The COVID-19 Vaccine: Considerations for Pregnant and Breastfeeding Women

As the different COVID-19 vaccines become available to more people in North Texas, you may be eager for your turn. But if you’re pregnant or currently breastfeeding, you may feel unsure. For most people, getting the COVID-19 vaccine is safer than getting the illness, however, these vaccines have not been tested in pregnant or breastfeeding women yet.

The decision to receive the vaccine is 100% up to you, pregnant or not, but the following information can help you make an informed choice based on recommendations and what we know as of April 19, 2021. Just as with any other medical care, talk to your doctor for guidance.

 

The Benefits

COVID-19 is dangerous for many different people, and it has been shown to be especially dangerous for pregnant people. According to a study published in the American Journal of Obstetrics & Gynecology, people who are pregnant and have COVID-19 are five times more likely to need intensive care or the use of a ventilator to help them breathe than other women the same age with COVID-19 who are not pregnant. Pregnant people are also more likely to die of COVID-19 than non-pregnant people with COVID-19, even if they are the same age, according to the Centers for Disease Control and Prevention (CDC). Additionally, pregnant people with COVID-19 might be at increased risk of unexpected pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19.

By getting the Pfizer vaccine, you could prevent your chance of infection by up to 95%. Moderna’s vaccine prevents infection by 94.5% and John & Johnson’s reduces infection by about 66%. While Johnson & Johnson’s efficacy rates are, on the surface, lower than Moderna and Pfizer’s, the vaccines cannot be compared to each other because Johnson & Johnson’s phase 3 clinical tests were much different from the Moderna and Pfizer results and the trials were testing for different outcomes.

All approved COVID-19 vaccines are highly effective in preventing infection and decreasing the severity of illness. It is possible for people who have been vaccinated to still get COVID-19, but most will experience a milder case and are less likely to need serious medical intervention or be hospitalized if they are vaccinated.

 

The Risks

Many individuals have concerns around the safety of mRNA vaccines, which Pfizer and Moderna’s vaccines are categorized as. There is a common misunderstanding that mRNA vaccines contain the live virus, which can make you sick. But according to the CDC, mRNA vaccines only use a messenger RNA gene, not the actual virus, to trigger a person’s immune system to make protective antibodies against COVID-19.

Think of it like a severe weather alert you may get from the weather service. Because of that alert, you then prepare for the storm, buying supplies, protecting your home, and getting yourself and your family ready in case the storm hits. There’s no guarantee the storm will hit your area, but you’re prepared, nonetheless.

Johnson & Johnson’s vaccine is a viral vector vaccine. These types of vaccines use a different virus to deliver important instructions to our cells in order to trigger an immune response. The virus in the Johnson & Johnson vaccine is adenovirus, an inactive form of the virus that causes the common cold. Neither mRNA nor viral vector vaccines contain the live virus that causes COVID-19. Also, the Johnson & Johnson vaccine does not cause an adenovirus infection (common cold).

As with any vaccine, there are potential side effects. For most people, these side effects are like the ones that people have with the flu shot, though some people experience stronger side effects.

Many people receiving the vaccines have symptoms caused by their immune system’s normal response to the vaccine. The most common side effects reported are:

  • Injection site reactions, such as a sore arm
  • Tiredness
  • Headache
  • Muscle pain
  • Chills
  • Joint pain
  • Fever
  • Nausea

Statistically, out of 100 people who get the vaccine, one will get a high fever (over 102°F). During pregnancy, a persistent high fever during the first trimester might increase the risk of fetal abnormalities or miscarriage, according to the CDC. If recommended by their doctor, pregnant women experiencing fever can take Tylenol (acetaminophen) to help lower and control the fever.

Some people have also experienced allergic reactions after receiving the vaccine. Allergic reactions are reactions to medications or vaccines, and can be either non-severe or severe (CDC). If you have had an immediate allergic reaction — even if it was not severe — to a vaccine or injectable therapy for another disease, you should ask your doctor if you should get a COVID-19 vaccine. If the decision is made to get the COVID-19 vaccine, let the people giving the vaccine know you have had a history of non-severe or severe allergic reactions to an ingredient in the COVID-19 vaccine, or any other vaccine or injectable therapy (e.g., medicines or shots in the muscle, by IV, or under the skin).

