COVID-19 Vaccines While Pregnant or Breastfeeding

People who are Pregnant

Although the overall risks are low, if you are pregnant or were recently pregnant, you are

• More likely to get very sick from COVID-19 compared to people who are not pregnant. People who get very sick from COVID-19 may require hospitalization, admission to an intensive care unit (ICU), or use of a ventilator or special equipment to breathe. Severe COVID-19 illness can also lead to death.
• At increased risk of complications that can affect your pregnancy and developing baby. For example, COVID-19 during pregnancy increases the risk of delivering a preterm or stillborn infant.

Getting a COVID-19 vaccine can protect you and others around you from getting very sick from COVID-19, and keeping you as healthy as possible during pregnancy is important for the health of your baby.

CDC recommends COVID-19 vaccines for everyone aged 6 months and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or those who might become pregnant in the future. This recommendation includes getting boosters when it is time to get one.

CDC recommendations align with those from professional medical organizations serving people who are pregnant, including the:

• American College of Obstetricians and Gynecologists,
• Society for Maternal Fetal Medicine, and
• American Society for Reproductive Medicine.

Safety and Effectiveness of COVID-19 Vaccination during Pregnancy

Evidence continues to build showing that COVID-19 vaccination before and during pregnancy is safe, effective, and beneficial to both the pregnant person and the baby. The benefits of receiving a COVID-19 vaccine outweigh any potential risks of vaccination during pregnancy. Below is a brief summary of the growing evidence:

• COVID-19 vaccines do not cause COVID-19, including in people who are pregnant or their babies. None of the COVID-19 vaccines contain live virus. They cannot make anyone sick with COVID-19, including people who are pregnant or their babies. Learn more about how vaccines work.
• Data on the safety of receiving an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech), before and during pregnancy are reassuring.
  • Data from vaccine safety monitoring systems have not found any safety concerns for people who received an mRNA COVID-19 vaccine late in pregnancy or for their babies.^1-6
  • Scientists have not found an increased risk for miscarriage among pregnant people who received an mRNA COVID-19 vaccine just before or during early pregnancy (before 20 weeks of pregnancy).^2-4,7
  • Data from American, European, and Canadian studies showed that vaccination with an mRNA COVID-19 vaccine during pregnancy was not associated with an increased risk for pregnancy complications, including preterm birth, stillbirth, bacterial infection of the placenta, and excessive maternal blood loss after birth.^4,7-9
  • A Chicago study has shown that vaccination of pregnant people with a COVID-19 vaccine prior to and during the first trimester was not associated with an increased risk of birth defects detectable on prenatal ultrasound.¹⁰
  • The monitoring of the effect of COVID-19 vaccination during pregnancy is ongoing. CDC will continue to follow people vaccinated during all trimesters of pregnancy to better understand any effects of the vaccine on pregnancies and babies.
• Data show that receiving an mRNA COVID-19 vaccine during pregnancy reduces the risk of severe illness and other health effects from COVID-19 for people who are pregnant. Recent studies compared people who were pregnant and received an mRNA COVID-19 vaccine with pregnant people who did not. Scientists found that COVID-19 vaccination was effective at reducing the risk of getting very sick from COVID-19.^9-15 One study that looked at people who were hospitalized during pregnancy found that most were not vaccinated.¹⁶ Other studies have shown that by reducing the risk of severe illness in pregnant people, COVID-19 vaccination might also help prevent stillbirths.¹⁷
• Vaccination during pregnancy builds antibodies that can help protect the baby. Much like people who are not pregnant, when people who are pregnant receive an mRNA COVID-19 vaccine, their bodies build antibodies against COVID-19. Antibodies made after pregnant people received an mRNA COVID-19 vaccine have been found in their baby’s umbilical cord blood. This means COVID-19 vaccination during pregnancy can help protect babies against COVID-19 by passing antibodies from the mother to her baby. More data are needed to determine how these antibodies may provide protection to the baby.^17-19
  • A recent small study found that at 6 months old, the majority (57%) of infants born to pregnant people who were vaccinated during pregnancy had detectable antibodies against COVID-19, compared with 8% of infants born to pregnant people who had COVID-19 illness during pregnancy.²⁰
  • Recent data show that completing a two-dose primary mRNA COVID-19 vaccine series during pregnancy can help protect babies younger than age 6 months from hospitalization due to COVID-19. In these reports, the majority of babies hospitalized with COVID-19 were born to pregnant people who were not vaccinated during pregnancy.^{21, 22}
  • Another study found that receiving a booster dose with an mRNA COVID-19 vaccine during pregnancy significantly increased the levels of antibodies found in umbilical cord blood. This means that getting a COVID-19 booster during pregnancy can help further protect babies against COVID-19.²⁴
• No safety concerns were found in animal studies. Studies in animals receiving a COVID-19 vaccine before or during pregnancy found no safety concerns in pregnant animals or their babies.

