COVID-19 Vaccine: Should Pregnant or Breastfeeding Women Get It?

December 22, 2020

Clinical Contributors to this Story

Thomas Bader, M.D. contributes to topics such as Medical Quality.

As the COVID-19 vaccine becomes available for more people, women who are pregnant have the option to take the vaccine. However, it’s important to note that the vaccine was not tested in clinical trials on pregnant women.

It is not unusual that vaccine clinical trials don’t enroll women who are pregnant or lactating until the vaccine has shown to be safe in people who are not pregnant. So far, this is true for the leading COVID-19 vaccines, including the Pfizer-BioNTech and Moderna clinical trials.

Here are some things to consider when deciding to receive the COVID-19 vaccine while pregnant or breastfeeding.

Virus Risk vs. Vaccine Risk

The first thing you should be aware of is that the virus itself likely poses a greater risk to pregnant or breastfeeding women than the vaccine. Based on this and what we know about other vaccines and pregnancy or breastfeeding, the Food and Drug Administration noted within Pfizer-BioNTech’s Emergency Use Authorization (EUA) that these women may opt in for immunization, if they choose.

Many health care associations, including the Society of Maternal Fetal-Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG), have emphasized the importance of pregnant and breastfeeding women being able to choose to get vaccinated, especially those who work in health care. ACOG expects that the safety of the vaccine in pregnant women would be similar to that observed in non-pregnant women.

“Historically, vaccines have been given to pregnant and breastfeeding women and have been deemed appropriate and safe to do so,” says Thomas Bader, M.D., OB/GYN and vice president of medical quality for Hackensack Meridian Health. “The general concern about vaccines and pregnancy or women who are breastfeeding is the use of ‘live virus’ vaccines but the Pfizer-BioNTech and Moderna COVID-19 vaccines are not ‘live virus’ vaccines, they are mRNA vaccines.”

How do mRNA vaccines work?

The vaccine is injected into the muscle and teaches the cells how to make a harmless piece of the spike protein for the new coronavirus. The spike protein’s presence sits on the surface of the cells and triggers the body’s immune response so that it develops antibodies to protect us from getting infected with COVID-19.

“The one major concern with this type of vaccine is that when your immune system is activated, you can develop a fever, which is something to be avoided when pregnant,” says Dr. Bader. “With that in mind, it is important that if a pregnant woman gets a fever from the vaccine, that the mom-to-be treat her fever with acetaminophen, unless otherwise directed by her physician, as that is what is recommend for treating fevers during pregnancy.”

The Centers for Disease Control and Prevention (CDC) noted that breastfeeding women can choose to receive the COVID-19 mRNA vaccines as they are not ‘live virus’ vaccines and therefore are not thought to pose a risk to nursing infants.

How Should I Decide if the Vaccine is Right for Me?

Since pregnant and breastfeeding women are eligible to receive this vaccine if they choose to, the CDC recommends that these women consult their practitioners and assess their individual risk before making their decision. This would include considering the likelihood of them becoming infected with COVID-19 and if they were to become infected, how high is the risk that they will become seriously ill.

A pregnant woman working in a health care setting would have a higher personal risk than one who is working from home and can quarantine, and therefore may benefit more from receiving the vaccine while pregnant.

“If you are pregnant or breastfeeding, speak with your physician or midwife to determine what’s best for you,” says Dr. Bader. “Together you can put a risk assessment together based on your personal risk factors, as well as what we know about mRNA vaccines and other vaccines given during pregnancy to decide what makes sense for you.”

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The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.