COVID-19 Vaccine During Pregnancy: Everything Parents Should Know
You have questions — and a baby on the way. Here’s what parents need to know about getting the COVID-19 vaccine during pregnancy, including promising new data.
Remember back in March 2020 when there were cheeky murmurs about a coming spike in births in nine months, since we were all stuck at home with our partners? As it turns out, there could be 300,000 fewer U.S. births in 2021. One potential reason: The Centers for Disease Control and Prevention (CDC) has said that pregnant people are at increased risk for severe illness and death from COVID-19 compared with non-pregnant folks of reproductive age.
One review of several studies indicated that pregnant people were 62 percent more likely to be admitted to the ICU and 88 percent more likely to require the use of a ventilator. "This is most likely a result of cardiovascular and respiratory changes that occur in pregnancy, which put pregnant people at higher risk of severe disease," says Marta Perez, M.D., a Parents advisor and assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis.
That's all the more reason for pregnant people to strongly consider getting the COVID-19 vaccine. The two-dose Pfizer and Moderna vaccines are about 95 percent effective. And with 66 percent overall efficacy, the one-dose Johnson & Johnson vaccine is also considered a huge achievement by health experts. (The Johnson & Johnson vaccine was temporarily paused after it was linked to a rare blood clotting disorder, but it's back in circulation now with a warning label.)
All of these vaccinations are highly effective in protecting against severe COVID-19, but health experts do not yet know whether they prevent asymptomatic COVID-19. And while there is emerging evidence that the vaccines reduce the spread, some unknowns remain.
Given evolving information around the virus and vaccines, it's natural that expectant folks have questions. Parents asked health experts to share the most up-to-date information on how the vaccine might affect those who are pregnant or who intend to be soon.
Can Pregnant People Get the COVID-19 Vaccine?
Yes, pregnant people can receive the COVID-19 vaccine. Three vaccine drugmakers (Pfizer, Moderna, and Johnson & Johnson) were granted emergency use authorization from the Food and Drug Administration (FDA). This made the vaccine available to high-risk individuals, including pregnant women-although every American older than 12 is now eligible to get vaccinated.
Research is currently being conducted on pregnant and lactating individuals because they weren't originally included in any clinical trials. But CDC Director Dr. Rochelle Walensky, who spoke during a White House COVID-19 briefing, recently recommended that pregnant women get vaccinated.
She cited a study published in The New England Journal of Medicine, which researched 35,000 pregnant people who got vaccinated with Pfizer or Moderna. It found no red flags in pregnant people-even those in the third trimester. Indeed, the participants only experienced typical COVID-19 vaccine side effects, such as pain at the injection site, headache, chills, and fever. What's more, no neonatal deaths were reported in the study, and adverse reactions (like preterm birth and small size) seemed unrelated to the vaccine.
The CDC hasn't updated their official guidance to reflect Dr. Walensky's recommendation. It still states that vaccination is a personal choice during pregnancy.
Why Weren't Pregnant People Included in Early COVID-19 Vaccine Trials?
Before a COVID-19 vaccine is released to the public, it has to undergo strict testing through the FDA. The White House's Operation Warp Speed, which aimed to deliver 300 million vaccine doses by January 2021, helped researchers complete clinical trials in record time. The trials mainly included healthy adults without underlying health conditions, according to Christine Turley, M.D., pediatrics specialist and vice chair of research at Atrium Health Levine Children's. In these early stages, pregnant women were completely excluded.
It's actually the norm for expectant parents to be left out of clinical trials. "Pregnant women are a complex group of individuals to include in any research," says Dr. Turley, adding that pregnancy itself is considered an "immunocompromised state." Experts simply don't understand the risks to the fetus, and they don't want to put any lives in danger.
"Usually trials with [pregnant women] start later, after deemed safe in other groups," explains Purvi Parikh, M.D., an allergist and immunologist with the Allergy and Asthma Network and co-investigator on the vaccine trials. And that's exactly what's happening now: COVID-19 vaccine safety and efficacy is being tested in pregnant women. In fact, Pfizer is expecting clinical trial data for pregnant women by early August, according to The New York Times.
