Pregnant people are often left out of medical studies, so when vaccines became available to protect against COVID-19, pregnant people looking for answers largely came up empty-handed. While the COVID-19 pandemic has shone some light on pregnant and breastfeeding people's age-old status as "vulnerable," the lack of data collected about pregnancy in the clinical trials of may have left you sifting through conflicting advice on how best to protect you and your child.
In August, the US Centers for Disease Control and Prevention made an official recommendation that pregnant people get a COVID-19 vaccine, citing the increased risk of severe illness in pregnant people with COVID-19 and mounting evidence that shows coronavirus vaccines don't increase the chance of miscarriage or harm the pregnancy. In tandem with news of more children getting sick with COVID-19, there is also growing research that suggests people who get the vaccine while breastfeeding produce COVID-19 antibodies in their breast milk.
The coronavirus vaccines are also recommended for people who are breastfeeding, trying to become pregnant or want to be pregnant in the future, the CDC says.
The recommendation is in line with other agencies that serve pregnant people, such as the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. In a joint statement last month, the ACOG and SMFM recommended pregnant people get the vaccine.
"Pregnant individuals should feel confident that choosing COVID-19 vaccination not only protects them but also protects their families and communities," ACOG President Dr. Martin Tucker said.
Because this announcement came after a whirlwind of clashing advice and misinformation about COVID-19 vaccines, pregnancy and fertility, there still might be some confusion out there. Here's what we know about COVID-19 vaccines during pregnancy.
I'm pregnant. Should I get the COVID-19 vaccine?
In May, CNET spoke with Dr. Ella Speichinger, an OB-GYN at University of Missouri Health Care. She says that she recommends the vaccine to patients, because the known risks of COVID-19 are greater than the unknown risks of COVID-19 vaccination during pregnancy.
"That's true of almost all vaccines, but it's especially true for COVID, even though there is the emergency exemption waiver on it, and it was not studied in pregnant women," Speichinger says. But the concerns pregnant people have about COVID-19 vaccines are valid, she says, because of the lack of early studies and information available to doctors. But at the same time, there are known risks for COVID-19, Speichinger says.
Pregnant people considering a vaccine should talk to their doctor, she says.
The current recommendation by the CDC is that all people over age 12 should get the COVID-19 vaccine, including pregnant and breastfeeding people.
Preliminary data on about 35,000 pregnant women who got vaccinated and volunteered information through the v-safe program shows that pregnant women have the same vaccine side effects as non-pregnant women -- temporary injection pain in the arm, fatigue, headache, muscle aches and fever.
However, it's important to note that fever from any cause has been associated with adverse pregnancy outcomes, and the CDC recommends pregnant people who experience fever after vaccination take acetaminophen to lower their body temperature.
I'm skeptical of the vaccine. What are the risks of getting COVID-19 while pregnant?
Pregnant and recently pregnant people are at higher risk of severe illness from COVID-19, including death, according to the CDC, and they're also at increased risk for preterm delivery (birth before 37 weeks) and other adverse pregnancy outcomes.
Although there is information available now about how risky COVID-19 can be for pregnant people, that wasn't necessarily the case at the beginning of the pandemic, and pregnant people were not highlighted specifically as "high risk." Speichinger says that is likely because people who get pregnant are usually generally healthy and under age 40. Recent research, however, gives cause for concern. A study published by the American Journal of Obstetrics and Gynecology found that pregnant women were three times more likely to be hospitalized with COVID-19 and 13 times more likely to die than similarly aged individuals who were not pregnant when infected with COVID-19.
Why are pregnant people at such a higher risk?
Speichinger says it isn't known, but that it may be because pregnant people's immune systems are naturally depressed so their bodies don't reject the growing fetus, or because pregnancy could alter the body's way of mounting an immune response to COVID-19.
"I've had many patients who have had COVID while they were pregnant, and they've been just fine," she says. "But there have definitely been severe cases where patients had to get delivered early because they could no longer oxygenate their fetus."
In these cases, Speichinger says the patients usually improved after giving birth, but that it was delayed. It's also impossible to know who will have a bad reaction to COVID-19 while pregnant.
