COVID-19 vaccines before and during pregnancy: What to know
There’s a lot of information to sort through during pregnancy, and it can be overwhelming to navigate. What medicine is safe to take for a cold, what does that weird feeling mean, and oh — what are the safest choices when you happen to be pregnant in the age of COVID-19?
One of the most important choices, says obstetrician/gynecologist Melissa Goist, MD, is whether to get the COVID-19 vaccine and a COVID-19 booster.
“COVID-19 infection can cause such severe complications in pregnant people, especially, and that risk is high compared to the rare and mild known side effects of the vaccine,” she says. “The vaccine has shown to be safe in pregnancy, and I have personally had many patients who have received the vaccine during pregnancy without any complications, as well as many who are now pregnant after obtaining the vaccine.”
Infectious disease specialist Nora Colburn, MD, MPH, also recommends the vaccine in these circumstances.
“As an infectious disease physician and a new mother, I urge every woman to get vaccinated against influenza and COVID-19 as soon as she can to protect herself and her baby,” Dr. Colburn says.
The COVID-19 vaccine is surrounded by misinformation and sometimes-confusing data, and that’s exponentially true with internet chatter about getting the vaccine while pregnant.
Dr. Goist and Dr. Colburn are here to explain what we know about the vaccine and why they support vaccination for their patients who are pregnant or might become pregnant.
- Question Can COVID-19 vaccines cause infertility?
Dr. Colburn: There’s absolutely no evidence that any vaccine, including the COVID-19 vaccines, cause infertility in men or women.
A recent study looked at pregnancy success rates in IVF (in vitro fertilization) in women who were vaccinated against COVID-19, those recently infected with COVID-19 and those who hadn’t been vaccinated or infected. The study found no differences in pregnancy among those three groups.
Dr. Goist: Monitoring is still ongoing, but the earliest data supports use of the vaccine while attempting to conceive as well as during pregnancy.
- Question Are the vaccines safe in pregnancy?
Dr. Goist: Yes. Data from the Developmental and Reproductive Toxicity (DART) studies for all three available vaccines (Pfizer, Moderna and Johnson & Johnson) didn’t demonstrate any safety concerns in pregnancy. Data in the CDC’s v-safe post-vaccination health registry also hasn’t demonstrated concerns in the pregnant people registered, and they are no more likely to experience acute vaccine side effects than the non-pregnant population.
- Question What are the risks of not getting vaccinated?
Dr. Goist: Pregnancy is associated with an increased risk of severe illness with COVID-19 infection. Pregnant people are more likely to need mechanical ventilation, more likely to be admitted to the ICU, and more likely to die of COVID-19 than non-pregnant people.
We’re also seeing an increased risk of pregnancy complicated with COVID-19 infection, such as pregnancy loss, preterm labor, preterm birth and Cesarean delivery. When a baby is born early, they often have a prolonged stay in the neonatal intensive care unit (NICU). Preterm babies are at risk for many complications, including infection, brain bleeds, developmental delays, needing a ventilator and long-term respiratory complications.
Dr. Colburn: In a study of more than 40,000 pregnant women, COVID-19 vaccination during pregnancy was not associated with preterm birth or delivering an infant small for their gestational age. Several studies have not found an increased risk of miscarriage (before 20 weeks of gestation) in women who receive the vaccine before or during pregnancy.
- Question Can the fetus/baby get vaccine antibodies from its vaccinated mother?
Dr. Colburn: When a pregnant or breastfeeding mother gets any vaccine, her protective antibodies against the infection circulate throughout her body through the bloodstream. When pregnant, the mother’s bloodstream connects with the fetus through the placenta, and protective antibodies can cross to the baby. This is why pregnant women are advised to get a Tdap (tetanus, diphtheria, pertussis) booster shot in their third trimester — the mother makes antibodies against pertussis, and that protects the baby from that disease.
Studies show that breastfeeding mothers have protective antibodies in their breastmilk, which can help protect their babies when they consume the milk.
Dr. Goist: A recent, small study found that, at 6 months old, the majority (57%) of babies born to pregnant people who were vaccinated during pregnancy did have detectable antibodies against COVID-19, compared to 8% of babies born to pregnant people who had COVID-19 during pregnancy. New data show that completing a two-dose primary mRNA COVID-19 vaccine series during pregnancy can help protect babies younger than 6 months old from hospitalization due to COVID-19. In the report, the majority (84%) of babies who were hospitalized with COVID-19 were born to pregnant people who weren’t vaccinated during pregnancy.
- Question Can COVID-19 vaccines cause long-term side effects?
Dr. Colburn: In all vaccines, side effects would develop within six to eight weeks of injection. There’s no evidence of any vaccination in history having long-term side effects (meaning many months/years).
COVID-19 vaccines also have been studied in humans since mid-2020, and more than 218 million people have been fully vaccinated in the United States alone. The vaccines continue to be closely monitored.
The mRNA in the vaccine also degrades quickly through normal cellular processes, within a few hours or days after injection in your body.
- Question Do the COVID-19 vaccines really work?
Dr. Colburn: The COVID-19 vaccines are incredibly effective at preventing severe COVID-19 disease as well as hospitalization and death. Efficacy data suggests that it’s equally effective in pregnant people.
In Ohio, the vast majority of all COVID-19 related hospitalizations and deaths are in unvaccinated people.
- Question How do we know the vaccines are safe in general?
Dr. Colburn: The COVID-19 vaccine has been through Phase 1, Phase 2 and Phase 3 clinical trials without any shortcuts. The clinical trials were able to be completed quickly because there was so much funding and so many volunteers participating in the trials.
The trials have been monitored by the Data and Safety Monitoring Boards throughout their duration. The CDC continues to monitor for any adverse events through several active reporting and monitoring systems.
- Question Are the vaccines FDA-approved? What does it mean for a vaccine to have emergency use authorization (EUA)?
Dr. Colburn: There are two COVID-19 vaccines with full FDA approval: Comirnaty (made by Pfizer-BioNTech) and Spikevax (made by Moderna).
Emergency use authorization is a tool the U.S. Food and Drug Administration (FDA) uses to make medical products available quickly during the COVID-19 pandemic. The vaccines have gone through all three phases of clinical trials, and we have nearly two years of data since the Phase 3 trials began in July 2020.
- Question Is the vaccine approved for children?
Dr. Colburn: The Pfizer vaccine is approved and recommended for all children age 5 and older. Moderna and Pfizer are conducting clinical trials on vaccines for children age 6 months to 4 years old.
- Question Can/should pregnant people get a COVID-19 booster? If they’ve already gotten a COVID-19 booster, how do they know when they should get their next shot?
Dr. Colburn: COVID-19 vaccination, including a booster dose, is strongly recommended for all people who are pregnant, breastfeeding, trying to become pregnant or who may become pregnant. We saw that during the recent omicron variant surge, individuals who were boosted were 21 times less likely to die from COVID-19 compared to those who were not vaccinated, and they were seven times less likely to be hospitalized. Individuals 50 years and older and individuals 12 years and older who are immunocompromised are eligible to receive a second booster. Talk to your doctor to see if you would benefit.
Dr. Goist: As we know that antibodies wane, and having data regarding antibodies in newborns delivered from people who are vaccinated — as well as breastfeeding literature that supports the vaccine — we can see that providing additional antibodies against COVID-19 is important not only for maternal health, but it also may benefit the newborn.