Is the Vaccine Safe for Pregnant People and Babies?
"We have very little concern that the COVID-19 vaccines could harm a pregnant person or their developing fetus," says Geeta Swamy, M.D., a member of The American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Doctors indicate that this is true regardless of trimester.
After injection, the vaccine doesn't move much beyond the muscle cells and immune cells in lymph nodes, and it doesn't alter DNA, so it cannot cause genetic changes. In addition, "the vaccine doesn't contain live virus, so there's no risk of infecting the mom or baby with COVID," says Judette Louis, M.D., department chair of obstetrics and gynecology at the University of South Florida in Tampa.
The CDC hasn't officially recommended the vaccine because pregnant people weren't included in the trials, but there's no reason to believe it's not safe, says Dr. Swamy, who notes that the vaccine's potential effects on pregnant people are being studied. President Joe Biden's chief medical advisor, Anthony Fauci, M.D., said in early February that the more than 10,000 pregnant people who'd been vaccinated had not experienced any unusual effects.
It's also worth noting that while the World Health Organization initially said there wasn't enough data to recommend vaccinating while pregnant, it now recommends vaccination for pregnant people who have a high risk of exposure or a high-risk medical condition. The bottom line: Most scientists studying the question believe that the risk of not getting the vaccine while pregnant far outweighs any risks associated with the vaccine itself.
Indeed, although increased risk of miscarriage or birth defects hasn't been associated with COVID-19, there appears to be a two- to three fold increased risk of preterm delivery, because if the mother has severe COVID-19 disease, delivery may be performed in hopes of optimizing her care, says Dr. Louis. If you're COVID-positive when you give birth and your baby is admitted to the NICU, you may not be permitted to visit for ten to 20 days.
Can Newborns Get the COVID-19 Vaccine?
As of now, the vaccines are approved only for people 12 and older. While there are vaccine trials underway that include kids, vaccines for babies will probably be the last to be approved. But COVID-19 infections in newborns are very uncommon, and severe illness appears to be rare, according to the CDC. However, preterm babies and those with underlying conditions may be at an elevated risk of severe COVID-19 illness.
That said, getting the vaccine while pregnant or nursing might help protect your baby from COVID-19. "We don't know for sure, but we think that it's highly probable," Dr. Swamy says. This hypothesis is based on the fact that when the influenza and Tdap vaccines are given during pregnancy, babies are protected for a few months. Similarly, "some types of antibodies cross into breast milk," says Dr. Perez, who got her own COVID-19 vaccine two weeks postpartum while nursing.
I Got the COVID-19 Vaccine-Now What?
No vaccine has an efficacy of 100 percent. And while the CDC says vaccinated individuals don't need to wear masks or social distance in most cases, pregnant people should try limiting exposure as much as possible. "Make sure you are in the best health possible so that if you do get sick, your body and immune system is able to fight it," says Dr. Parikh. "This includes appropriate doctors visits, vitamins, getting other vaccines like the flu shot, and proper sleep and nutrition."
Another COVID-19 prevention method is creating a "bubble of protection" around expectant parents, suggests Lorene Temming, M.D., Medical Director of Labor and Delivery, maternal-fetal medicine specialist, and Director of the Medical Student Clerkship program at Atrium Health. This means that partners, family members, and other close contacts should be vaccinated, so if they're ever exposed to the coronavirus, they have a smaller chance of transmitting it to the expectant parent.
The Bottom Line
While the American College of Obstetricians and Gynecologists recommends that pregnant women receive the vaccine, the CDC suggests pregnant people discuss with their health care provider to make an informed decision. Hopefully as the COVID-19 vaccine becomes more widely available and more testing is done, we'll have a lot more information about how it impacts pregnant people. For now, expectant parents must make the decision for themselves. If you're still unsure, check out this guide from the ACOG, which gives pointers for talking to your health care provider about vaccine considerations.