The COVID-19 Vaccine and Pregnancy: What You Need to Know

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The first COVID-19 vaccines are available to patients and the public, and with that come many questions regarding administration of the available COVID-19 vaccines in pregnant and lactating women. Andrew Satin, M.D., director of gynecology and obstetrics, and Jeanne Sheffield, M.D., director of maternal-fetal medicine, provide information on this topic.

Is the COVID-19 vaccine available to pregnant women?

Yes, COVID-19 vaccines currently authorized by the Food and Drug Administration (FDA) are recommended for pregnant and lactating individuals as well as those trying or intending to become pregnant. We strongly recommend that women with remaining concerns, talk with their doctor to discuss all factors about the vaccine and their pregnancy. The recommendation is based on the following:

  • Symptomatic pregnant women who contract COVID-19 are at more risk of severe illness, complications and death than non-pregnant women. Many pregnant women have medical conditions that put them at further increased risk.
  • COVID-19, particularly the delta strain, is on the rise in many communities.
  • Over 200,000 pregnant women have received an mRNA vaccine (Pfizer or Moderna), without any safety concerns.

Why it is important for pregnant individuals to get vaccinated?

Data strongly indicate that the benefits of getting a COVID-19 vaccine far outweigh risks for individuals who are pregnant or might become pregnant in the future.

The CDC recently released data showing the highest number of COVID-19-related deaths in pregnant people in a single month was in August 2021. Data also indicate that 97% of pregnant people hospitalized, either for illness or labor and delivery, with confirmed SARS-CoV-2 infection were unvaccinated.

Should pregnant and lactating women receive the COVID-19 vaccine?

Yes. Johns Hopkins Medicine agrees with and strongly supports the recommendations of the CDC, the Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) who recommend that all pregnant or lactating individuals, along with those trying to get pregnant, be vaccinated against COVID-19.

The Centers for Disease Control and Prevention includes pregnant women as a high-risk group for severe COVID-19 illness, though severe disease is fortunately uncommon. The decision to receive the COVID-19 vaccine should be a shared decision among a woman, her care partner(s) and medical provider(s).

Starting Sept. 1, 2021, all Johns Hopkins Medicine personnel, including newly hired individuals, are required to be fully vaccinated for COVID-19. This includes women who are pregnant, breastfeeding or planning to become pregnant. We have changed our policy because of recently updated CDC guidance based on accumulated data of the COVID-19 vaccines’ efficacy. JHM personnel requesting or who have previously been approved for a pregnancy-related exception to the vaccine must provide a note from their physician before Oct. 4.

JHED ID required: Full vaccination requirements for Johns Hopkins Medicine staff can be viewed on our internal portal.

COVID-19 Vaccine Guidelines for Pregnant and Breastfeeding Women

  • The FDA’s original emergency use authorization for the Pfizer-BioNTech COVID-19 mRNA vaccine, which was made before much was known about impacts during pregnancy, states: “If you are pregnant or breastfeeding, discuss your options with your healthcare provider.”
  • Recently, based on review of evidence, the CDC, ACOG and SMFM recommend that FDA- authorized COVID-19 vaccines should be recommended to pregnant and lactating individuals.
  • For those with on-going concerns, a conversation between the patient and her clinical team may assist with decisions regarding the use of vaccines.
  • Over 200,000 pregnant women have received an mRNA vaccine (Pfizer or Moderna), without any safety concerns.
  • The World Health Organization (WHO) states they do not have any reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women. Pregnant women at high risk of exposure to SARS-CoV-2 (for example, health workers) or who have comorbidities (health conditions that may contribute to death) that add to their risk of severe disease, may be vaccinated in consultation with their health care provider.
  • You can review their recommendations here:

Can I get the COVID-19 vaccine if I am breastfeeding?

Yes. In fact, it is now recommended by ACOG, SMFM, and Johns Hopkins Medicine Obstetrics leaders. Based upon available data, it appears safe to get the COVID-19 vaccine if you are nursing a baby. Although the vaccines were not initially studied in nursing mothers, review of the evidence by ACOG, SMFM, and CDC revealed no adverse safety issues in women and their babies. The vaccines do not contain live virus, so being vaccinated does not pose a risk to the baby. If you are vaccinated for the coronavirus, there is no need to delay or discontinue breastfeeding. 

Will the COVID-19 vaccine affect my fertility?

No, getting the COVID-19 vaccine will not affect your fertility. Women actively trying to conceive may be vaccinated with the current COVID-19 vaccines — there is no reason to delay pregnancy after completing the vaccine series.

Confusion around this issue arose when a false report surfaced on social media, saying that the spike protein on this coronavirus was the same as another spike protein called syncitin-1 that is involved in the growth and attachment of the placenta during pregnancy. The false report said that getting the COVID-19 vaccine would cause a woman’s body to fight this different spike protein and affect her fertility. The two spike proteins are completely different, and getting the COVID-19 vaccine will not affect the fertility of women who are seeking to become pregnant, including through in vitro fertilization methods. During the Pfizer vaccine tests, 23 women volunteers involved in the study became pregnant, and the only one in the trial who suffered a pregnancy loss had not received the actual vaccine, but a placebo. 

Does the COVID-19 vaccine affect pregnant women’s immune systems?

The vaccine activates the immune system to help patients fight the viral infection.

Some expectant moms have voiced concerns about the risk of miscarriage after being vaccinated. What can you tell us about that?

Results from published studies suggest that there is no increased risk of first trimester loss in patients who receive any of the three vaccines currently approved for emergency use authorization. These include the Pfizer, Moderna and the Johnson & Johnson vaccines.

What effects does the vaccine have on me and my child while breastfeeding?

There is limited data regarding breastfeeding, but some case reports suggest that lactating women who receive the vaccine will pass protective antibodies in the breast milk to their babies. It’s important to remember, the vaccines do not contain live virus, so there isn’t an infection risk to the baby, nor should you delay or discontinue breastfeeding after getting the vaccine.

Can I get COVID-19 from the coronavirus vaccine?

No, you cannot catch COVID-19 from the currently available vaccines. You may experience mild, temporary side effects, but this is an indication of the immune response to the vaccination, not COVID-19.

Learn more about COVID-19 vaccines, their safety and side effects, and what to expect if you choose to be vaccinated

Can COVID-19 be severe in pregnant women?

Yes, the Centers for Disease Control and Prevention includes pregnant women as a high-risk group for severe COVID-19 illness. Therefore, getting vaccinated for the coronavirus is an important consideration for pregnant women.

  • Recent data report an increased risk of intensive care unit admission, need for mechanical ventilation and ventilator support, and death in pregnant women with symptomatic COVID-19.
  • Co-morbidities (health conditions that may contribute to death) as well as several racial and socioeconomic factors increase the risk of severe COVID-19.
  • Lactating women are not considered at higher risk of developing severe illness compared with the non-pregnant population.

As always, be sure to talk to your obstetrician about care considerations that are specific to you.

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Updated August 23, 2021