COVID-19 Vaccine and Pregnancy

Dr. David Jude, chair of the Department of Obstetrics & Gynecology, addresses many of the questions pregnant and breastfeeding women may have when deciding whether the COVID-19 vaccine is right for them.

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Do pregnant women have an increased risk of developing severe disease due to COVID-19?

Recent data indicate that pregnant women who contract COVID-19 have a higher risk of having severe disease compared to women who are not pregnant including:

• 3 times increased risk of ICU admission
• Mechanical ventilation (used to help a patient breathe)
• 1.7 times increased risk of death among pregnant patients with symptomatic COVID-19 infection compared to symptomatic non-pregnant patients

Risk of poor outcomes are increased in women with underlying health conditions including obesity, diabetes, heart disease, chronic lung disease and smoking.

For these reasons, the Society for Maternal–Fetal Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG) strongly recommend that pregnant and breastfeeding women have access to the COVID-19 vaccines.

Are the COVID-19 vaccines safe to use during pregnancy?

Since the FDA emergency use authorization for the Pfizer and Moderna vaccines, many pregnant women have received both doses of the vaccine. Early data from the CDC and FDA safety monitoring programs did not identify any safety concerns for pregnant women who were vaccinated or for their babies.

Formal clinical trials that study the safety of COVID-19 vaccine and how well they work in pregnant people are underway.

There is a rare risk of blood clots after receiving the Johnson & Johnson Janssen COVID-19 vaccine. This risk is not seen with the other vaccines. Since the risk of blood clots is higher during pregnancy, some obstetricians recommend that pregnant women who want to be vaccinated receive either the Pfizer or Moderna vaccines.

What should I consider when deciding on vaccination while I am pregnant?

People who are pregnant and considering COVID-19 vaccination should balance the low but unknown fetal risk with the increased risk of severe disease during pregnancy.  Patients should also weigh their individual risk for both acquiring COVID-19 infection as well as their individual risk of developing severe disease.  Prevalence of the disease in the community is also another factor to consider in deciding whether or not to receive the vaccine.

So, if you are pregnant and have comorbidities like being overweight, have high blood pressure, smoke or any other underlying condition that makes severe disease more likely, or if you have a job or other factor that increases your risk of exposure, or if you live in an area with high prevalence of COVID-19 infections, you should strongly consider receiving the vaccine.

What are the side effects of the COVID-19 vaccine?

Expected side effects are a normal part of the body’s reaction to the vaccine and developing antibodies that protect against the disease.  Most side effects experienced include injection site reactions and flu like symptoms like fatigue, chills, muscle and joint pain, and headaches.  Side effects are more common after the second injection.

Should I get vaccinated if I have already had an infection due to COVID-19?

Prior infection due to COVID-19 does not automatically confer immunity.  Women who have had COVID-19 infections previously should consider being vaccinated.

Should I get the vaccine if I am breastfeeding?

Both SMFM and ACOG recommend COVID-19 vaccines be offered to breastfeeding women.  Stopping or avoiding starting breastfeeding is not necessary in order to receive the vaccine.

Should I get the vaccine if I am considering becoming pregnant soon?

ACOG strongly encourages COVID-19 vaccination for non-pregnant women who are otherwise eligible for the vaccine.  It is not necessary to delay pregnancy after completing COVID-19 vaccination.  If a person becomes pregnant after the first dose of the vaccine series, the second dose should be administered as indicated.  Pregnancy testing is not recommended prior to receiving a COVID-19 vaccine.

If you are pregnant and receive a COVID-19 vaccine, consider participating in the v-safe pregnancy and other registry programs.

A v-safe pregnancy registry has been established by the CDC to gather information on the health of pregnant women who have received a COVID-19 vaccine. Additionally, many facilities, including Cabell Huntington Hospital, are participating in national registries to gather more information about vaccine use in pregnancy.  If you received a vaccine and deliver at Cabell Huntington Hospital, you may be asked to allow collection of data and blood form the umbilical cord after your baby is born.

Patients are encouraged to discuss any questions with their ob-gyn or primary care provider. For more information, call Marshall OB/GYN at 304-691-1400.

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This Healthy Herd article was originally published on Dec. 21, 2020, and last updated on May 18, 2021.