Now that the COVID-19 vaccines are here, many of us are breathing a sigh of relief. But questions still remain. One big question: Should pregnant people or people who are breastfeeding still get the COVID-19 vaccine?
How the COVID-19 vaccines work
There are many different, safe types of vaccines that have been used for a long time. Protein-based vaccines, like the hepatitis B and Tdap shots, alert our bodies to the presence of foreign proteins. Live attenuated (weakened) virus vaccines, such as MMR vaccines, use a weakened virus to trigger an immune response.
The Moderna and Pfizer-BioNTech COVID-19 vaccines are mRNA vaccines. Our bodies make different types of mRNA all the time. The mRNA in the vaccine helps our bodies learn how to make a protein that our bodies can then recognize and fight back against the new coronavirus.
“The messenger RNA is kind of like an instruction manual. It tells our cells how to make the spike protein, which is a protein that’s found on the outside of the coronavirus. Then, our white blood cells can see that the spike protein is foreign to our bodies and mount an immune response, make some memories and are able to fight back if we encounter the SARS-CoV-2 virus in real life,” explains Dr. Alisa Kachikis, a maternal fetal medicine specialist who studies vaccine safety during pregnancy and is currently studying the COVID-19 vaccine in pregnant people.
Also, some quick mythbusting: Despite what you may see on social media, the COVID-19 vaccines do not contain the virus, they will not give you COVID-19 and they do not disrupt your DNA in any way. In fact, once the mRNA passes along its instructions, it gets broken down quickly by your body.
Are the COVID-19 vaccines safe during pregnancy?
While live virus vaccines like the MMR vaccine aren’t recommended during pregnancy out of an abundance of caution, other types of vaccines are given to pregnant people all the time, says Kachikis.
For example, the flu shot is recommended and regularly given during pregnancy.
“We know that pregnant people who have influenza tend to have worse outcomes than non-pregnant people, and by protecting the pregnant individual we protect the fetus, we protect the placenta and ultimately also the newborn baby,” she explains.
Despite this, vaccines are rarely tested during clinical trials in pregnant people — and the COVID-19 vaccine is no exception. Still, several major medical organizations including the Society for Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists advocate for the right to get the vaccine during pregnancy, despite the lack of data.
Why? There are several reasons. First, based on how well-tolerated other vaccines are in pregnant people, there’s no reason to suspect the COVID-19 vaccine will cause problems, Kachikis says.
Though there isn’t much data yet on how the COVID-19 vaccine affects pregnant people, there is data showing that the vaccines don’t cause any major problems in pregnant animals.
Oh, and one quick clarification. You may have heard that the World Health Organization (WHO) put out a statement advising against getting the COVID-19 vaccine in pregnancy. They have since changed their stance, now recommending the vaccine for pregnant women who are at higher risk.
What about during breastfeeding?
Again, there isn’t any data yet on breastfeeding people who have been vaccinated, though studies are currently underway.
“There’s no reason to suspect the vaccine poses any risk to babies being breastfed, especially since other vaccines are safe for breastfeeding infants,” says Dr. Esther Chung, a pediatrician and professor of pediatrics at the UW School of Medicine and Seattle Children’s Hospital.
In fact, there might be benefits: “Doctors think antibodies may pass to babies during breastfeeding, helping protect them (at least for a little while) from the new coronavirus as well,” Chung says.
“The antibody response to the vaccines is very similar to the antibody and immune response seen in individuals who've been infected. Breast milk from mothers with COVID-19 infection contained COVID-specific antibodies and this suggests that vaccinated mothers are likely to have COVID-specific antibodies in their breast milk,” she explains.
COVID-19 can be more severe for pregnant people
Perhaps the most compelling reason to offer the vaccine during pregnancy is the fact that pregnant people are at higher risk for severe COVID-19 infection.
“Pregnant individuals with COVID-19 have a higher risk of being admitted to the hospital, needing to be in the ICU, needing to have mechanical ventilation, and then also needing ECMO therapy,” Kachikis says.
Additionally, anyone who is pregnant and who also has other risk factors — such as obesity, heart disease or lung disease — has a greater chance of COVID-19 complications.
“Other conditions like high blood pressure or asthma may also put people at greater risk,” says Dr. Porshia Underwood, an OB-GYN who sees patients at the Women’s Health Care Center at UW Medical Center – Roosevelt and at Harborview Medical Center.
Racial disparities can factor in, too.
“Black people, Indigenous people, Hispanic people and Asian people face higher rates of COVID-19 infection and complications from it,” Underwood says. (Not to mention the fact that Black women face higher maternal mortality rates than women of other races.)
Because of this, getting COVID-19 is riskier for most pregnant people than getting the COVID-19 vaccine.
When should pregnant people get the vaccine?
While the COVID-19 vaccine (both doses) can be given anytime during pregnancy, it’s important to note that it shouldn’t be given within 14 days of receiving another vaccine. Underwood recommends discussing with your doctor when to get different vaccines and make sure you have a plan in place.
If you’re feeling on the fence about getting the vaccine, the first step is to consider your potential risk factors and any potential complications of getting sick. Then, think about the benefits of the vaccine and how you would handle any potential side effects. Lastly, talk with your doctor for their insight.
“Information is evolving every day, so just keep the lines of communication open and keep revisiting things at subsequent visits during follow-up with your provider,” Underwood says.
“For people who have had miscarriages before, there’s no reason to think the vaccine causes miscarriages, though data is still lacking,” Kachikis says.
What about vaccine side effects?
Some people who get the vaccine experience mild flu-like symptoms after (particularly after the second dose). Pregnant people are no exception. Luckily, if you feel icky it shouldn’t last long — the symptoms typically last just two or three days.
If you have side effects, taking Tylenol or acetaminophen to reduce fever and body aches is totally fine.
“We know that having those medications on board after getting the vaccination doesn’t impact the antibody response,” Underwood says.
However, NSAIDs such as Aspirin and Ibuprofen should be avoided during pregnancy, and they could hinder the antibody response during breastfeeding.
Does the COVID-19 vaccine pass on antibodies to the baby?
For some vaccines given during pregnancy, such as the Tdap vaccine (which protects against tetanus, diphtheria and pertussis), the vaccine doesn’t just help the pregnant person but it helps the baby as well.
“When we give the Tdap vaccine during pregnancy, the placenta actively pushes over antibodies to the fetus. After delivery, that boost in antibodies actually helps the baby have higher antibody levels, which is helpful because we know that babies who get pertussis within the first year of life can have really severe sickness or even death,” Kachikis says.
So, does that mean a similar antibody transfer will occur with the COVID-19 vaccine? Researchers suspect it might, but there still isn’t enough research or data to prove or disprove it. Fingers crossed.
The bottom line
Though there isn’t much data yet showing how pregnant people do after getting the COVID-19 vaccine, doctors do not think there is any cause for concern. This is based on past research involving other vaccines that pregnant people typically receive. Kachikis anticipates data from current studies on the COVID-19 vaccine’s effects on pregnancy and breastfeeding will be available within the next few months.
If you want to get the COVID-19 vaccine, talk about it with your doctor.
“Figure out what’s best for you. There may be conditions or exposures that you had in the past that put you at increased risk that you yourself aren’t aware of, but through that conversation and history-taking with your provider you are able to discuss any risks and benefits,” Kachikis says.
The info in this article is accurate as of the publishing date. While Right as Rain strives to keep our stories as current as possible, the COVID-19 pandemic continues to evolve. It’s possible some things have changed since publication. We encourage you to stay informed by checking out your local health department resources, like Public Health Seattle King County or Washington State Department of Health.