More clinical trials on the safety of COVID-19 vaccines and how well they work in people who are pregnant are underway or planned. Vaccine manufacturers are also collecting and reviewing data from people in the completed clinical trials who received a vaccine and became pregnant during the trial.

Talk to Your Healthcare Provider

If you are pregnant, talk to your healthcare provider about COVID-19 vaccination. While such a conversation might be helpful, it is not required before vaccination. You can receive a COVID-19 vaccine, including a booster shot, without any additional documentation from your healthcare provider.

Common Questions about Vaccination during Pregnancy

People who are Breastfeeding

CDC recommends that people who are breastfeeding get vaccinated and stay up to date with their COVID-19 vaccines, including getting a COVID-19 booster shot when it’s time to get one.

Clinical trials for the COVID-19 vaccines currently used in the United States did not include people who were breastfeeding. Therefore, limited data are available on the

• Safety of COVID-19 vaccines in people who are breastfeeding
• Effects of vaccination on the breastfed baby, and
• Effects on milk production or excretion

Available data on safety of COVID-19 vaccination while breastfeeding indicate no severe reactions after the first or second dose, neither in the breastfeeding person not the breastfed child.²⁵ There has been no evidence to suggest that COVID-19 vaccines are harmful to either people who have received a vaccine and are breastfeeding or to their babies.²⁶

COVID-19 vaccines cannot cause COVID-19 in anyone, including pregnant people and their babies. None of the COVID-19 vaccines contain live virus. 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 in their breastmilk, which could help protect their babies. More data are needed to determine what level of protection these antibodies might provide to the baby.^{20, 23-31}

CDC also recommends COVID-19 vaccines for children aged 6 months and older.

People Who Would Like to Have a Baby

CDC recommends that people who are trying to get pregnant now or might become pregnant in the future, as well as their partners, get vaccinated and stay up to date with their COVID-19 vaccines, including getting a COVID-19 booster shot when it’s time to get one. COVID-19 vaccines are not associated with fertility problems in women or men.³²

Vaccine Side Effects

Side effects can occur after receiving any of the available COVID-19 vaccines, especially after the second dose for vaccines that require two doses, or after a booster.

People who are pregnant have not reported different side effects from people who are not pregnant after vaccination with mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech vaccines). ^1,9

• Fever during pregnancy, for any reason, has been associated with adverse pregnancy outcomes.
• Fever in pregnancy may be treated with acetaminophen as needed, in moderation, and in consultation with a healthcare provider.
• Learn more at Possible Side Effects After Getting a COVID-19 Vaccine.

Although rare, some people have had severe allergic reactions after receiving a COVID-19 vaccine. Talk with your healthcare provider if you have a history of allergic reaction to any other vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous).

Key considerations you can discuss with your healthcare provider include:

• The benefits of vaccination
• The unknown risks of developing a severe allergic reaction
• If you have an allergic reaction after receiving a COVID-19 vaccine during pregnancy, you can receive treatment for it.

