Covid Vaccines in Pregnancy & Breastfeeding

Can or should you get the Covid vaccine during pregnancy? It is going to be a hard choice for pregnant and nursing moms. Balancing the risk and the benefits is going to be key, and the answer may be different for each family.

How do I know this, and why should you value my opinion? Hi, I’m Hilary — The Pregnancy Nurse. I’ve been a nurse since 1997 with varied experience along with 20 years in labor and delivery.

As a nurse, with tons of labor and delivery experience, as well as being in the covid 19 vaccine trial myself I am interested in this topic, and excited to give you guys a review of what I have read so far.

As a note: Covid is a crazy time during pregnancy and I have an online course that prepares you for your birth. It is done entirely from the safety of your home and thousands of women take it each year and love it.

Covid Vaccine in Pregnancy

What types of risks does Covid pose towards pregnant people?

Pregnant women ARE at a higher risk from Covid. They are a vulnerable population, similar to the elderly. They aren’t more likely to GET Covid, but they are more likely to be admitted to the ICU or have pregnancy complications associated with it. It is similar risks to pregnancy and the flu (and we do recommend pregnant women get the flu shot, including at any point in their pregnancy).

It does NOT look like the virus is passed to the baby during its gestation (meaning if mom is positive and delivers their baby, most often the baby is tested as negative).

** Keep in mind that data is small at this point in time because it is so new, so stay tuned for more information.

Also, I have a whole article on Covid during pregnancy on my sister site Pulling Curls.

What are the types of vaccines?

Currently, there are two types of vaccines that have shown to be effective towards covid thus far:

Moderna & Pfizer are an mRNA vaccine, which is a new type of vaccine.

The Johnson & Johnson and the AstraZeneca vaccine is a vector vaccine that has been used (in things like Ebola) although not in general vaccines we already get routinely in the US.

FYI, I was in the AstraZeneca vaccine trial.

Can the RNA vaccine alter your own DNA?

No, your DNA is already made you, you. Dr Perez (see her video here) says it’s like trying to take eggs out of a cake you’ve already baked — which is a great metaphor.

Were pregnant women in the Covid Vaccine Trial?

No, they were not. In fact, when I was in the trial they confirmed when my IUD was placed and that my chance of pregnancy was very low. I also got a pregnancy test each time before I got the vaccine.

Keep in mind that vaccines ARE routinely recommended during pregnancy and breastfeeding including the flu shot and the tDap (which protects against pertussis).

We also give the MMR vaccine after pregnancy while women are breastfeeding. Because the MMR is a live vaccine (all Covid vaccines are dead versions of the virus) it is not recommended during pregnancy.

They, however are starting vaccine trials in pregnant women which is GREAT NEWS. I think this has really also started a discussion on if pregnant women should be included in trials, especially phase 3 — which is probably overdue.

SMFM Vaccine Statement

This statement can be found here. SMFM is the professional group of high risk pregnancy doctors (called maternal fetal medicine).

This group of maternal fetal medicine is frustrated that pregnant and lactating women were not included in the study. A valid concern but I know the pharma companies don’t want to get sued — which is why most medical companies shy away from testing pregnant and breastfeeding women (especially first thing).

mRNA vaccines have not be tested in pregnant women, as they are brand new. But they do say that the theoretical risk of fetal harm from this type of vaccine is very low.

The vector vaccine type was used in the ebola vaccine, and was used safely in pregnant women. This obviously wasn’t the SAME vaccine, but was the same kind. Kind of like cousins.

They do recommend that healthcare workers are offered the vaccine, and they recommend those outside of the health care profession consider it in consultation with their provider.

In general, I have heard that some health care facilities (providing it to their front line workers) are not offering it to pregnant women, and some are.

Since, as of this writing the vaccine isn’t available at all — it will be interesting to see as it rolls out.

ACOG Statement on Vaccinating Pregnant & Lactating Women

ACOG is the professional organization for OB’s and gynecologists. You can see it all here.

They remind us that it is a fluid situation, which I think is important to remember. We will constantly be getting more data.

They recommend the vaccine is offered to both pregnant and lactating women. But they also recommend we support women who make either choice, and if the mother would prefer to not get it. Those who surround her should continue with Covid precations. Which is good advice.

And, similarly, women should council with their providers as well as understand the risks (including a lack of data) and the benefits before making their choice.

