COVID-19 Vaccine During Pregnancy

Getting vaccinated against COVID-19 is important to protect your health and your baby’s health.

COVID-19 vaccination is the best way to reduce the risks of COVID-19 infection for both you and your baby.

The Society for Maternal-Fetal Medicine (SMFM), along with the Centers for Disease Control and Prevention (CDC) and other pregnancy experts, recommend that people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future, be vaccinated against COVID-19.

Pregnant People Can Get Very Sick if They Get COVID.

About 1 to 3 per 1,000 pregnant women with COVID-19 will develop severe disease (1, 2). Compared with those who aren’t pregnant, pregnant people infected by the COVID-19 virus:

  • Are 3 times more likely to need ICU care

  • Are 2  to 3 times more likely to need advanced life support and a breathing tube

  • Have a small increased risk of dying due to COVID-19

They may also be at increased risk of stillbirth and preterm birth (3-5).

Data show that older pregnant women; those with preexisting health conditions, such as obesity, diabetes, and heart disorders; and Black or Latinx people have an especially increased risk of severe disease and death from COVID-19 (3-5).

Getting Vaccinated

You can get vaccinated at any time during pregnancy. There’s no need to wait until later in your pregnancy to get vaccinated.

Three vaccines are available to prevent COVID-19:

  • The two-dose Pfizer vaccine for people 12 years and older and a lower-dose vaccine for people 5 to 11 years old (also given in two doses). The second dose is given 21 days after the first dose (6).

  • The two-dose Moderna vaccine for people 18 years and older. The second dose is given 28 days after the first dose (6).

  • The one-dose Johnson & Johnson vaccine for people 18 years and older (7).

The CDC recommends a preference for people to get an mRNA vaccine (Pfizer or Moderna) over the Johnson & Johnson vaccine. The reasons for this recommendation are:

  • The superior effectiveness of mRNA vaccines against recent COVID-19 variants

  • Johnson & Johnson vaccine’s association with a very rare, yet serious, side effect (blood clots)

  • The current large supply of mRNA vaccines in the United States

Anyone who isn’t willing or able to get an mRNA vaccine can still get the Johnson & Johnson vaccine (8).

Why Get Vaccinated?

If you are pregnant or planning to become pregnant and are thinking about getting vaccinated, consider talking with your health care professional about the vaccine. To help with your decision, you should consider the following key points:

The Vaccines Work

The vaccines can help protect you from severe illness and hospitalization if your get COVID-19. With the two-dose vaccines, you should get both doses and a booster for maximum effectiveness.

Getting Vaccinated May Help Protect Your Baby

Getting the vaccine while pregnant may help you pass anti-COVID-19 antibodies to your baby. In numerous studies of vaccinated moms, antibodies were found in the umbilical cord blood of babies and in the mother’s breast milk (9-19).

The Vaccines Don’t Cross the Placenta or Affect Future Fertility

The current COVID-19 vaccines are not live vaccines. The vaccines do not cross the placenta because they are quickly broken down by the muscle where they’re given. The antibodies that your body makes in response to the vaccine do cross the placenta and protect your baby from COVID-19 after birth.

There is no evidence that vaccines affect future fertility.

What About Side Effects?

Side effects may occur in the first 3 days after getting vaccinated (6). These include mild to moderate fever, headache, and muscle aches. Side effects may be worse after the second dose of the Pfizer and Moderna vaccines (1, 20). Fever should be avoided during pregnancy, especially in the first trimester. Experts recommend that pregnant people who’ve gotten the vaccine and develop a fever take acetaminophen (Tylenol). This medication is safe to use during pregnancy and does not affect how the vaccine works.

The CDC, along with other federal partners, are monitoring people who have been vaccinated for serious side effects (21). You can help this effort by signing up for v-safe, a program that monitors people who’ve been vaccinated. No unexpected pregnancy or fetal problems have occurred. There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects (21, 22).

References

1. Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020. MMWR Morbidity and Mortality Weekly Report 2020;69.

2. FDA Briefing Document. Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19. 2021  Accessed  Mar 5, 2021; Available from: https://www.fda.gov/media/146217/download

3. Centers for Disease Control and Prevention. CDC endorses ACIP's updated COVID-19 vaccine recommendations. 2021.

4. Flannery DD, Gouma S, Dhudasia MB, Mukhopadhyay S, Pfeifer MR, Woodford EC, et al. Assessment of Maternal and Neonatal Cord Blood SARS-CoV-2 Antibodies and Placental Transfer Ratios. JAMA pediatrics 2021 2021.

5. Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa-Cohen Y, et al. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest 2021 Jul 1;131(13).

