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The US Food and Drug Administration (FDA) has issued emergency use authorization for two vaccines to prevent COVID‐19 for people age 16 years (for the Pfizer vaccine) and 18 years (for the Moderna vaccine) and older. Persons who are pregnant and breastfeeding may also choose to be vaccinated. Both vaccines are given intramuscularly in 2 doses administered 21 days and 28 days apart, respectively.¹ The vaccines will be given first to healthcare workers and people living in long‐term care facilities.² It is likely the next group to receive a vaccine will be people with preexisting high‐risk health conditions, teachers and other frontline workers, and people older than 65 years of age. Everyone else will get the vaccine after these groups are vaccinated.

Information for Pregnant Individuals

If you are pregnant or planning to become pregnant and are thinking about getting vaccinated, talk with your health care professional about the vaccines’ risks and benefits. During this conversation, you can decide what is best for you based on your risk of getting COVID‐19, your risk of getting severe disease if you become infected with COVID‐19, and general discussion about the risks and advantages of getting the vaccine.

To help with your decision, you and your healthcare professional should answer the following key questions:

What are the known risks of getting the COVID‐19 vaccines during pregnancy?

• The vaccines have not yet been tested in pregnant women. Pregnant women were not allowed to take part in the clinical trials of the vaccine. A few people who received the vaccines in the clinical trials did get pregnant. There have been no reports of any problems with these pregnancies, and they are continuing to be monitored.
• Going forward, as pregnant individuals get vaccinated, the FDA will gather detailed information about their safety and effectiveness during pregnancy. The Centers for Disease Control and Prevention (CDC), along with other federal partners, will monitor the vaccines for serious side effects using existing vaccine safety monitoring systems. You can participate in this effort by enrolling in V‐Safe After Vaccination Health Checker (more information on this program is given below).
• A safe vaccine is generally considered one in which the benefits of getting it outweigh the risks. The two current vaccines are not live vaccines. There is only a very small chance that they cross the placenta, so it’s unlikely that they even reach the fetus, although we don’t know this for sure. There is no evidence at this time that the vaccines affect future fertility. The only people who should NOT get vaccinated are those who have had a severe allergic reaction to vaccines in the past or any vaccine ingredients.
• Side effects may occur in the first 3 days after getting vaccinated.1 These include mild to moderate fever, headache, and muscle aches. Side effects may be worse after the second dose.^{3, 4} Experts recommend that pregnant people receiving the vaccine who develop fever take acetaminophen (Tylenol). This medication is safe to use during pregnancy and does not affect how the vaccine works.

What are the benefits of getting the COVID‐19 vaccine?

The vaccines can help protect you from getting COVID‐19. You must get both doses of the vaccine to be fully effective.1 It’s not yet known whether vaccination prevents passing the virusto others if you do get COVID‐19 or how long protection lasts. At this time, vaccinated people still need to wear masks and practice social distancing.

What are the known risks of getting COVID‐19 during pregnancy?

About 1 to 3 per 1,000 pregnant women with COVID‐19 will develop severe disease. Compared with those who aren’t pregnant, COVID‐19‐infected pregnant people:

• Are 3 times more likely to need ICU care
• Are 2 to 3 times more likely need advanced life support and a breathing tube
• Have a small increased risk of dying due to COVID‐19

They may also be at increased risk of stillbirth and preterm birth.^5‐7

What is my risk of getting COVID‐19?

Your risk of getting COVID‐19 depends on the chance that you will come into contact with another infected person. The risk may be higher if you live in a community where there is a lot of COVID‐19 infection or work in healthcare or another high‐contact setting.

What is my risk for severe complications if I get COVID‐19?

Data show that older pregnant women; those with preexisting health conditions, such as a body mass index higher than 35 kg/m2, diabetes, and heart disorders; and Black or Latinx women have an especially increased risk of severe disease and death from COVID‐19.^5‐7

After you and your healthcare provider discuss the above questions, you can make an informed decision about whether to get vaccinated. If you still have questions about the vaccines or need more information, ask your health care provider or go to the Centers for Disease Control and Prevention’s COVID‐19 vaccine webpage.

Information for Breastfeeding/Lactating Individuals

The COVID‐19 vaccines are being offered to people who are breastfeeding/lactating. Although lactating individuals were not allowed in the clinical trials, based on experience with other vaccines, the benefits of vaccination outweigh the very small safety concerns. You don’t have to delay or stop breastfeeding just because you get vaccinated.

Choosing Vaccination…Or Not

If you choose to get vaccinated, the CDC is committed to making sure that it is safe for all individuals. Your health professional will give you information about enrolling in the V‐Safe After Vaccination Health Checker. This program lets your healthcare professional check in daily for 1 week following your vaccination. You can also report any side effects or concerns you might have – all through your smartphone! You’ll receive information about how to sign up when you get your vaccine.

If you choose not to get the vaccine while pregnant, you can get it after you have your baby. Talk to your health care provider about a plan to get the vaccine after pregnancy.

No matter what you decide, it is important that you continue to follow COVID‐19 infection prevention steps such as wearing a mask, washing your hands frequently, and maintaining physical distancing of at least 6 feet.

References

1. Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer‐BioNTech COVID‐19 Vaccine — United States, December 2020. MMWR Morbidity and Mortality Weekly Report 2020;69.
2. Dooling K, McClung N, Chamberland M, Marin M, Wallace M, Bell BP, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID‐19 Vaccine ‐ United States, 2020. MMWR Morb Mortal Wkly Rep 2020 Dec 11;69(49):1857‐9.
3. PFIZER‐BIONTECH COVID‐19 VACCINE [package insert] New York: Pfizer and Mainz, German: Biontech;2020.
4. FDA Briefing Document Moderna COVID‐19 Vaccine. 2020. Accessed 2020, Dec 18; Available from: https://www.fda.gov/media/144434/download
5. Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, et al. SARS‐CoV‐2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics ‐ Eight U.S. Health Care Centers, March 1‐May 30, 2020. MMWR Morb Mortal Wkly Rep 2020 Sep 23;69(38):1355‐9.
6. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory‐Confirmed SARSCoV‐2 Infection by Pregnancy Status ‐ United States, January 22‐October 3,
7. 2020. MMWR Morb Mortal Wkly Rep 2020 Nov 6;69(44):1641‐7.
8. Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory‐Confirmed COVID‐19 ‐ COVID‐NET, 13 States, March 1‐August 22, 2020. MMWR Morb Mortal Wkly Rep 2020 Sep 25;69(38):1347‐54.