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Pregnancy, breastfeeding and the COVID-19 vaccine

The COVID-19 pandemic has, undoubtedly, changed our lives forever. As a maternal-fetal medicine specialist at Texas Children’s Pavilion for Women®, I’ve talked with my patients over the past nine months about what this virus means for themselves, and potentially, their unborn baby, too. We continue to learn more each day, and below are some of the most common questions we’ve received thus far related to the COVID-19 vaccine.

Can those who are pregnant receive the COVID-19 vaccine? 
The decision to receive the COVID-19 vaccine should be made with your provider about not only the vaccines risks and benefits, but your risk of getting moderate or severe disease if you were to remain unvaccinated and get infected with the virus.

The FDA has issued emergency use authorization for the Pfizer and Moderna vaccines to prevent COVID-19 disease. The Pfizer vaccine is approved for those age 16 and older, and the Moderna vaccine is approved for those 18 and older. It is anticipated that other similar vaccines may receive authorization in the future.

Persons who are pregnant, planning to become pregnant or breastfeeding may also choose to be vaccinated. Just like other people, pregnant or breastfeeding women would need to take the current authorized vaccines at the prescribed injection intervals.  

The Society for Maternal Fetal Medicine (SMFM) and the American College of Obstetrician Gynecologists (ACOG) has issued guidance statements to aid in patients evaluating the benefits and potential risks. There are several facts that are worth knowing when making this decision:

1. The risks of COVID-19 disease in pregnant women are greater than in non-pregnant women. Specifically, pregnant women are up to five times more likely to be hospitalized, three to four times more likely to need to be cared for in an ICU, and two to three times more likely to require life-saving measures (like a breathing tube or life support). In addition, while the data is not yet complete, there is at least a small increased risk of maternal death, stillbirth, and preterm birth with COVID-19 disease during pregnancy. Black and Latino women have an especially increased risk of severe disease and death from COVID-19.

2. The COVID-19 vaccine has not yet been thoroughly tested in pregnant women. Pregnant women were not allowed to take part in the clinical trials of the vaccine. However, a few people received the vaccine in the clinical trials and did become pregnant. Although these were small numbers, there were no reports of problems and monitoring continues.

3. The Pfizer and Moderna authorized vaccines are not a live vaccine, meaning that you cannot become infected with the virus when you receive the vaccine. Although about 4 in 100 people had a fever with the first dose of the Pfizer vaccine in the trial, and 16 in 100 after the second dose in the trial, this did not mean that they became infected. These are anticipated responses to the vaccine, and clues that it is arming your immune system to fight the virus should you become infected. Pregnant and lactating women can take acetaminophen (Tylenol) to help with the fever and muscle aches that might come with receiving the vaccine, and it won’t cause harm or lessen the effectiveness of the vaccine.

What if I am nursing? Can the virus be transmitted to my infant or toddler through the vaccine?
Because the vaccine does not contain a live virus, there is no virus to transmit with nursing.

Does the COVID-19 vaccine affect fertility? 
This is unknown at this time. However, as summarized above, it is felt that the benefits to the vaccine outweigh any possible small and still theoretical risks.

Is there an increased miscarriage rate and/or risk?
This is unknown at this time. However, as summarized above, it is felt that the benefits to the vaccine outweigh any possible small and still theoretical risks. In the Pfizer trial, the only women suffering miscarriage were in the placebo group. However, the data is simply not robust enough to make any conclusions.

We will continue to keep you informed of the latest information, and, of course, let you know as soon as a vaccine is available for our patients.