As providers we understand that the recommendations for the novel Covid-19 vaccines are an everchanging matter with updates as new vaccine platforms become available. Pregnant and breastfeeding women should be allowed to make an informed decision about their COVID vaccination through consultation with their medical providers utilizing a shared decision-making model.
Available data on mRNA Covid-19 vaccines were recently reviewed by the Advisory Committee for Immunization Practices to the CDC (ACIP). The committee stated that, “if a woman is part of a group who is recommended to receive a COVID-19 vaccine and is pregnant, she may choose to be vaccinated. A discussion with her healthcare provider can help her make an informed decision.” In addition, “while there are no data on the safety of COVID-19 vaccines in lactating women or the effects of mRNA vaccines on the breastfed infant or milk production/excretion, mRNA vaccines are not considered live virus vaccines and are not thought to be a risk to the breastfeeding infant. If a lactating woman is part of a group who is recommended to receive a COVID-19 vaccine, she may choose to be vaccinated.” Major Societies that focus on pregnant women recognize that COVID 19 infection in pregnancy can result in significant morbidity to both mother and child. ACOG, SMFM and the ACIP have stated that the vaccination should be administered to pregnant women should they request it.
The Pfizer and Moderna vaccine platforms are novel. These are mRNA vaccines and they do not contain a live virus like other vaccines. The vaccine delivers a viral mRNA in a lipid nanoparticle (coat) to the cells near the injection site. The cells produce a viral spike protein, and this generates an immune reaction that leads to protection. The mRNA itself is broken down and does not enter the cells’ nucleus. It is therefore believed that the theoretical risk of harm to a fetus or breastfeeding infant from mRNA vaccines is low.
1. Pregnant individuals will need to consider their own risk for exposure and illness in the event of SARS Cov-2 infection (i.e. the presence of additional risk factors) and balance those considerations against the absence of specific pregnancy data about vaccine safety in pregnancy. Not all pregnant employees face the same risk of exposure or progression to severe disease, and therefore these decisions should be individualized. Pregnant individuals should be given the option to be vaccinated in the wave in which they are eligible or defer until more data are available.
2. Pregnant women who are identified after receipt of the first dose of a COVID-19 vaccine should be offered the option to receive the second dose at the recommended interval or defer the second dose if they choose. We recommend completing the vaccination series and do not recommend only receiving one dose.
3. Breastfeeding should not be considered a contraindication to receipt of a COVID-19 vaccine. Breast milk may be given to the baby regardless of vaccination and therefore there is no need to “pump and dump”.
4. Fertility patients should not delay childbearing at this time to await vaccine administration.
Additional COVID-19 vaccines utilizing different platforms are in active development. Some vaccines in the pipeline employ conventional vaccine platforms commonly and safely used in pregnancy (e.g. similar to seasonal flu vaccines) while others utilize technology similar to an Ebola vaccine (Ebola vaccine is an mRNA vaccine similar to current COVID vaccines), which has been inadvertently administered to pregnant women without a statistically increased observed risk of pregnancy loss.
Physicians at New England OB-GYN do support vaccination against COVID 19 during pregnancy and in breastfeeding patients given the current support and backing from our major obstetrical societies. We will continue to update our patients as more information comes due.