virus in the mRNA vaccines. You cannot get COVID or give COVID to your baby by getting vaccinated. The components of the vaccine are not known to harm breast-fed infants.
- When you receive the vaccine, the small mRNA particles in the vaccine are used up by your muscle cells at the injection site and are therefore unlikely to get into your breast milk. Any small particles of mRNA that reach breast milk would likely be digested.
- When a person is vaccinated while breastfeeding, their immune system develops antibodies that protect against COVID-19. These antibodies can be passed on to the baby in breast milk. Newborn babies of vaccinated mothers who are breastfeeding can benefit from these antibodies to COVID-19.
What to consider if you are thinking of getting pregnant soon or in the future?
If you are considering a soon pregnancy, adopting the COVID-19 vaccine once it becomes available to you is an excellent way to ensure that you – and your pregnancy – are protected.
The COVID-19 vaccination is not believed to affect future fertility.
The final result
COVID-19 vaccination for pregnant or breastfeeding people has potential benefits and raises some unanswered questions. It helps to be as informed as possible about your decision. However, be aware that the information may change quickly. We will learn more about the safety of COVID vaccines during pregnancy and while breastfeeding from ongoing animal and human studies in which participants are participating.
In the meantime, you can stay tuned by checking trustworthy health websites like the ones listed above and speaking to your health care providers. Together you can weigh the latest data on the risks of COVID-19 in pregnancy, the safety of available vaccines, your individual risk factors and exposures, and most importantly, your values and preferences.