With COVID-19 vaccines widely available across the U.S., you may be debating whether or not you should get the shot during pregnancy.

The Food and Drug Administration (FDA) has given full approval to the Pfizer-BioNTech vaccine for the prevention of COVID-19 in those 16 and older (and emergency use authorization in children 6 months and up). It also approved the use of the Moderna vaccine — marketed as Spikevax — for people 18 and up (and emergency use authorization for children 6 months and older). Novavax, a protein subunit vaccine, is authorized for emergency use in those 18 and up.[1] Another COVID-19 vaccine made by Johnson & Johnson/Janssen Pharmaceuticals is authorized for limited use in adults. Each of the four vaccines has been shown to be effective against COVID-19 in large-scale clinical trials.

Here’s everything parents-to-be should know about the COVID-19 vaccines, including why it's so critical for pregnant women to get vaccinated as soon as possible, especially with the Omicron variant and its subvariants still going strong.

Can I get the COVID-19 vaccine if I’m pregnant or breastfeeding?

Yes. Leading experts including the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) strongly recommend that all who are eligible, including pregnant and lactating women, get the COVID-19 vaccine.

Tens of thousands of pregnant women have gotten vaccinated, and experts note that there's plenty of real-world evidence showing that the vaccines are safe and effective when you're expecting.

Experts also note that the risks of contracting COVID-19 while pregnant — including increased risk of preterm birth and other adverse outcomes for your baby — are higher than the potential risks of getting the vaccine while pregnant.

Compared to women who are not pregnant, expectant moms have an increased risk of severe illness and hospitalization from COVID-19. The vaccines offer protection against serious illness, including from the highly contagious Omicron variant, and increase the chances that you would experience mild symptoms from a breakthrough infection.

That's why the CDC previously issued a statement recommending "urgent action" to increase COVID-19 vaccination among pregnant women.

Its current guidelines state that for most people, including pregnant and breastfeeding women, an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) is preferred for primary and booster vaccination. A three-week interval (for Pfizer-BioNTech) and four-week interval (for Moderna) between the first and second doses is recommended for most people. 

If at least five months have passed since you received your first two doses of the Pfizer-BioNTech or Moderna vaccines, you're eligible for a booster. People who received the Johnson & Johnson vaccine are eligible for a booster shot two months later. 

The U.S. Department of Health and Human Services (HHS) has procured booster shots that specifically target BA.4 and BA.5 Omicron subvariants, which currently account for more than 90 percent of cases.[2] 

These multi-strain Omicron boosters were approved for emergency use authorization by the FDA in August 2022, after which they got the green light from the CDC, and they're now available in the U.S.[3] Kids ages 12 and older and adults can get the one made by Pfizer, while everyone ages 18 and older can receive the Moderna version.

Those who want the so-called "updated boosters" can get them at least two months after primary or booster vaccination, according to the FDA. These new bivalent vaccines contain two mRNA components of COVID-19, one of the original strain of the virus and the other one in common between the BA.4 and BA.5 lineages of the Omicron variant, the agency says. 

The COVID-19 vaccine is available to everyone in the U.S. free of charge, regardless of immigration status or whether or not you have health insurance. To find a COVID-19 vaccine site near you, visit Vaccines.gov.

In September 2022, the CDC echoed previous statements it had made that COVID-19 vaccines may become annual like flu shots.

Is the COVID-19 vaccine safe if you’re pregnant or breastfeeding?

We now have plenty of data showing that the COVID-19 vaccines are safe and effective, and moms-to-be should feel confident getting their shot at any point during pregnancy. There have been many myths about the COVID-19 during pregnancy, including rumors that the vaccine increases risk of miscarriage or could cause infertility. These myths and others are untrue and are not rooted in science.

Leading experts note that mRNA vaccines like the ones from Pfizer-BioNTech and Moderna have been studied for years, and we have plenty of strong data about their safety.

"If you look at the literally — literally — tens and tens and tens of thousands of women who have been followed by the CDC who were vaccinated when they were pregnant, there's no indication whatsoever that there's any increase of any adverse issues in a pregnant woman who was vaccinated compared to a pregnant woman who wasn't vaccinated," said Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and Chief Medical Advisor to the President, in an interview with What to Expect founder Heidi Murkoff. "It's really one of those things that's kind of not a close call. It really is pretty clear that pregnant women should get vaccinated."

The CDC has been following vaccinated pregnant women through three safety monitoring systems: the V-safe After Vaccination Health Checker monitoring health check-in system, the V-safe COVID-19 Pregnancy Registry and the Vaccine Adverse Event Reporting System (VAERS).

A report published in the New England Journal of Medicine found no safety concerns for 35,691 pregnant participants aged 16 to 54 years old who received an mRNA vaccine. Rates of miscarriage, preterm birth and babies born with low birth weights among participants in the program were consistent with studies of pregnant women before the pandemic.

Another analysis of data from the V-safe pregnancy registry assessed vaccination early in pregnancy (before 20 weeks) and did not find an increased risk for miscarriage. Among nearly 2,500 pregnant women who received an mRNA COVID-19 vaccine before July 19, 2021, reported rates remained similar to pre-pandemic averages.

Emerging research also suggests that being vaccinated during pregnancy might offer added protection for your newborn. A small study published this past September in the American Journal of Obstetrics and Gynecology found that the antibodies made after pregnant and breastfeeding women received an mRNA COVID-19 vaccine were also found in their breast milk and in baby’s umbilical cord blood, and another small study found that vaccinated nursing moms had antibodies in their breast milk.

What's more, a large Norweigan study published in June 2022 found additional evidence that babies may gain passive protection from vaccination during pregnancy. In the study, the researchers found that newborns were less likely to test positive for COVID-19 in the first four months of life if their mothers were vaccinated while pregnant.

Infants whose mothers received a second or booster dose in their second or third trimester were 33 percent less likely to test positive during the Omicron wave; the benefits were even more pronounced during the Delta period, when infants of mothers vaccinated during pregnancy were 71 percent less likely to test positive.

What do I need to know about the Johnson & Johnson vaccine?

In May 2022, the FDA limited the use of the Johnson & Johnson vaccine to certain adults for whom the other vaccines aren’t accessible or clinically appropriate and to those who wouldn’t get the COVID-19 vaccine otherwise. 

The agency made the change due the risk of a rare blood clot disorder called thrombosis with thrombocytopenia syndrome (TTS). Back in April 2021, the CDC and the FDA paused the use of the Johnson & Johnson vaccine "out of an abundance of caution" after a very small number people who got the shot developed the condition. Then after reviewing the cases, a federal health panel lifted the pause since the benefits of the Johnson & Johnson vaccine outweighed the risks.

But now that the FDA has conducted additional monitoring and approved the use of other COVID-19 vaccines that do not present a risk for TTS, it made the decision to limit the use of the Johnson & Johnson vaccine to those select groups. 

You should seek immediate medical care if you experience any of the following symptoms after receiving a Johnson & Johnson COVID-19 vaccine: severe headache, blurred vision, fainting, seizures, pain in your abdomen (chest or stomach), leg pain or swelling, shortness of breath, new neurologic symptoms, tiny red spots on the skin (petechiae), or new or easy bruising.

Again, the CDC states that the Pfizer-BioNTech and Moderna vaccines are preferred in most situations. While your risk for developing blood clots after getting the Johnson & Johnson vaccine is very low in general, it's extremely low if it has been more than three weeks since you got your shot. If you have any concerns, speak to your health care practitioner.