Dr. Nicholas Bodenheimer smiles in a white lab coat
Dr. Nicholas Bodenheimer

As more people become eligible to receive the COVID-19 vaccine, experts continue to say it is safe for both pregnant and breastfeeding mothers. So, what can pregnant women expect? And what are the known risks, if any? Dr. Nicholas Bodenheimer, an obstetrician and gynecologist at Novant Health OB/GYN – Bolivia, answers the important questions about vaccine safety.

If I am breastfeeding or considering pregnancy, should I get the vaccine?

At this time, one of the largest professional organizations guiding women's health in the United States, the Society for Maternal Fetal Medicine (SMFM), endorses the recently approved Pfizer and Moderna COVID-19 vaccines for use in pregnancy, lactation or in those considering pregnancy.

The American College of OB/GYN (ACOG) also states the vaccine should not be withheld from pregnant women who meet the criteria. Both ACOG and SMFM support vaccination of nursing mothers without discarding breastmilk and support getting the vaccine even if you are trying to conceive. They recommend getting the vaccine even if you are pregnant.

Is the vaccine safe?

Since the vaccines are not live and provide "blueprint instructions" for your body to generate a protective response, there is only a very small chance the vaccine can cross the placenta, so it's unlikely to reach the fetus. These "blueprint instructions" in the vaccine also degrade within 24 to 48 hours and do not survive long enough to affect a developing pregnancy over time.

The only people older than age 16 who should NOT get the vaccine are those who have previously had an immediate or severe allergic reaction to an mRNA vaccine or any of its components (for example, someone who had an immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine should not receive the second dose at this time).

The Centers for Disease Control and Prevention considers a history of previous immediate allergic reaction to any other vaccine as a precaution, but not a contraindication, to receiving an mRNA COVID-19 vaccine. If you have had such a reaction, the CDC suggests consulting your doctor.

Why is it OK to get the COVID-19 vaccine but not the MMR vaccine during pregnancy?

The only vaccines that are not recommended for pregnant women to receive are live vaccines (those that use weakened viruses to create immunity), such as the measles, mumps, rubella (MMR) shot. If you’re not already immunized with the MMR vaccine, the CDC says is very important to get that shot at least a month before becoming pregnant, as it protects against rubella, which can cause birth defects or death to the unborn child.

Unlike the MMR, other vaccines (including the flu, TDaP, hepatitis A and hepatitis B vaccines) are OK to receive during pregnancy or while breastfeeding. The COVID-19 vaccine is NOT live, and therefore considered safe to receive.

What are the known risks of getting the COVID-19 vaccine during pregnancy?

The vaccine has not yet been specifically tested in pregnant women as they were not included in the clinical trials. However, a few people who received the vaccine in the clinical trials did get pregnant. There have been no reports of any problems with these pregnancies, and they are continuing to be monitored.

What should I expect after receiving the vaccine?

Expected effects may occur in the first three days after getting the COVID-19 vaccine including mild to moderate fever, headache and muscle aches, signs the vaccine is generating the appropriate immune response. Experts recommend that pregnant people receiving the COVID-19 vaccine who develop fever take acetaminophen (Tylenol). This medication is safe to use during pregnancy and does not affect how the vaccine works.

What are the benefits of getting the COVID-19 vaccine?

The vaccine can help protect you from getting COVID-19. You must get both doses of the vaccine for it to be fully effective. It's not yet known whether the vaccine prevents passing the virus to others if you do get COVID-19 or how long protection lasts. At this time, vaccinated people still need to wear masks and practice social distancing.

What are the known risks of getting COVID-19 infections during pregnancy?

About 1 to 3 per 1,000 pregnant women with COVID-19 will develop severe disease. Compared with those who aren't pregnant, COVID-19-infected pregnant people:

  • 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 infection.

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