COVID-19 Vaccination Considerations for Pregnant People

January 14, 2021

The American College of Obstetricians and Gynecologists (ACOG)—the professional membership organization for obstetrician–gynecologists—has developed initial guidance for COVID-19 vaccine use for pregnant and lactating patients. Laura E. Riley, MD, chair of Obstetrics and Gynecology  and Given Foundation Professor in Clinical Obstetrics and Gynecology Weill Cornell Medical College, Cornell University, helped draft the evolving recommendations.

Pregnant people are at greater risk for severe illness from COVID-19

“If a pregnant or lactating patient meets the criteria for vaccination, vaccines should not be withheld,” Dr. Riley explains. “Although data on these patients isn’t yet available, there also is no biologic reason to suspect that the vaccine would be unsafe in pregnancy or while breastfeeding. Importantly, we do know that COVID 19 disease in pregnant women is associated with greater risk for severe illness leading to ICU admission and need for mechanical ventilation.”

Pregnant patients should have access to vaccine trial data and weigh the benefits and risks of receiving the vaccine with their physicians, discussing the viral transmission rate in their community, vaccine efficacy, and virus risks and side effects to the mother and fetus or newborn, she adds.

“While a conversation with a clinician may be helpful,” the ACOG guidance states, “It should not be required prior to vaccination as this may cause unnecessary barriers to access.”

What pregnant people should consider with the COVID-19 vaccine

The organization also outlines several considerations regarding the vaccine:

There is no preference for the mRNA-based Moderna or Pfizer-BioNtech vaccines, although 16- and 17-year-olds only are eligible for the Pfizer-BioNtech vaccine.
Patients should complete their two-dose series with the same vaccine.
Within 14 days of receiving the COVID-19 vaccine, patients should not receive another type of vaccine, such as Tdap and influenza.
Patients should be counseled about potential side effects from the COVID-19 vaccine (most common include pain at the injection site, malaise, headache). Pregnant and lactating patients who receive the vaccine should know about and participate in the V-SAFE program, which the Centers for Disease Control and Prevention uses to track potential vaccine side effects, and provide reminders about second vaccine doses.
Physicians may counsel pregnant patients to take acetaminophen—proven safe for use in pregnancy—if they experience a fever following vaccination.

ACOG also recommends that patients trying to become pregnant who meet vaccination criteria receive the vaccine, and says that those who have completed the vaccine series don’t need to delay pregnancy.

In fact, Dr. Riley adds, “If a patient becomes pregnant between the first and second vaccine doses, the patient should receive the second dose as indicated.”

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