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Is It Safe to Get a COVID Vaccine If You’re Pregnant or Breastfeeding?

Is It Safe to Get a COVID Vaccine If You’re Pregnant or Breastfeeding?

The Pfizer and Moderna mRNA vaccines appear to be safe, a large CDC report shows.

Updated on April 22, 2021 at 12:30pm EDT.

One of the largest reports on COVID-19 vaccination in pregnancy is adding to growing evidence that the Pfizer and Moderna mRNA vaccines are safe for pregnant people and their babies.

Researchers at the Centers for Disease Control and Prevention (CDC) compiled preliminary results based on data from the Vaccine Adverse Event Reporting System (VAERS), a national vaccine safety monitoring system, and its V-safe After Vaccination Health Checker and pregnancy registry—surveillance programs that are tracking the COVID vaccines’ effects among people who voluntarily register.

Reports from 35,691 pregnant women who received their shots between December 14, 2020 and February 28, 2021 showed rates of miscarriage, premature births and other complications among the vaccinated women were unchanged from those reported before the pandemic began.

Although research on the long-term safety and effectiveness of the COVID-19 vaccines is ongoing, the study, published on April 21 in the New England Journal of Medicine, is reassuring.

Pregnant women at higher risk for severe COVID-19
If you’re pregnant or breastfeeding, it’s understandable if you’re concerned about the possible risks that a COVID-19 vaccine could pose to your baby. It’s true that the vaccines available for use in the United States were developed in record time and the monitoring of these vaccines for safety and effectiveness will continue for the foreseeable future.

Although data on vaccines and pregnancy are limited, there’s no question that pregnant people are at increased risk for developing severe complications from COVID-19.

If you’re pregnant and have COVID-19, you’re more likely than a woman who’s not pregnant to be admitted to a hospital, stay in an intensive care unit, be placed on a ventilator and not survive the disease, according to the Centers for Disease Control and Prevention (CDC). It’s still not clear whether COVID-19 causes premature birth or miscarriage.

Based on the available evidence, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine and the CDC advise that the vaccines are unlikely to pose any risk and agree they should be offered to pregnant women and breastfeeding women. The American Society for Reproductive Medicine also advises everyone, including pregnant women and those trying to become pregnant, to get a COVID-19 vaccine.

But it’s a good idea to talk with your OB/GYN so you can make an informed decision about being vaccinated against COVID-19 and do what is best for you and your baby. Learning as much as you can about the vaccines and the research that is available can also help.

What we know so far
Initial clinical trials exploring the safety and efficacy of the Pfizer, Moderna, and Johnson & Johnson (J&J) vaccines didn’t include pregnant or lactating women. Larger trials with pregnant people and new mothers, such as the CDC report, which tracked people after they were vaccinated, are underway or planned.

Jeanne Sheffield, M.D., director of the division of Maternal-Fetal Medicine and a professor in the Johns Hopkins Medicine Department of Gynecology and Obstetrics, regularly engages in shared decision making and risk-benefit discussions with her pregnant and lactating patients.

“We talk about the efficacy of the vaccine—how effective it is in preventing disease and hospitalizations in nonpregnant individuals,” Dr. Sheffield explains. “And then we talk about what limited data there is on risk.” She informs her patients of the available data on the vaccine’s use in pregnant people and data obtained from animal studies, which she finds reassuring.

“We are getting more and more data,” she adds, “showing that, besides benefiting the mom, the vaccines might actually benefit the baby after the baby is born.” Sheffield also points to safety data emerging from the CDC’s V-safe After Vaccination Health Checker.

The CDC encourages people to enroll in V-safe, which is open to anyone who’s received one of the three FDA-authorized vaccinations. You can sign up as soon as you receive your first vaccine.

Dr. Sheffield hasn’t seen any difference between her pregnant and nonpregnant patients’ reactions. “They’ve had the standard arm soreness, body aches, low-grade fever. We have not had anybody that has had significant side effects.” She recommends that patients take Tylenol to relieve symptoms.

As the CDC registry grows—by March 29, 2021, more than 69,000 pregnant people had registered—even more data will be included in the agency’s monthly safety reports.

More research is underway
Results of a new independent study support the safety of vaccination in pregnant women. The small study, published in March 2021 by the American Journal of Obstetrics and Gynecology, compared the effects of Pfizer’s and Moderna’s COVID vaccines among 84 pregnant women, 31 lactating women and 16 women who weren’t pregnant.

