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

Please note: Following the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA), Hackensack Meridian Health has resumed administration of the one-shot J&J vaccine at all vaccination locations. We concur with federal and state authorities and do not recommend one vaccine over another. All authorized COVID-19 vaccines are safe, effective, and reduce the risk of severe illness. HMH continues to proudly offer all three of the authorized COVID-19 vaccines to our patients and members of the community. Schedule your vaccine appointment today!

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, Moderna and Johnson & Johnson (J&J) Janssen 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 the Emergency Use Authorizations (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 Abdulla Al-Khan, M.D., division director of the department of obstetrics, gynecology & women’s health 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 the vaccines work?

In the case of the vaccines using mRNA technology, 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 J&J vaccine is based on a viral vector platform which uses a gene code unique to SARS-CoV-2 that helps produce a spike protein and display it on the cell’s surface. Once on the surface of the cell, it causes the immune system to begin producing antibodies and activating T-cells to fight off what it thinks is an infection.

“The one major concern is that when your immune system is activated, you can develop a fever, which is something to be avoided when pregnant,” says Dr. Al-Khan. “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 recommended 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.

Does the vaccine provide any protection for the baby?

As of this writing, there have been limited studies as to the transfer of protective immunity to babies while in the womb. There was a study that was published on a preprint server in early March 2021 which showed that an infant in Florida had tested positive for COVID-19 antibodies after birth from a vaccinated mother.

“While the results of this initial study are certainly encouraging, we still need some more definitive research before we’re able to determine if there’s strong evidence of immunity in these babies,” says Dr. Al-Khan.

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. Al-Khan. “Together you can put a risk assessment together based on your personal risk factors, as well as what we know about these vaccines and other vaccines given during pregnancy to decide what makes sense for you.”

Next Steps & Resources:

• Meet our clinical contributor: Abdulla Mohammad Al-Khan, M.D.
• Need a doctor? Visit our website to find one near you or call 800-822-8905

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.