"It's really unclear who of the healthy pregnant cohorts is going to be the one that gets sick," she says.
During what trimester should I get the vaccine?
Scientists who looked at people who got vaccinated earlier than 20 weeks pregnant didn't find an increased risk of miscarriage compared to those who didn't, according to a report from the v-safe pregnancy registry. Earlier data that was available reflected vaccination during the later stages of pregnancy.
Some people holding out on getting vaccinated during the first trimester may be due to the naturally high rate of miscarriage in the first three months, and patients being more cautious because of that. Anywhere from 9% to 80% of pregnancies, depending on the patient's age, will end in miscarriage during the first trimester, according to the ACOG.
"Most people feel concerned in the first trimester because there's such a high risk of miscarriage in general," Speichinger says. "Conflating the miscarriage with vaccine administration is what leads to vaccine hesitancy in the first trimester."
Research shows that parents vaccinated during the third trimester of pregnancy may pass antibodies onto their newborns.
What if I'm breastfeeding?
"If a woman is uncomfortable doing it while pregnant, I absolutely think getting it while she's breastfeeding is a good idea," Speichinger says. "Because all of those antibodies can then cross through to the milk and protect baby while the mom is still producing those antibodies."
There's not enough data to show how long that protection lasts, but the CDC reports that breastfeeding people who have received an mRNA vaccine produce COVID-19 antibodies in their breast milk. In a small study on lactating health care workers who received a mRNA vaccine while breastfeeding, researchers from the University of Florida found that their breast milk had a "significant" amount of antibodies.
Does the vaccine type matter?
Moderna's and Pfizer's are mRNA vaccines, which use a new technology that delivers instructions to our immune systems on how to make protective proteins. Johnson & Johnson's, the third vaccine available for emergency use in the US, uses viral vector technology by delivering a harmless virus into our bodies that triggers an immune response. Viral vector vaccines, notably the Ebola vaccine, have been studied in pregnant and breastfeeding people with no adverse effects found, according to the CDC.
The early research available now shows that mRNA vaccines are safe for pregnant women, and that miscarriage rates among women who received a COVID-19 vaccine are similar to miscarriage rates of women who didn't get vaccinated. In a v-safe survey of 827 pregnant women who got a COVID-19 vaccine, about 14% experienced pregnancy loss -- within the range that is naturally expected.
After the US Food and Drug Administration lifted the pause that had been placed on Johnson & Johnson after reports of blood clots (the CDC identified 28 cases out of 8.7 million people vaccinated with Johnson & Johnson, the majority of them in women), the CDC issued a statement that women under age 50 should be aware of their increased risk of this still rare, but serious form of blood clots, and consider the other vaccines that don't carry this risk. Given the demographic of the blood-clotting risk, Speichinger says her bias would steer her pregnant patients toward a Pfizer or Moderna vaccine.
"I still think the risk is exceedingly rare compared to the complications of COVID," she says. "But if you had a choice, I would pick one of the other two."
I want to be pregnant in the future. Will the COVID-19 vaccine make me infertile?
The fear people have regarding their fertility and vaccination isn't exclusive to the COVID-19 vaccine, but that's a conversation for another time. The specific fear about infertility and COVID-19 vaccines stems from a now-debunked post on Facebook that claimed the vaccine would make pregnant people's bodies attack a protein needed for placenta formation in early pregnancy, because the spike protein in the COVID-19 vaccine is "similar." Experts have disproved this, saying that not only do the two proteins have "almost nothing in common," but even if they did, infection with COVID-19 would have the same outcome. There is no research to suggest people who have had COVID-19 will have a more difficult time getting pregnant, and many have since the beginning of the pandemic.
Speichinger says she "cannot think of a theoretical reason" COVID-19 vaccines would cause infertility, and many of her pregnant patients have received a vaccine. The only fertility advice she offers is that if you're hesitant about getting a vaccine while pregnant, you should try to get fully vaccinated before you become pregnant.
"Delaying a cycle is absolutely worth it," Speichinger says.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.