References

1. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med2021; 384:2273-2282. DOI: https://doi.org/10.1056/NEJMoa2104983.
2. Zauche LH, Wallace B, Smoots AN, et al. Receipt of mRNA COVID-19 vaccines and risk of spontaneous abortions. New Engl J MedPublished online September 8, 2021; DOI: https://doi.org/10.1056/NEJMc2113891
3. Kharbanda EO, Haapata J, DeSilva M, et al. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. JAMA. Published online September 8, 2021. DOI: https://doi.org/10.1001/jama.2021.15494
4. Lipkind HS, Vazquez-Benitez G, DeSilva M, et al. Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth — Eight Integrated Health Care Organizations, United States, December 15, 2020–July 22, 2021. MMWR Morb Mortal Wkly Rep 2022;71:26–30. DOI: https://dx.doi.org/10.15585/mmwr.mm7101e1
5. Moro PL, Olson CK, Clark E, et al. Post-authorization surveillance of adverse events following COVID-19 vaccines in pregnant persons in the vaccine adverse event reporting system (VAERS), December 2020 – October 2021. Vaccine. Published online April 12, 2022. DOI: https://doi.org/10.1016/j.vaccine.2022.04.031
6. Sadarangani M, Soe P, Shulha HP, et al. Safety of COVID-19 vaccines in pregnancy: a Canadian National Vaccine Safety (CANVAS) network cohort study [published online ahead of print, 2022 Aug 11]. Lancet Infect Dis. 2022;S1473-3099(22)00426-1. doi:10.1016/S1473-3099(22)00426-1
7. Magnus MC, Gjessing HK, Eide HN, et al. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. New Engl J Med2021; 385:2008-2010. DOI: https://doi.org/10.1056/NEJMc2114466
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18. Yang YJ, Murphy EA, Singh S, et al. Association of Gestational Age at Coronavirus Disease 2019 (COVID-19) Vaccination, History of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, and a Vaccine Booster Dose With Maternal and Umbilical Cord Antibody Levels at Delivery. Obstetrics & Gynecology: 2021. DOI: https://doi.org/10.1097/AOG.0000000000004693
19. Nir O, Schwartz A, Toussia-Cohen S, et al. Maternal-neonatal transfer of SARS-CoV-2 immunoglobulin G antibodies among parturient women treated with BNT162b2 messenger RNA vaccine during pregnancy. Am J Obstet Gynecol 2022; 4(1): https://doi.org/10.1016/j.ajogmf.2021.100492
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21. Shook LL, Atyeo CG, Yonker LM, et al. Durability of Anti-Spike Antibodies in Infants After Maternal COVID-19 Vaccination or Natural Infection. JAMA. Published online February 07, 2022. DOI: https://doi.org/10.1001/jama.2022.1206
22. Halasa NB, Olson SM, Staat MA, et al. Vaccine Effectiveness Against COVID-19 Hospitalization in Infants <6 Months of Age from Maternal mRNA COVID-19 Vaccination — United States, July 2021– January 2022 MMWR Morb Mortal Wkly Rep 2022;71: 264–270. DOI: https://dx.doi.org/10.15585/mmwr.mm7107e3
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24. Munoz FM, Posavad CM, Richardson BA, et al. COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn. medRxiv. 2022 Jun 13 (Preprint) DOI: https://doi.org/10.1101/2022.06.13.22276354
25. Muyldermans J, De Weerdt L, De Brabandere L, Maertens K, Tommelein E. The Effects of COVID-19 Vaccination on Lactating Women: A Systematic Review of the Literature. Front Immunol. 2022;13:852928. Published 2022 Apr 8. doi:10.3389/fimmu.2022.852928
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28. Kelly JC, Carter EB, Raghuraman N, et al. Anti–severe acute respiratory syndrome coronavirus 2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination. Am J Obstet Gynecol. 2021;225(1):101-103. DOI: https://doi.org/10.1016/j.ajog.2021.03.031
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