6. Douxfils J, Gillot C, De Gottal É, Vandervinne S, Bayart JL, Dogné JM, et al. Efficient Maternal to Neonate Transfer of Neutralizing Antibodies after SARS-CoV-2 Vaccination with BNT162b2: A Case-Report and Discussion of the Literature. Vaccines (Basel) 2021 Aug 15;9(8).

7. Zdanowski W, Waśniewski T. Evaluation of SARS-CoV-2 Spike Protein Antibody Titers in Cord Blood after COVID-19 Vaccination during Pregnancy in Polish Healthcare Workers: Preliminary Results. Vaccines (Basel) 2021 Jun 19;9(6).

8. Charepe N, Gonçalves J, Juliano AM, Lopes DG, Canhão H, Soares H, et al. COVID-19 mRNA vaccine and antibody response in lactating women: a prospective cohort study. BMC pregnancy and childbirth 2021 Sep 17;21(1):632.

9. Juncker HG, Mulleners SJ, van Gils MJ, de Groot CJM, Pajkrt D, Korosi A, et al. The Levels of SARS-CoV-2 Specific Antibodies in Human Milk Following Vaccination. J Hum Lact 2021 Aug;37(3):477-84.

10. Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol MFM 2021 Sep 20;4(1):100492.

11. Perl SH, Uzan-Yulzari A, Klainer H, Asiskovich L, Youngster M, Rinott E, et al. SARS-CoV-2-Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. Jama 2021 May 18;325(19):2013-4.

12. Romero Ramírez DS, Lara Pérez MM, Carretero Pérez M, Suárez Hernández MI, Martín Pulido S, Pera Villacampa L, et al. SARS-CoV-2 Antibodies in Breast Milk After Vaccination. Pediatrics 2021 Aug 18.

13. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, et al. Detection of SARS-CoV-2-Specific IgA in the Human Milk of COVID-19 Vaccinated Lactating Health Care Workers. Breastfeed Med 2021 Aug 20.

14. Centers for Disease Control and Prevention. v-safe and Registry Monitoring people who report pregnancy. 2021  Accessed  July 1, 2021; Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafepregnancyregistry.html

15. Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England journal of medicine 2021 Jun 17;384(24):2273-82.

16. Lipkind HS, Vazquez-Benitez G, DeSilva M, Vesco KK, Ackerman-Banks C, Zhu J, et al. Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth - Eight Integrated Health Care Organizations, United States, December 15, 2020-July 22, 2021. MMWR Morbidity and mortality weekly report 2022 Jan 7;71(1):26-30.

17. PFIZER-BIONTECH COVID-19 VACCINE [package insert] New York: Pfizer and Mainz, German: Biontech;2020.

18. FDA Briefing Document. Moderna COVID-19 Vaccine. 2020  Accessed  2020, Dec 18; Available from: https://www.fda.gov/media/144434/download

19. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morbidity and mortality weekly report 2020 Jun 26;69(25):769-75.

20. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morbidity and mortality weekly report 2020 Nov 6;69(44):1641-7.

21. Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, et al. SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics - Eight U.S. Health Care Centers, March 1-May 30, 2020. MMWR Morbidity and mortality weekly report 2020 Sep 23;69(38):1355-9.

22. Delahoy MJ, Whitaker M, O'Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morbidity and mortality weekly report 2020 Sep 25;69(38):1347-54.

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Top 5 Reasons to Get the COVID-19 Vaccine

  1. Pregnant people are more likely to get very sick from COVID-19 than nonpregnant people (1-4). Getting COVID-19 while pregnant increases the risk of preterm birth5 and the risk that your baby will need intensive care (6). Getting the vaccine helps protects you and your baby from serious illness, hospitalization, and death from COVID-19 (7-9).

  2. The antibodies that your body makes in response to the vaccine can cross the placenta to your baby (10, 11). Breastfeeding also transfers antibodies to your baby (12-14). The antibodies from the vaccine protect your baby against COVID-19 after birth (15).

  3. Thousands of pregnant people have safely received COVID-19 vaccines. There have been no reports of any increased risk of pregnancy loss (16-20), fetal growth problems, or birth defects (9).

  4. COVID-19 vaccines have no effect on fertility. There is no information to suggest that any vaccines—including COVID-19 vaccines—affect your ability to get pregnant now or in the future (9, 21-23).

  5. Pregnant people may have the same mild side effects from the COVID-19 vaccines, like fever, headache, and being tired, that nonpregnant people have. No serious side effects have been reported by people who have been vaccinated while pregnant (9, 24, 25).

