The journey of trying to conceive, pregnancy and giving birth is one often filled with significant emotion. For many couples, the coronavirus pandemic has heightened these feelings, bringing with it added anxiety and questions regarding the safety of both pregnant mothers and their babies.
Much of this confusion stems from the ever-changing nature of the pandemic and the healthcare system’s approach to tackling Covid-19; one such new intervention in our fight against coronavirus is the introduction of the Pfizer-BioNTech Covid-19 vaccination across multiple countries, including the UK, USA and Canada (1-5).
This post will summarise the most up-to-date guidance from public health and specialist women’s health regulatory bodies concerning the safety of the Covid-19 vaccination in pregnancy and breastfeeding.
If you would like more in-depth information on trying to conceive, being pregnant and/or delivering a baby amidst the coronavirus pandemic, please see our detailed blog post on this topic.
💉 Is it safe for pregnant women to receive vaccinations?
Current evidence has shown that there is no known risk to either a woman or her baby of receiving an inactivated viral, bacterial or toxoid-containing vaccine during pregnancy and/or breastfeeding (1). Pregnant and breastfeeding women are routinely offered multiple vaccinations, such as those that protect against the flu and whooping cough (2). These vaccines have been widely demonstrated to be safe in both pregnancy and breastfeeding, and help keep both mother and baby safe from serious infections (2).
💉 Will pregnant women be offered the Covid-19 vaccination?
The current guidance on receiving the Covid-19 vaccination during pregnancy is changing rapidly as new information is collected on its safety (1-4, 6, 7); these guidelines were most recently updated on December 30 2020 (2).
The Royal College of Obstetricians and Gynaecologists (RCOG) has advised UK-based pregnant women who are classified as ‘clinically extremely vulnerable‘ to consider receiving the Covid-19 vaccination during pregnancy (2). Women who meet these criteria would include: transplant recipients, those currently receiving chemotherapy for cancer and those with serious heart conditions, among others (8); the complete list of conditions categorised as ‘extremely vulnerable’ can be found here.
The guidance for ‘extremely vulnerable’ pregnant women in the UK is based on advice from both the Joint Committee on Vaccination and Immunisation and Public Health England who have taken a risk-benefit approach to their recommendations (1, 2, 6, 8). At present, there is very limited specific information on the safety of the Covid-19 vaccination in pregnancy (1, 2, 6); however, data gathered thus far by Public Health England has not demonstrated any safety concerns for pregnant women or babies related to the vaccine (1).
In addition, there is no known safety risk to pregnant women of receiving other inactivated (non-live) vaccinations (1, 2). The rationale for their recommendation is that pregnant women who are ‘extremely vulnerable’ are more likely to be at high-risk of suffering serious complications of Covid-19 should they contract the virus, putting both mother and baby’s health at risk (1, 2, 6).
At present, the risk to these women and their babies of developing serious adverse effects of Covid-19 (should they contract the virus) is considered greater than the risk of adverse effects from the vaccination itself (1, 2, 6).
Frontline workers
Frontline workers who are pregnant (including healthcare professionals, social care workers and residential home carers) can also discuss the option of receiving a Covid-19 vaccination with their doctor or midwife (2). This is because frontline workers are more likely to be exposed to coronavirus on a regular basis, even if they are otherwise fit and well and thus unlikely to develop serious complications from the virus (2).
Current guidance specifies that there is insufficient safety data available to recommend routine Covid-19 vaccination of pregnant women in the UK (2, 6). This means that being pregnant on its own will not qualify you to receive a vaccination; however, if you would have otherwise been called for a Covid-19 vaccine (e.g. because you are ‘clinically extremely vulnerable’), you will be offered the choice to receive a vaccine and need not refrain from having one just because you are pregnant (2, 6).
Guidance for pregnant women in the USA is based on advice from the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) (3, 4). Their guidance is very similar to that in the UK, currently advising that the the Covid-19 vaccination should not be withheld from USA-based pregnant women who meet the criteria for receipt of a vaccine (3-5). This means that, as in the UK, only pregnant women who would otherwise be offered a vaccine will be able to receive one at this time (3-5).
Both the CDC and ACOG acknowledge the same concerns regarding the lack of available evidence on the safety of the Covid-19 vaccination in pregnancy (3, 4); however, they have publicly shared their views that the vaccine–which is not live–is unlikely to pose a safety risk to pregnant women (3-5).
Additionally, pregnant women who contract coronavirus may be at increased risk of developing a severe form of the infection (as discussed in our blog post on pregnancy and coronavirus) (3-5).
It is important to remember that for all pregnant women based in the UK and USA, the ultimate decision as to whether or not to receive a Covid-19 vaccination will always rest with the individual woman (1-4). If you have any questions or concerns about the vaccination, you can always discuss your options with a healthcare professional, such as your obstetrician, GP and/or midwife (2-4).
💉 Will women who are breastfeeding be offered the Covid-19 vaccination?
The guidance for those who are breastfeeding is very similar to that for pregnant women in both the UK and USA (1-5). The RCOG currently advises that women in the UK who are breastfeeding should be offered a Covid-19 vaccine if they would otherwise be called for one (e.g. frontline workers) (2). As with pregnancy, there is limited data on the safety of the Covid-19 vaccine in breastfeeding (1, 2, 6); however, the Joint Committee on Vaccination and Immunisation states there is no known risk of receiving the vaccine for breastfeeding women (2, 6).
