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I'm pregnant. Should I get a COVID-19 vaccine?

For most people, getting the COVID-19 vaccine as soon as possible is the safest choice. The information below will help you make an informed choice about whether to get an mRNA (Pfizer or Moderna) COVID vaccine while you are pregnant or trying to get pregnant. 

Doctors at the University of Massachusetts Medical School – Baystate created the following shared decision making guide to help pregnant people and their providers decide whether or not to get the coronavirus vaccine.

You can also download the guide in English, Spanish, Arabic, Chinese, Haitian Creole, Nepali, Portuguese, Russian, Somali, Turkish, and Vietnamese. 

Here is a summary of our guidance:

  1. COVID seems to cause more harm in pregnant people than in people of the same age who are not pregnant.
  2. The risks of getting an mRNA COVID vaccine during pregnancy are thought to be small but are not totally known.
  3. You should consider your own personal risk of getting COVID. If your personal risk is high, or there are many cases of COVID in your community, it probably makes sense for you to get a vaccine while pregnant.
  4. Whether to get a COVID vaccine during pregnancy is your choice.

Your options include:

  1. Get a COVID vaccine as soon as it is available to you.
  2. Wait for more information about the vaccines in pregnancy.

Please consider the following when making your decision:

Understanding COVID in pregnancy

  • COVID is dangerous. It is more dangerous in pregnancy.
  • Pregnant COVID patients are 5 times more likely to end up in the intensive care unit than non-pregnant COVID patients.
  • Preterm birth may be more common.
  • Pregnant people are more likely to die of COVID than other people with COVID who are the same age.

What are the benefits of getting the COVID vaccine?

The COVID vaccines prevent moderate and severe COVID. Getting a vaccine will prevent you from getting very sick with COVID.

The COVID vaccines may reduce spread. The vaccine may help keep you from giving COVID to people around you. As COVID infections go up in our communities, your risk of getting —and giving—COVID goes up too.

These vaccines have no live virus and do NOT contain ingredients that are known to be harmful to pregnant people or to the fetus.

Many vaccines are routinely given in pregnancy and are safe (for example: tetanus, diphtheria, and flu).

What are the risks and unknowns of getting the COVID vaccine?

Each vaccine was tested in over 20,000 people, and there were no serious side effects.

We do not know if the vaccines work as well in pregnancy as they do in nonpregnant people.

We know that in studies done by Moderna and Johnson & Johnson, there were no adverse effects on female reproduction or fetal development.

So far, the mRNA vaccines have been given to over 30,000 pregnant people in the US who registered with the CDC.

Of those pregnancies, 275 have been reported as complete. The number of miscarriages in people who got the vaccine (15%) was about the same as we see in pregnant people who have NOT gotten a COVID vaccine (10-25 %).

Birth defects were seen in the same number of people as in the general population who have NOT gotten a COVID vaccine (3-4%).

People getting the vaccine will probably have some side effects. This is a normal response by the immune system. These effects are more common after the second dose and in the mRNA vaccines but were not more common in pregnancy. The most common side effects are:

  • Arm pain (~84%)
  • Fatigue (~62%)
  • Fever (~14%)

Of every 100-500 people who get a vaccine, 1 will get a high fever (over 102°F).

  • A persistent high fever during the first trimester might increase the risk of fetal abnormalities or miscarriage.
  • The CDC recommends using acetaminophen during pregnancy if you have a high fever. Another option is to delay your COVID vaccine until after the first trimester.

What do the experts recommend?

The CDC recommends the COVID vaccines for adults. However, because there are no studies of pregnant people yet, there are no clear recommendations for pregnant people. This is standard for a new drug and early research of the vaccines in pregnancy is reassuring.

The Society for Maternal-Fetal Medicine strongly recommends that pregnant individuals have access to COVID vaccines, and that each person talk to their doctor or midwife about their own personal choice.10

The American College of Obstetricians and Gynecologists recommends that the COVID vaccine should not be withheld from pregnant individuals.

The World Health Organization states the mRNA vaccine can be given to people who are breastfeeding without stopping breastfeeding after vaccination. They recommend that pregnant people at high risk of exposure to COVID or with medical problems may be vaccinated in consultation with their health care provider.

What else should I think about to help me decide?

Make sure you understand as much as you can about COVID and about the vaccine. Ask a trusted source, like your midwife or doctor.

Think About Your Own Personal Risk

Look at the columns below and think about your risk of getting COVID (left) and think about your safety —are you able to stay safe (right)?

 The risks of getting sick from COVID are higher if...  If you are not at higher risk for COVID and...
You have contact with people outside your home You always wear a mask
You are 35 years old or older You and the people you live with can socially distance from others for the whole pregnancy 
You are overweight  Your community does NOT have high or increasing COVID cases 
You have other medical problems like diabetes, high blood pressure, or heart disease You think the vaccine itself will make you very nervous (you are more worried about the unknown risks than about getting COVID) 
You are a smoker You have had a severe allergic reaction to a vaccine 
You are a racial or ethnic minority, or your community has a higher rate of COVID infections   
You are a healthcare worker   
...it probably makes sense to get the vaccine.  ...it might make sense for you to wait for more information. 