Researchers, including those from Brigham and Women’s Hospital and Harvard Medical School, reported that both vaccines confer a robust immune response in pregnant women—and the immunity can be transferred to their babies. The two-dose vaccines generated strong antibodies to fight COVID infection in all the women with no associated harms to the fetus.

Antibodies were present in babies who were born after their mother received either one or two vaccine doses. They also detected antibodies in breast milk and umbilical cord blood.

Despite the small size of the study, it provides valuable preliminary data, according to Sheffield. “It certainly allows us to be able to talk to patients and tell them we have some early data showing that it is safe in pregnancy. It has allowed us to be a little more reassuring to patients who are concerned,” she says. “We tell them upfront there’s still not a large study showing safety, but it is coming.”

What about the J&J vaccine?
Even if the J&J rollout resumes in the United States, experts don’t have enough evidence to know whether this single-dose vaccine will yield similar results. The J&J vaccine is a viral-vector vaccine that’s made differently than the Pfizer and Moderna vaccines. The latter vaccines were developed using messenger RNA (mRNA) technology. The mRNA vaccines are the first of their type to be approved in the United States, but the technology has been in development for the last decade.

Don’t forget your other vaccines
With all the talk centered around COVID vaccines, don’t overlook vaccines that protect against other infections while you’re pregnant. The CDC, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend that all pregnant women get flu and TDAP (tetanus, diphtheria and pertussis) vaccines. Both vaccines are safe for pregnant women and their babies. Talk to your healthcare provider about the vaccine schedule that is appropriate for you.

Medically reviewed in April 2021.

Sources:
Tom T. Shimabukuro, M.D., Shin Y. Kim, M.P.H., Tanya R. Myers, Ph.D., et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England Journal of Medicine. Apr 21, 2021.
CDC National Center for Immunization & Respiratory Diseases. COVID 19 vaccine safety update. Advisory Committee on Immunization Practices (ACIP). March 1, 2021.
Gray KJ, Bordt EA, Atyeo K, et al. COVID-19 vaccine response in pregnant and lactating women: A cohort study. Am J Obstet Gynecol. 2021 Mar 24:S0002-9378(21)00187-3.
Centers for Disease Control and Prevention. V-safe After Vaccination Health Checker. Accessed Apr. 1, 2021.
Centers for Disease Control and Prevention. V-safe COVID-19 Vaccine Pregnancy Registry. Accessed March 31, 2021.
American College of Obstetricians and Gynecologists. Immunization for pregnant women: a call to action. Accessed Apr. 1, 2021.
Centers for Disease Control and Prevention. Pregnant people at increased risk for severe illness from COVID-19. Accessed March 30, 2021.
American College of Obstetricians and Gynecologists. COVID-19 vaccines and pregnancy: conversation guide for clinicians. Accessed March 30, 2021.
American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), pregnancy, and breastfeeding: a message for patients. Accessed March 31, 2021.
Adhikari EH, Spong CY. COVID-19 vaccination in pregnant and lactating women. JAMA. 2021 Mar 16;325(11):1039-1040.
American College of Obstetricians and Gynecologists. Vaccinating pregnant and lactating patients against COVID-19. Accessed March 29, 2021.
Centers for Disease Control and Prevention. Information about COVID-19 vaccines for people who are pregnant or breastfeeding. Accessed March 29, 2021.
UpToDate.com. COVID-19: Pregnancy issues and antenatal care. Accessed March 29, 2021.
Rubin, R. Pregnant people’s paradox—excluded from vaccine trails despite having a higher risk of COVID-19 complications. JAMA. 2021 Mar 16;325(11):1027-1028.
Society for Maternal-Fetal Medicine. Experts in high-risk pregnancy applaud CDC discussions of Janssen COVID vaccine. Accessed March 29, 2021.
Society for Maternal-Fetal Medicine. Vaccines during pregnancy. Accessed April 1, 2021.
Centers for Disease Control and Prevention. COVID-19: Breastfeeding and Caring for Newborns. Feb 2021.
BMJ. “Pregnant women with covid-19 are less likely to have symptoms and may more likely need intensive care.” Jan 2020.
Elizabeth A. N. Wastnedge, Rebecca M. Reynolds, Sara R. van Boeckel, Sarah J. Stock, Fiona C. Denison, Jacqueline A. Maybin, and Hilary O. D. Critchley. Pregnancy and COVID-19. Physiological Reviews 2021 101:1, 303-318
Kathryn J. Gray, MD PhD, Evan A. Bordt, PhD, Caroline Atyeo, BS. “COVID-19 vaccine response in pregnant and lactating women: a cohort study. AJOG. Mar 25, 2021.

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