What to Expect When Considering the COVID-19 Vaccination While Pregnant

I can still clearly remember the day I heard my oldest son’s heartbeat for the first time. I was overwhelmed with excitement, joy and uncertainty. I know there are many families all over the country who are currently experiencing similar feelings of wonder, thrill and worry for the future. The pandemic has complicated the feelings of excitement and joy for many expecting parents — they might be struggling with fear of getting COVID-19, economic instability or other unknowns. With more than 3 million Americans receiving the COVID-19 vaccine per day, I know the questions on every expecting parents’ minds are “What if I get COVID-19?”, “Is the COVID-19 vaccine safe?” and “Will getting the COVID-19 vaccine harm my baby?” Safely navigating pregnancy during a pandemic can be challenging, but the choice to get the COVID-19 vaccine can increasingly be informed by science and data.

The current data for the COVID-19 vaccine may feel incomplete because initial clinical trials for the vaccines excluded pregnant people. Traditionally, pregnant people have been left out of studies that assess the safety of new medicines or vaccines because of the theoretical risk to a fetus. However, I’m here to let you know that COVID-19 vaccination can protect pregnant people from developing severe COVID-19 and other pregnancy-related consequences, such as preterm birth. CDC recently released early, yet promising, real-world evidence about the safety of COVID-19 vaccines in pregnant people: we have followed up with nearly 4,000 pregnant people, and so far, we have not identified any safety concerns for those who were vaccinated in their third trimester or for their babies. Because many of the pregnancies are ongoing, we have limited information on the outcomes among people vaccinated during their first or second trimester of pregnancy. 

Following the science

CDC is committed to following the science and reporting it to you. We prioritize the safety of pregnant people and their babies. Our latest study on vaccination in pregnant people included data from three safety monitoring systems, the Vaccine Adverse Event Reporting System (VAERS), v-safe after vaccination health checker and the v-safe pregnancy registry, to understand the safety of mRNA COVID-19 vaccines in pregnant people. mRNA vaccines are a new type of vaccine to protect against infectious diseases. At the time this specific report was written, pregnant people had not yet reported receiving the Johnson & Johnson vaccine.

Data on vaccination in pregnant people

Pregnant people reported similar side effects compared to non-pregnant people after receiving a COVID-19 vaccine; these side-effects were more common after the second dose. Because the rollout of COVID-19 vaccination began in late December, newborn outcomes in this report are mostly from people vaccinated during their third trimester. While additional data are needed to understand the impact of COVID-19 vaccines in the first and second trimesters of pregnancy, preliminary information from CDC’s latest report delivered reassuring news: people who self-reported receiving COVID-19 vaccines during their third trimester did not experience safety concerns related to mRNA COVID-19 vaccines for themselves or for their babies.

In fact, nearly 4,000 people enrolled in the v-safe pregnancy registry, of which 827 pregnancies have completed thus far. Among these 827 completed pregnancies, 86 percent resulted in a live birth. About 9 percent of these newborns were born preterm, about 3 percent were small for gestational age and about 2 percent had a major birth defect. The proportions of these pregnancy outcomes, including pregnancy losses and health effects in newborns, were consistent with what we would expect based on rates published before the COVID-19 pandemic.

Risks and benefits of COVID-19 vaccines

While the data across all three safety monitoring systems are reassuring, it is crucial that if you are pregnant, you consider the known risks of COVID-19 and the benefits of vaccination during pregnancy when deciding to receive a COVID-19 vaccine. Some key considerations include:

• Risk of COVID-19 exposure
• Risks of severe COVID-19 illness: Pregnant people are at increased risk of severe illness compared to non-pregnant people. Severe illness includes sickness that results in intensive care admission, mechanical ventilation or death. Furthermore, pregnant people who have COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth or pregnancy loss.
• Benefits of vaccination: Getting a COVID-19 vaccine during pregnancy can protect pregnant people from developing severe COVID-19. Emerging data have shown that people who have received mRNA COVID-19 vaccines during pregnancy, mostly during the third trimester, have passed antibodies to their fetuses that could help protect them after birth. However, more data are needed to determine what protection this may provide to the infant.
• Side effects of vaccination: Pregnant people have experienced similar side effects compared to non-pregnant people after receiving a COVID-19 vaccine, particularly after the second dose.
• Limited but growing evidence about the safety of vaccinations during pregnancy:  Because initial clinical trials for the vaccines did not include pregnant people, limited data exist about safety of COVID-19 vaccine in pregnancy. Data from this report provide early, yet promising, data on COVID-19 vaccine among pregnant people, especially those vaccinated in the third trimester. Data for those vaccinated earlier in their pregnancy are still evolving.

People who would like to have a baby

If you are trying to conceive now or in the future, you may receive a COVID-19 vaccine. There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility issues — problems getting pregnant. You do not need to delay or decline COVID-19 vaccination if you are hoping to become pregnant.

People who are breastfeeding

Clinical trials for the COVID-19 vaccines also did not include people who are breastfeeding. Therefore, there are no data available on the safety of COVID-19 vaccines in lactating people and the effects of vaccination on the breastfed infant. Based on how these vaccines work in the body, experts believe they should not pose a risk to people who are breastfeeding or their infants. Additionally, recent reports have shown that breastfeeding people who have received COVID-19 mRNA vaccines have antibodies in their breast milk, which could help protect their babies. More data are needed to determine what protection these antibodies may provide to the baby.

Getting vaccinated is a personal choice

I understand the decision to get vaccinated before, during or after pregnancy can be complicated, especially during a pandemic. If you’re struggling with that choice, I encourage you to reach out to your doctor, nurse or midwife. However, a conversation with a healthcare provider is not required and should not impact your access to vaccination. In the meantime, CDC will continue to collect information on vaccination during all trimesters of pregnancy and will report new findings as they become available. If you have received the COVID-19 vaccination just before or during pregnancy, I invite (even encourage!) you to participate in the one or more of our safety monitoring programs to help us better understand the effects of vaccination during pregnancy.