Pregnancy & COVID-19

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), the two leading organizations representing specialists in obstetric care, recommend that all pregnant individuals be vaccinated against COVID-19. The Centers for Disease Control and Prevention (CDC) currently recommend that all individuals aged 6 months and older receive one dose of updated 2023-24 vaccine, regardless of previous immunization status, at least two months from the last dose of any COVID-19 vaccine. If you are uncertain, this is a decision that can be made after a discussion with a health care professional who knows your personal medical history.

The updated Pfizer-BioNTech and Moderna monovalent XBB.1.5 COVID-19 2023-2024 vaccines were recently approved and authorized by the United States Food and Drug Administration (FDA), based on studies that showed a stronger immune response against current circulating COVID-19 strains than previous versions of the vaccine. As would be expected, since there is no actual virus in the mRNA vaccines, they have similar safety profiles to previously available mRNA vaccines. The process for creating these updated vaccines is no different than for the original COVID-19 vaccines, and is comparable to the annual revision of the annual flu vaccine to match circulating strains for that year’s flu season. These updated vaccines are expected to provide improved protection against COVID-19 from the currently circulating variants. The Novavax COVID-19 vaccine should also be available in a revised form to target newer COVID-19 strains, and uses a more “traditional” protein-based format, but it has not yet been approved for use by the FDA. It is recommended that all pregnant women receive any of the available vaccines as soon as possible, especially if their last vaccine was last year. 

A growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection or transmit COVID-19 to others. However, the most compelling data have demonstrated that individuals who are up to date on their COVID-19 vaccines, including boosters, are significantly less likely, if they do become infected, to need to be hospitalized for severe illness or to die. More recent studies have shown that people who are up to date on their vaccines are also less likely to develop long COVID if they do get infected.  Pregnant people who receive a COVID-19 vaccine during pregnancy produce antibodies against COVID-19, similar to non-pregnant people. Antibodies produced after a pregnant person receives a COVID-19 vaccine pass to the fetus and have been identified in studies of umbilical cord blood samples from newborns. This means that COVID-19 vaccination during pregnancy also helps protect newborns against COVID-19. 

COVID-19 vaccination is the best method to reduce maternal and fetal complications of COVID-19 infection among pregnant people. ACOG is recommending vaccination of pregnant individuals because there is strong evidence supporting the safety and effectiveness of the vaccine during pregnancy based on data from thousands of reporting individuals. Although pregnancy-specific data are unavailable for the updated vaccine, ongoing surveillance and reporting continuously demonstrate the safety and efficacy of the earlier mRNA COVID-19 vaccines in pregnancy.

Research from the beginning of the pandemic onward has consistently shown that pregnant and recently pregnant people have a higher risk of more severe illness from COVID-19 than nonpregnant people. Pregnant people who have COVID-19 and show symptoms are more likely than nonpregnant people with COVID-19 and symptoms to need care in an intensive care unit (ICU), to need a ventilator (for breathing support), or to die from the illness. Still, the overall risk of severe illness and death for pregnant people is low. Pregnant and recently pregnant people with some health conditions, such as obesity and gestational diabetes, may have an even higher risk of severe illness, similar to nonpregnant people with these conditions. Certain complications such as preterm delivery and risks of miscarriage or stillbirth may be increased for those with COVID-19 during pregnancy.

COVID-19 vaccination is recommended for all people 6 months and older, including people who are breastfeeding. COVID-19 vaccines cannot cause infection in anyone, including the mother or the baby, and the vaccines are effective at preventing COVID-19 in people who are breastfeeding. Recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies present in their breastmilk, which could help protect their babies. However, these levels are lower and possibly less effective than antibodies passed to the fetus if the mother is vaccinated while still pregnant. You do not have to delay or stop breastfeeding just because you get a vaccine.

Individuals who receive an updated vaccine may experience similar side effects (such as local injection site pain, headache, and malaise) as those reported by individuals who previously received mRNA COVID-19 vaccines. Fever was reported in 6% of updated vaccine recipients (previously reported range: 4-8%).  If pregnant people experience fever after vaccination, acetaminophen is recommended and can safely be used in pregnancy.

These three sites contain trusted, evidence-based, patient-focused information for pregnant and lactating individuals:

• Centers for Disease Control
• Society for Maternal-Fetal Medicine
• American College of Obstetricians and Gynecologists