 

Get the Facts.
Get Vaccinated.

References

1.         Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morbidity and mortality weekly report 2020 Jun 26;69(25):769-75.

2.         Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MWR Morbidity and mortality weekly report 2020 Nov 6;69(44):1641-7.

3.         Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, et al. SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics - Eight U.S. Health Care Centers, March 1-May 30, 2020. MMWR Morbidity and mortality weekly report 2020 Sep 23;69(38):1355-9.

4.         Delahoy MJ, Whitaker M, O'Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020. MMWR Morbidity and mortality weekly report 2020 Sep 25;69(38):1347-54.

5.         Karasek D, Baer RJ, McLemore MR, Bell AJ, Blebu BE, Casey JA, et al. The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. Lancet Reg Health Am 2021 Oct;2:100027.

6.         Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.

7.         Dagan N, Barda N, Biron-Shental T, Makov-Assif M, Key C, Kohane IS, et al. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy. Nat Med 2021 Oct;27(10):1693-5.

8.         Goldshtein I, Nevo D, Steinberg DM, Rotem RS, Gorfine M, Chodick G, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. Jama 2021 Aug 24;326(8):728-35.

9.         Girardi G, Bremer AA. Scientific Evidence Supporting Coronavirus Disease 2019 (COVID-19) Vaccine Efficacy and Safety in People Planning to Conceive or Who Are Pregnant or Lactating. Obstet Gynecol 2021 Nov 2.

10.       Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa-Cohen Y, et al. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest 2021 Oct 1;131(19).

11.       Prabhu M, Murphy EA, Sukhu AC, Yee J, Singh S, Eng D, et al. Antibody Response to Coronavirus Disease 2019 (COVID-19) Messenger RNA Vaccination in Pregnant Women and Transplacental Passage Into Cord Blood. Obstet Gynecol 2021 Aug 1;138(2):278-80.

12.       Perl SH, Uzan-Yulzari A, Klainer H, Asiskovich L, Youngster M, Rinott E, et al. SARS-CoV-2-Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. Jama 2021 May 18;325(19):2013-4.

13.       Pace RM, Williams JE, Jarvinen KM, Belfort MB, Pace CDW, Lackey KA, et al. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio 2021 Feb 9;12(1). pubmed/33563823

14.       Romero Ramirez DS, Lara Perez MM, Carretero Perez M, Suarez Hernandez MI, Martin Pulido S, Pera Villacampa L, et al. SARS-CoV-2 Antibodies in Breast Milk After Vaccination. Pediatrics 2021 Nov;148(5).

15.       Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. American journal of obstetrics and gynecology 2021 Mar 26.

16.       Kharbanda EO, Haapala J, DeSilva M, Vazquez-Benitez G, Vesco KK, Naleway AL, et al. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. Jama 2021 Oct 26;326(16):1629-31.

17.       Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Haberg SE. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. The New England journal of medicine 2021 Oct 20.

18.       Trostle ME, Limaye MA, Avtushka V, Lighter JL, Penfield CA, Roman AS. COVID-19 vaccination in pregnancy: early experience from a single institution. Am J Obstet Gynecol MFM 2021 Aug 16;3(6):100464. 19. Trostle ME, Penfield CA, Roman AS. Adjustment of the spontaneous abortion rate following COVID-19 vaccination. Am J Obstet Gynecol MFM 2021 Oct 14:100511. 20. Zauche LH, Wallace B, Smoots AN, Olson CK, Oduyebo T, Kim SY, et al. Receipt of mRNA Covid-19 Vaccines and Risk of Spontaneous Abortion. The New England journal of medicine 2021 Oct 14;385(16):1533-5.

21.       Schaler L, Wingfield M. COVID-19 vaccine - can it affect fertility? Ir J Med Sci 2021 Oct 15. https://www.ncbi.nlm.nih.gov/pubmed/34496196.

22.       Bowman CJ, Bouressam M, Campion SN, Cappon GD, Catlin NR, Cutler MW, et al. Lack of effects on female fertility and prenatal and postnatal offspring development in rats with BNT162b2, a mRNA-based COVID-19 vaccine. Reprod Toxicol 2021 Aug;103:28-35.

23.       Bentov Y, Beharier O, Moav-Zafrir A, Kabessa M, Godin M, Greenfield CS, et al. Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Hum Reprod 2021 Aug 18;36(9):2506-13.

24.       Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. The New England journal of medicine 2021 Jun 17;384(24):2273-82.

25.       Centers for Disease Control and Prevention. v-safe and Registry Monitoring people who report pregnancy. 2021 Accessed July 1, 2021; Available from: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafepregnancyregistry.html

 

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