This article was medically reviewed by Carolyn Swenson, M.D., an assistant professor of obstetrics and gynecology and member of the Prevention Medical Review Board.
Since the arrival of the COVID-19 vaccines, there’s been confusion around whether or not they’re safe for pregnant women. The reason: Early clinical trials of the vaccine did not include pregnant or breastfeeding women, making it impossible to know for sure if it’s safe for them to be immunized.
Reminder: Pregnant people are at an increased risk of severe illness from COVID-19, along with an increased risk of other adverse outcomes, like preterm birth, according to the Centers for Disease Control and Prevention (CDC).
At a recent press briefing, Anthony Fauci, M.D., the nation’s leading infectious disease expert, said that clinical trials for pregnant women (and children) are underway, so we should have more definitive answers soon. And in the meantime, approximately 20,000 pregnant women have received the COVID-19 vaccine “with no red flags,” Dr. Fauci said.
These revelations are promising but if you’re pregnant (or a loved one is), you may still be wondering if it’s a good idea for pregnant women to get vaccinated. Here’s what you need to know.
How does the COVID-19 vaccine work, again?
Both the Pfizer-BioNTech and Moderna vaccines use a newer technology called messenger RNA, or mRNA, which is genetic material from the virus, according to the CDC. (Note: It’s not the virus itself—just the genetic coding of the virus. The vaccine will not make you sick with COVID-19.)
The mRNA tells your body how to make a spike protein, which the novel coronavirus uses to latch onto human cells. When your body starts to pump out spike proteins, your system sees them as foreign and creates antibodies unique to the coronavirus. Your body eventually eliminates both the protein and the mRNA, but the antibodies stick around, providing you with protection from COVID-19 should you get infected in the future.
What do public health organizations say about getting the COVID-19 vaccine when you’re pregnant or breastfeeding?
Here’s where things get confusing. Both the American College of Obstetricians and Gynecologists (ACOG) and the CDC have largely said that pregnant and breastfeeding women should be able to get the COVID-19 vaccine, if they want it. However, both organizations stop short of actually recommending that pregnant women get vaccinated.
Meanwhile, the World Health Organization (WHO) initially advised women against getting the vaccine. But in late January, the organization revised its recommendation, stating: “Based on what we know about this kind of vaccine, we don’t have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women.”
Before getting the vaccine, the ACOG recommends that pregnant women talk to their doctor about the following:
- the level of activity of the virus in the community
- the potential efficacy of the vaccine available to them
- the risk and potential severity of maternal disease, including the effects of disease on the fetus and newborn
- the safety of the vaccine for the pregnant patient and the fetus
However, the ACOG also states that a conversation with your doctor “should not be required,” as it can cause “unnecessary barriers” to vaccination.
So, is it safe for pregnant and breastfeeding women to get the COVID-19 vaccine?
“In the absence of any data obtained in pregnant and lactating individuals, it is hard to overtly recommend an intervention,” says Emily S Miller, M.D., M.P.H., assistant professor in the department obstetrics and gynecology at Northwestern Medicine.
But based on what has been studied so far, “there’s no reason to think that pregnant women or their fetus would be at risk from getting the COVID-19 vaccine,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. And, he points out, studies on pregnant animals haven’t found a cause for concern.
“Everything we know about the vaccine would indicate it should be safe,” Dr. Schaffner says. “The RNA in the vaccine doesn’t go anywhere near human DNA—either the mother’s or the fetus’s.”
Statements from public health organizations (like the WHO) have been cautious but “everything we’ve seen from women who got pregnant during clinical trials or were already pregnant and got the vaccine is reassuring,” says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security.
Public health officials and organizations, including the ACOG, are “doing the best they can with what they have to work with,” explains Michael Cackovic, M.D., a maternal fetal medicine physician at The Ohio State Wexner Medical Center. “They’re saying, ‘We don’t have the data to make that recommendation,’ and that’s sound.”
At the same time, Dr. Cackovic points out that this type of vaccine is considered safer for pregnant women than other types of vaccines. “The COVID-19 mRNA vaccine does not contain a live virus, and these types of vaccines are considered more compatible in pregnancy, as they work by inducing an immune response by the host,” he explains.
Plus, the fact that pregnant women are at a high risk of severe complications from COVID-19 makes the vaccine at least worth considering, says Joanne Stone, M.D., division director of maternal fetal medicine for the Mount Sinai Health System in New York. “It seems the benefits outweigh the risks, although a conversation with a health care professional may help in making an individual decision,” she explains. “And it’s important that women be informed of the lack of data regarding vaccine safety in pregnant women.”
Bottom line: Pregnant women should talk to their doctor about the COVID-19 vaccine.
Now that pregnant women are now being included in vaccine trials, Dr. Cackovic says “ongoing conversations with your physician should include newly published information on the safety, efficacy, and availability for the vaccine in pregnancy.”
Dr. Adalja agrees. “I do think this is a decision between a doctor and a patient,” he says. “But, in most cases, pregnant women should be immunized.”
This article is accurate as of press time. However, as the COVID-19 pandemic rapidly evolves and the scientific community’s understanding of the novel coronavirus develops, some of the information may have changed since it was last updated. While we aim to keep all of our stories up to date, please visit online resources provided by the CDC, WHO, and your local public health department to stay informed on the latest news. Always talk to your doctor for professional medical advice.
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