Guidance from the CDC and ACOG states that the small theoretical risk of receiving a Covid-19 vaccination while breastfeeding does not outweigh the potential benefits for women of receiving the vaccine (3-5). As such, their current advice is that the Covid-19 vaccine should not be withheld from breastfeeding women in the USA who would otherwise be called for the vaccine (3, 4).
Women in both countries who have received the vaccine do not need to delay or stop breastfeeding (1-4, 6). As always, all breastfeeding women who are offered the Covid-19 vaccine can freely opt in or out of receiving it (and should be supported to discuss all questions and concerns with a healthcare professional) (1-4).
💉 What does this mean for me if I am trying to conceive?
The Joint Committee on Vaccination and Immunisation recommends that UK-based women who are trying to conceive do not need to delay pregnancy after receiving a Covid-19 vaccine (2, 6). The advice from the CDC for women living in the USA is the same (3). General guidance from the RCOG, CDC and ACOG remains for women in both countries: women who are eligible to receive the vaccination should be offered the vaccine regardless of their pregnancy status (1-4, 6).
However, it is important to acknowledge that receiving the full course of the Covid-19 vaccination prior to becoming pregnant will help protect you from contracting coronavirus and developing the serious side-effects that the virus can cause in pregnancy (2). For some women — especially for those who are high-risk for coronavirus — this might mean weighing up the pros and cons of delaying pregnancy until the vaccine is offered to them (2). There is no evidence to suggest that the Covid-19 vaccine causes any problems with fertility or one’s ability to carry future pregnancies (2).
💉 What if I learn that I am pregnant after having a Covid-19 vaccination?
As discussed previously, USA-based guidance recommends that Covid-19 vaccinations are not withheld or postponed for eligible women at any point during pregnancy (3-5).
Current guidance for UK-based pregnant women is a little less explicit (1, 2, 6). At present, the Joint Committee on Vaccination and Immunisation does not specifically comment on whether UK-based women who find out they are pregnant after receiving the first dose of the Covid-19 vaccination should have the second dose (2, 6). However, the RCOG highlights that the Committee’s most recent advice states that eligible pregnant women can receive the vaccine and those who are trying to conceive do not need to delay pregnancy post-vaccination (2).
If you have received a dose of the Covid-19 vaccination while pregnant, this will not impact the success of your vaccine and the risk of any harm to your pregnancy is very small (1, 2). The vaccination itself does not contain live SARS-CoV-2 virus, and therefore it cannot give either you or your baby coronavirus (1). Some of the vaccines contain a different virus that enables the medication to be delivered successfully; this virus is live but harmless and cannot cause Covid-19 infection in pregnant women or their babies (1).
💉 What does the future hold?
The sudden and swift introduction of the Covid-19 vaccination might understandably leave some women feeling anxious and overwhelmed about choices regarding trying to conceive and planning throughout their pregnancy. However, research is being vigorously and actively conducted to help shape our understanding of the safety of vaccinating pregnant and breastfeeding women against coronavirus, and this research will be used to shape future practice on a global scale (1, 2).
The UK Vaccine in Pregnancy Surveillance Programme is collecting data on all women who are exposed to the Covid-19 vaccine from the first day of their last menstrual period to any time-point in pregnancy (1, 7). The goal of this Programme is to assess the safety of exposure to vaccinations (including the coronavirus vaccination) among pregnant women (1, 7).
As information is compiled from this Programme and other research initiatives, the guidance on Covid-19 vaccination in pregnancy will be updated appropriately to best and most safely address the health needs of women and their babies (1, 2, 7).
If you are based in the UK and would like to stay up-to-date with the most recent advice for pregnant women on the Covid-19 vaccination programme, regular updates are posted on the Government website.
It is important to remember that current evidence suggests the risk of harm to women and their babies following exposure to the Covid-19 vaccination during pregnancy is very small (1, 2). If you have any concerns about receiving (or not receiving) the vaccination while trying to conceive, pregnant and/or breastfeeding, you can always discuss these concerns openly with a healthcare professional, such as your obstetrician, midwife or GP (2-4).
References
(1) The Safety of COVID-19 Vaccines When Given in Pregnancy. Public Health England. Published: December 18, 2020. Link: https://www.gov.uk/government/publications/safety-of-covid-19-vaccines-when-given-in-pregnancy/the-safety-of-covid-19-vaccines-when-given-in-pregnancy#the-uk-vaccine-in-pregnancy-surveillance-programme
(2) Coronavirus Infection and Pregnancy. Section: COVID-19 Vaccines, Pregnancy and Breastfeeding. Royal College of Obstetricians and Gynaecologists. Updated: December 30, 2020. Link: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/#vaccines
(3) Vaccination Considerations for People who are Pregnant or Breastfeeding. Centers for Disease Control and Prevention. Updated: December 15, 2020. Link: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html
(4) Vaccinating Pregnant and Lactating Patients Against COVID-19. The American College of Obstetricians and Gynecologists. Published: December 13, 2020. Link: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19
(5) Experts: Pregnant Women Can Get COVID-19 Vaccine. WebMD. Published: December 18, 2020. Link: https://www.webmd.com/vaccines/covid-19-vaccine/news/20201218/experts-pregnant-women-can-get-covid-vaccine#1
(6) Joint Committee on Vaccination and Immunisation: Advice on Priority Groups for COVID-19 Vaccination. Joint Committee on Vaccination and Immunisation. Updated: January 6, 2021. Link: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020
(7) Vaccination in pregnancy (VIP). Public Health England. Updated: December 18, 2020. Link: https://www.gov.uk/guidance/vaccination-in-pregnancy-vip
(8) Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. Department of Health & Social Care and Public Health England. Updated: December 31, 2020. Link: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19#cev