If you have a severe or non-severe allergic reaction after getting the first dose of a COVID-19 vaccine, the CDC recommends that you should not get the second dose of that vaccine. The CDC also recommends people who have had a severe allergic reaction to any ingredient of the COVID-19 vaccine should not get the vaccine.

As of 4/13, the J&J vaccine is on hold by the FDA. The pause relates to potential concern over blood clots and may be associated with the adenoviral vector vaccine. The CDC is doing additional data analysis and information will be provided once available.

 

Considerations If You’re Breastfeeding

While COVID-19 vaccines are not thought to be a risk to breastfed infants, there is no data on the safety of COVID-19 vaccines in lactating women nor on the effects of the vaccines on milk production/excretion or the baby receiving the milk.

 

Developments Are Ongoing

Until we can learn more from studies, there is only limited information about the safety of COVID-19 vaccines given during pregnancy or breastfeeding, including mRNA vaccines such as Moderna and Pfizer’s vaccines, and viral vector vaccines such as Johnson & Johnson’s. But the Pfizer and Moderna vaccines have been deemed safe and effective in pregnant and breastfeeding women, according to a new study published in the American Journal of Obstetrics & Gynecology. The study also found that mothers can pass protective antibodies to their newborns via placenta or breastmilk.

Compared to pregnant women who had recovered from COVID-19, pregnant women who received the vaccine had “strikingly higher” antibody levels, the authors wrote.

In addition, the CDC has not found any safety concerns seen in animals that received the Pfizer, Moderna, or Johnson & Johnson COVID-19 vaccine before or during pregnancy. Studies of all three vaccines are ongoing.

Both Moderna and Pfizer are continuing to monitor people in their clinical trials who became pregnant after receiving the vaccine. Eighteen of these women were in the vaccine group, and two months later none had miscarried. Seventeen women in the placebo group became pregnant, and two months later two of them had had miscarriages. (In general, 11% of pregnancies end in miscarriage).

The CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and will continue to closely monitor reports. One monitoring system example is the CDC’s v-safe, a smartphone tool that uses text messaging and web surveys to provide health check-ins after someone has received a COVID-19 vaccine.

Johnson & Johnson is planning to test its vaccine in infants as well as pregnant women in the near future but they are testing the vaccine in children between the ages of 12 and 18 first. That being said, the CDC concluded that pregnant and breastfeeding women can receive the Johnson & Johnson vaccine (as well as the mRNA vaccines) because it does not contain the live virus.

 

What You Should Consider

If you are considering the vaccine, you should discuss your concerns with your health care provider. Both of you can go over your specific health and any unique risk factors you may have concerning the likelihood of being around someone else with COVID-19 and/or the likelihood of having severe illness from COVID-19, or a reaction to the vaccine. If your personal risk is high, or there are many cases of COVID-19 in your community, it may make sense for you to get a vaccine while pregnant or breastfeeding. Your health care provider will be able to talk with you about what they know so far to help you make a decision.

 

Going Forward

Ultimately, no matter what, you have the decision to receive the vaccine if it is available to you or choose to wait it out until more is known about the vaccines’ effects on pregnant women and their babies.

Pregnant and breastfeeding women who decide to get vaccinated, and those who are currently not vaccinated, should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. That means:

  • Wearing a mask
  • Staying at least six feet away from others
  • Avoiding crowds
  • Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
  • Wiping commonly-touched surfaces with EPA-approved disinfectants
  • Following CDC travel guidance
  • Following quarantine guidance after exposure to COVID-19 or isolation guidance if you get COVID-19
  • Following any applicable workplace guidance

 

For more information on the COVID-19 vaccine and additional resources, visit TexasHealth.org/Vaccine.

 

 

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