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The Covid-19 Vaccine in Pregnancy and Breastfeeding

Covid Vaccine

If you are currently pregnant or breastfeeding, then you probably are wondering whether or not you should get the COVID-19 vaccine. With diverse viewpoints and conflicting opinions, it can be so challenging to navigate this decision. Here, we outline the context and summarize the recommendations of leading maternal, fetal, pediatric and lactation organizations.

First, we know that pregnant people are at greater risk for more serious illness and effects from COVID-19. COVID-19 can also result in other adverse outcomes in pregnancy and birth, such as preterm birth. We also know that the virus causing COVID-19 is unlikely to be passed/transmitted through breastmilk, but that newborns and infants under age 1 are at risk of more severe illness from COVID-19.

Second, we know that pregnant and lactating people were excluded from both the Moderna and Pfizer vaccines trials. Exclusion of pregnant people is actually very common, due to the complicated ethical questions that arise regarding consent, as well as the practical simplicity of excluding pregnant individuals, allowing researchers and developers to focus on just one person rather than both the adult and baby.

This brings us to the question of risks versus benefits. The risks stemming from not having pregnant/lactating people involved in vaccine trials, with the benefits of greater protection from severe illness in pregnant and breastfeeding people and potentially greater protection for their babies. So, what do the experts say about the risk versus benefit question?

  • The American College of Obstetricians and Gynecologists recommends that pregnant women discuss the vaccine decision with their medical provider, and does unequivocally recommend COVID-19 vaccination for breastfeeding parents.

  • The Society For Maternal Fetal Medicine has a similar stance, encouraging shared decision-making between the pregnant woman and her medical provider.

  • InfantRisk Center, a reputable source for pregnancy and lactation medical questions, states (as do the previous two sources) that because the COVID-19 vaccines are not live vaccines, they believe the risks of vaccination are very low for pregnant and breastfeeding people and their babies, and agrees with ACOG and SMFM’s stance on recommending the vaccine when patients discuss it with their doctors.

  • Similarly, The Academy of Breastfeeding Medicine encourages breastfeeding moms to discuss the vaccine with their providers. They say, “there is little biological plausibility that the vaccine will cause harm, and antibodies to SARS-CoV-2 in milk may protect the breastfeeding child.” Their assessment is that the benefits of vaccination most likely outweigh the risks.

  • The American Academy of Pediatrics and the Center for Disease Control also recommends pregnant and breastfeeding people discuss the vaccine with their provider (sensing a pattern here?) and suggests that the benefits likely outweigh the risks.

  • Finally, for those wondering about the vaccines’ effects on fertility, the American Society for Reproductive Medicine’s recommendations are that, “Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.” They go on to say, “Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies.”

Ultimately, the experts all seem to be saying that even though pregnant and lactating women were not included in the trials of the Moderna and Pfizer vaccines, the risks to both mom and baby are likely very low, with the benefits potentially being much greater in being vaccinated against this virus that can be very serious in pregnant women and infants. But, as all the sources above say, we encourage you to discuss the COVID-19 vaccine with your medical provider to make a shared decision.

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