I’m pregnant, I’m trying to get pregnant or I’m breastfeeding. Should I get the COVID vaccine?
For most people, getting the COVID vaccine as soon as possible is the safest choice. However, trials testing the vaccine in pregnant and breastfeeding women have not been completed.
The information below will help you make an informed choice about whether or not to get the COVID vaccine while you are pregnant, breastfeeding or trying to get pregnant.
Your options:
Get the COVID vaccine as soon as it is available
or
Wait for more information about the vaccine in pregnancy
- What are the benefits of getting the COVID Vaccine?
-
- COVID is dangerous. It is more dangerous for pregnant women.
- COVID patients who are pregnant are five times more likely to end up in the intensive care unit (ICU) or on a ventilator than COVID patients who are not pregnant.1
- Preterm birth may be more common for pregnant women with severe COVID, but other obstetric complications such as stillbirth do not appear to be increased.2
- Pregnant women are more likely to die of COVID than non-pregnant women with COVID who are the same age.3,4
- The COVID vaccine may prevent up to 95 percent of COVID infections.
- As COVID infections go up in our communities, your risk of getting COVID goes up too.
- Getting the vaccine will prevent you from getting COVID and will help keep you from giving COVID to people around you.
- The COVID vaccine cannot give you COVID.
- The COVID vaccine has no live virus.5
- The COVID vaccine does NOT contain ingredients that are known to be harmful to pregnant women or to the fetus.
- Many vaccines are routinely given in pregnancy and are safe (for example: tetanus, diphtheria, and flu).
- COVID is dangerous. It is more dangerous for pregnant women.
- What are the risks associated with getting the COVID vaccine?
-
- The COVID vaccine has not yet been tested in pregnant women.
- The vaccine was tested in over 20,000 people. It was not tested in pregnant women.
- We do not have data on whether the vaccine works as well in pregnancy as it did in the study of non-pregnant individuals.
- We do not have data on whether or not there are unique downsides in pregnancy or different side effects.
- People getting the vaccine will probably have some side effects.
- The more common side effects were:
- injection site reactions like sore arm (84%)
- fatigue (62%)
- headache (55%)
- muscle pain (38%)
- chills (32%)
- joint pain (24%)
- fever (14%)
- The more common side effects were:
- The CDC recommends using Tylenol (acetaminophen) during pregnancy if you have a high fever.
- The COVID vaccine has not yet been tested in pregnant women.
- What do the experts recommend?
-
The Society for Maternal-Fetal Medicine strongly recommends that pregnant individuals have access to COVID vaccines. They recommend that each person have a discussion with their healthcare professional about their own personal choice.7
The American College of Obstetricians and Gynecologists recommends that the COVID vaccine should not be withheld from pregnant individuals who meet criteria for vaccination.8
The American Society of Reproductive Medicine does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating.10
- What about breastfeeding?
-
The Society for Maternal-Fetal Medicine reports there is no reason to believe the vaccine affects the safety of breastmilk.7
When we have an infection or get a vaccine, our bodies make antibodies to fight the infection. Antibodies formed from vaccines given during pregnancy pass into the breastmilk and then to the baby to help prevent infections.
- What if I am planning to become pregnant or am undergoing fertility treatment?
-
The American Society of Reproductive Medicine (ASRM) COVID-19 Task Force regarding the COVID-19 vaccine is recommending the following:
- The ASRM Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant or who are lactating.
- Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria.
- Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies.
- Patients who conceive in the window between the first and second dose of the vaccine should be offered the second dose of the vaccine at the appropriate interval.
- We do not recommend delaying fertility treatments while undergoing vaccination or waiting any particular duration of time after the vaccine prior to attempting conception.
What else should I think about to help me decide?
- Make sure you understand as much as you can about COVID and about the vaccine. Ask a trusted source, like your midwife or doctor.
- Think about your own personal risk.
Look at the columns below and think about your risk of getting COVID (left column). Think about your safety - are you able to stay safe (right column)?
The risk of getting sick from COVID are higher if...
- You have contact with people outside your household who do not wear masks
- You are 35 years or older
- You are overweight
- You have other medical problems such as diabetes, high blood pressure, or heart disease
- You are a smoker
- You are a racial or ethnic minority, or your community has a high rate of COVID infections
- You are a healthcare worker
If you are at a higher risk of getting COVID, it probably makes sense to get the vaccine.
If you are not at higher risk for COVID and...
- ...you are always able to wear a mask
- ...you and the people you live with can socially distance from others for your whole pregnancy
- ...your community does NOT have high or increasing COVID cases
- ...you think the vaccine itself will make you very nervous (you are more worried about the unknown risks than about getting COVID)
- ...you have had a severe allergic reaction to a vaccine
...it might make sense for you to wait for more information.
Summary
- COVID seems to cause more harm in pregnant women than in women of the same age who are not pregnant.
- The risks associated with getting the COVID vaccine during pregnancy are thought to be minor but are not totally known.
- You should consider your own personal risk of getting COVID. If your personal risk is high, or there are many cases of COVID in your community, it probably makes sense for you to get the vaccine while pregnant.
- Whether to get the vaccine or not is your choice.
Do you have more questions? Call your doctor or midwife to talk about your own personal decision.
References
- DeBolt CA, et al. Pregnant women with severe or critical COVID-19 have increased composite morbidity compared to non-pregnant matched controls. Am J Obstet 2020 Nov doi: 10.1016/j.ajog.2020.11.022
- Adhikari EH, et al. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus 2 infection. JAMA Network Open 2020 Nov 3(11):e2029256
- DiMascio D, WAPM working group on COVID-19. Maternal and Perinatal Outcomes of Pregnancy Women with SARS-coV-2 infection. Ultrasound Obstet Gynecol. 2020 Sept. doi: 10.1002/uog.23107.
- Centers for Disease Control and Prevention. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. November 2020:1-7.
- Abbasi J. COVID-19 and mRNA Vaccines—First Large Test for a New Approach. JAMA. 2020;324(12):1125– 1127. doi:10.1001/jama.2020.16866
- https://www.cdc.gov/vaccines/acip/recs/grade/covid-19-pfizer-biontech-etr.html (Accessed December 14, 2020)
- SMFM statement on COVID vaccination in pregnancy: https://www.smfm.org/publications/339-society-formaternal- fetal-medicine-smfm-statement-sars-cov-2-vaccination-in-pregnancy
- https://www.acog.org/en/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-Pregnantand- Lactating-Patients-Against-COVID-19 (Accessed December 14, 2020)
- Mutambudzi M, Niedwiedz C, Macdonald EB, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occupational and Environmental Medicine Published Online First: 09 December 2020. doi: 10.1136/oemed-2020-106731
- https://www.asrm.org/news-and-publications/covid-19/