Feedback

Thoughts about this tool?

Was this decision aid helpful? Please take a moment to give us feedback about this decision aid.

Tell the CDC about your experience with the vaccine

If you decide to get the vaccine, you will get a “V-safe information sheet” with instructions about the V-safe website and app. Consider registering so we can better counsel people in the future.

 

Working Group & References

This information is compiled and is updated by the shared decision-making working group. All sources and research that back up the information in this materials appear below and are specifically cited in the pdf decision aid.

Shared Decision-Making: COVID Vaccination in Pregnancy Working Group from the University of Massachusetts Medical School – Baystate. 

Kathaleen Barker, MD, FACOG; Assistant Professor of Obstetrics and Gynecology, Medical Director of Informatics for Women’s Health, Associate Director of Obstetrics. Dr. Barker is a practicing obstetrician gynecologist and medical informaticist. She is a leader of obstetrical safety and quality programs at Baystate as well as a leader of digital innovations to support safe obstetrics care.

Fadi Bsat, MD: Associate Professor of Obstetrics & Gynecology, Chief, Maternal-Fetal Medicine. Dr. Bsat serves on the Board of Directors of the Society for Maternal Fetal Medicine and is Chair Elect of its Practice Management Division.

Ashley Deutsch, MD; Director of Quality and Patient Safety, Department of Emergency Medicine, Baystate Medical Center – Dr. Deutsch is a practicing emergency physician and a leader of quality improvement in the ED at Baystate as well as the Director of Telemedicine. She is currently breastfeeding.

Andrew Healy, MD; Assistant Professor of Obstetrics and Gynecology, Medical Director of Obstetrics, Division of Maternal-Fetal Medicine. Dr. Healy has an interest in quality and safety work. In addition to efforts to improve the care of patients at Baystate Medical Center, he serves on the Patient Safety and Quality Committee of the Society for Maternal Fetal Medicine, the Massachusetts Maternal Mortality and Morbidity Review Committee, and works closely with the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN).

Elizabeth Morgan, MD, MS; Assistant Professor, Division of Maternal-Fetal Medicine. Dr Morgan is a practicing Maternal Fetal Medicine Physician with a background in biohazardous threat agents and emerging infectious diseases. Her research interests include health disparities and maternal prenatal stress, and their effects on fetal growth and development.

Corina Schoen, MD, FACOG; Assistant Professor of Obstetrics and Gynecology, Assistant Director of Obstetric Research; Division of Maternal-Fetal Medicine. Dr. Schoen is a practicing Maternal-Fetal Medicine physician with research interests in the field of labor induction and preterm birth. She is a mentor for both residents and faculty in obstetric research. She is currently breastfeeding.

Elizabeth Schoenfeld, MD, MS; Vice Chair of Research; Department of Emergency Medicine; Dr. Schoenfeld is a practicing emergency medicine physician, Shared Decision-Making researcher, and decision aid designer.

Liza Smith, MD; Assistant Professor of Emergency Medicine, Assistant Program Director and Clerkship Director for Emergency Medicine. Dr. Smith is a practicing emergency medicine physician. She has a focus on medical education and metacognition--how physicians think and make decisions--and its applications in residency education. She is currently pregnant.

Lauren Westafer, DO, MPH, MS; Assistant Professor of Emergency Medicine, Research Fellowship Director; practicing emergency medicine physician, implementation science researcher, currently pregnant.

References

  1. DeBolt CA, et al. Pregnant women with severe or critical COVID-19 have increased composite morbidity compared to
    non-pregnant matched controls. Am J Obstet 2020 Nov doi: 10.1016/j.ajog.2020.11.022
  2. Adhikari EH, et al. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus
    2 infection. JAMA Network Open 2020 Nov 3(11):e2029256
  3. DiMascio D, WAPM working group on COVID-19. Maternal and Perinatal Outcomes of Pregnancy Women with SARScoV-2 infection. Ultrasound Obstet Gynecol. 2020 Sept. doi: 10.1002/uog.23107.
  4. Centers for Disease Control and Prevention. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020.
    November 2020:1-7.
  5. Abbasi J. COVID-19 and mRNA Vaccines—First Large Test for a New Approach. JAMA. 2020;324(12):1125–1127.
    doi:10.1001/jama.2020.16866
  6. FDA Pfizer Briefing.
  7. FDA Moderna Briefing.
  8. CDC: ACIP Evidence to Recommendations for Use of Pfizer-BioNTech COVID-19 Vaccine under an Emergency Use Authorization (Accessed Dec 14, 2020)
  9. CDC Information about COVID-19 Vaccines for People Who are Pregnant or Breastfeeding. (Accessed March 10, 2021)
  10. SMFM statement on COVID vaccination in pregnancy
  11. ACOG: Vaccinating Pregnant and Lactating Patients Against COVID-19 (Accessed December 14, 2020)
  12. WHO: The Moderna COVID-19 vaccine: what you need to know.
  13. Mutambudzi M, Niedwiedz C, Macdonald EB, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occupational and Environmental Medicine Published Online First: 09 December doi: 10.1136/oemed-2020-106731
  14. ABM: Considerations for COVID-19 Vaccination in Lactation

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