Consensus on Covid Vaccine in Pregnant Women

While the data is sparse, it is coming in — the consensus seems to be that vaccinating pregnant women is likely safe. But, they also say that they want to see data, because that’s how doctors/researchers are.

Adverse Events for Covid Vaccines in General

In the general population, adverse events were VERY low with these vaccines. They seem to be very safe. That is reassuring to pregnant women (and to all of us).

Taking your risks into your decision

You and your family’s circumstances will be difficult to decide. I would discuss it with your provider considering both your family’s risks and your benefits.

Things like:

• Your occupation (obviously healthcare workers have the hardest time with this one
• Your other risks (like other health problems)
• How much your family can isolate (so, if your partner is a health care provider)
• Your family’s risk (because you could pass it onto them if you are not vaccinated)

The good news is that you can discuss your individual risks and benefits with your provider. Everyone’s answer is going to be different.

What the FDA Says about the Covid Vaccine During Pregnancy

The US government current says that the pfizer vaccine: “has not yet been assessed in pregnancy, so it has been advised that until more information is available, those who are pregnant should not have this vaccine.”

Similar advice is given in UK Government.

Why this? Because they haven’t been tested, that’s why. They have to say that because they are all about data. So far there is no positive OR negative data towards these vaccines during pregnancy. And, like I said above — they are doing formal clinical trials (but the results will take a bit).

Transferring Covid Antibodies to Babies

The extremely positive news is that it looks like antibodies to covid (both gotten through getting the disease as well as the immunization) do transfer to the fetus, which would mean that your baby has some protection during their early life. This is extra good news, as babies will be one of the last ones to have the vaccine tested on them.

They are also showing that the antibodies transfer through breastmilk. All GREAT news!

Keep in mind, you will have more/greater antibodies due to the immunization most often vs the disease. So, it’s a reason to get the vaccine even if you have had the disease.

Why the hesitancy on the vaccine during pregnancy?

Vaccine companies did not want to test pregnant women. In general, science is hesitant to possibly create a life that could be hampered by this choice during their creation.

Also, the courts have most often favored pregnant women and children who were harmed in any way by things done in pregnancy, even if they know the risks at the time. That makes risks to the companies offering the vaccine very high.

Covid Vaccine Risks During Lactation

As far as I can tell, they are not finding that there are many risks to breastfeeding, and the huge benefit is that your antibodies could be passed to the baby while nursing. Good news!

As far as I know (beyond some vaccines if you are traveling outside the US) no vaccines are contraindicated during pregnancy.

Conception & the Covid Vaccine

If you are waiting for significant data on the safety of the vaccine, you will be waiting many months to possibly years.

You will have to weigh the risks of waiting or getting the vaccine.

Be mindful that all the vaccines so far require 2 dosages, so that would further delay pregnancy by about 3-4 weeks.

Fertility & the Covid Vaccine

There is no evidence that the people in the vaccine trials so far have had any issue with fertility. Several people did get pregnant during the mRNA trials, and more miscarriages were found in the placebo group vs the vaccine group.

I found this article to be helpful.

Covid Vaccine Videos & Articles

There are a few videos that I found helpful:

Dr Perez (she’s a favorite of mine)

Mama Doctor Jones

NPR had an article on how pregnant women should decide on getting the vacine.

What should you do?

You should weigh the risks and the benefits. Just like any other decision during pregnancy.

What would I do? Since I was a pregnant nurse with all three of my kids I probably would have held back a bit, especially if I was early in my pregnancy. However, I was young and with few problems with the pregnancies. For me, the risks of Covid probably wouldn’t have been enough for ME to be in the first few pregnant women to be vaccinated.

If I was breastfeeding, and past about my intial first six weeks (which are fairly easy to quarantine through) I would get it. Mostly, I wouldn’t add to my immune system’s strain (or to feel MORE tired from getting the vaccine) in those first six weeks as I was healing — that would be my reasoning as well.

I only say what I would do to give you an idea of how I would weigh my own risks and benefits.

But, you need to take you and your risks into mind. What will you do? Tell us in the comments!

As a note: This is not an area for anti-vaccine comments. I will delete them, and possibly turn off comments in an area where pregnant women can talk openly and freely about the considerations they are each having during this precarious time.

Please allow each person their own choice for themselves, their body and their family. Any general negativity towards vaccines or women making choices will NOT BE TOLERATED.