Neha Arti 
Should you get the COVID-19 vaccine if you’re pregnant?
It’s the leading question on many expecting mother’s minds right now. Is the vaccine risky? Is it riskier than getting the virus?
The CDC recommends that pregnant people are offered the vaccine. Current evidence suggests the risks of the virus during pregnancy are greater than that of the vaccine. That is, while COVID-19 has been linked to preterm birth, the vaccine that prevents it hasn’t been linked to any risks.
This is why some doctors are recommending the vaccine to their pregnant patients. Still though, getting the shot during pregnancy is a personal choice. Since the best decisions are informed ones, we’re laying out the information for you in this post.
Read on to learn the facts on the COVID-19 vaccine and pregnancy.
How COVID-19 Affects Pregnancy
When doctors are deciding on a treatment for a patient, they weigh the benefits and the risks. This helps them make decisions where a positive outcome is more likely.
Similarly, when considering whether to get the COVID-19 vaccine, you should weigh the risks of the virus versus the risks of the vaccine. If you ask your healthcare provider for advice about the shot, this is the information they’ll likely point out. To start, let’s go over the known risk of the virus on pregnant women.
COVID-19-Related Complications in Mother
The overall risk of getting severely ill from COVID-19 is low. However, it’s higher while expecting. Pregnant people are more likely to get severely ill from COVID-19 compared to others, according to the CDC. Severe illness can include a virus that causes hospitalization, intensive care, breathing equipment or death.
The risk of virus-related complications is also higher for pregnant women with underlying health conditions, like diabetes, obesity and increasing age, according to the American College of Obstetrics and Gynecologists.
COVID-19 and Negative Pregnancy Outcomes
COVID-19 carries a risk specific to pregnant women: It may cause negative pregnancy outcomes. Although the research isn’t clear yet, data suggests that pregnant people with COVID-19 may be at an increased risk for preterm birth.
An April 2021 paper evaluated the results of 42 coronavirus studies, accounting for over 438,000 pregnant people. The findings are below.
Compared to pregnant people without the virus, COVID-19 was associated with:
- Preeclampsia
- Preterm birth
- Stillbirth
Compared with mild COVID-19, severe COVID-19 was strongly associated with:
- Preeclampsia
- Preterm birth
- Gestational diabetes
- Low birth weight
This lead researchers to ultimately conclude that the virus may be associated with increased risks of preeclampsia, preterm birth and other negative pregnancy outcomes.
COVID-19 Vaccine: Is It Effective?
When making your decision on whether to get a COVID-19 vaccine, you should also consider the effectiveness of the shot. To evaluate the benefits, we need to turn to the evidence. Let’s look at the clinical trials for the three COVID-19 vaccines available in the U.S.
Pfizer-BioNTech
Clinical trials found that the Pfizer-BioNTech vaccine was 95% effective at preventing COVID-19. Although typical vaccine side effects were noted, most were mild to moderate. No specific safety concerns were found.
Moderna
According to clinical trials, the Moderna vaccine was 94.1% effective at preventing COVID-19 after two doses. In particular, Moderna seemed to be highly effective among diverse age, sex, race and ethnicity categories. It was also highly effective for people with underlying medical conditions. Although typical vaccine side effects were noted, most were mild to moderate. Interestingly, volunteers who received a placebo (fake injection) were more likely to be admitted to hospital than those who received the actual Moderna vaccine. No specific safety concerns were found.
Johnson & Johnson’s Janssen
Clinical trials found that the J&J vaccine was 66.3% effective at preventing COVID-19. The most protection occurred two weeks after vaccination. Although this vaccine has a lower rate of preventing the virus, it’s highly effective at preventing hospitalization and death in people who get sick. Four weeks after vaccination, out of everyone in the study who got COVID-19, nobody needed to be hospitalized. Although typical vaccine side effects were noted, most were mild to moderate. No specific safety concerns were found.
Mitigating the Risk
All of the evidence suggests that the vaccines available work. According to the CDC, getting a COVID-19 vaccine during pregnancy can protect you from getting severely ill from the virus. It might protect your baby too. One woman who was vaccinated passed the antibodies onto her newborn. If the virus increases negative pregnancy outcomes, it could also cancel out that elevated risk.
Research on COVID-19 Vaccines and Pregnancy
Unfortunately, pregnant women aren’t typically prioritized when it comes to vaccines or healthcare developments. The COVID-19 shots aren’t any different.
The decision-makers for Moderna, Pfizer and J&J trials all made the choice to exclude pregnant women in their original studies. As predicted at the start of the pandemic, this ethical issue has led to knowledge gaps: Is the vaccine safe for pregnant people too?
Although we know the three major vaccines are safe for the general population, there’s less evidence on how it affects pregnancy. The current studies suggest there’s no risks. To confirm this finding, experts are continuing to gather data.
What We Know Already
COVID-19 is a new vaccine. As such, it takes time to gather information about how it works. Researchers already have some clues though. That’s because they can make educated guesses based on what they already know about vaccines.
“Based on how these vaccines work in the body, experts believe they are unlikely to pose a specific risk for people who are pregnant,” the CDC says on its website.
The available COVID-19 vaccines fall into two categories: mRNA and viral vector.
- mRNA Vaccines (Moderna and Pfizer):These types of vaccines don’t contain a live COVID-19 virus. Since mRNA shots have been well-studied, we know that they don’t enter the nucleus of the cell. For that reason, they don’t interact with DNA or cause genetic changes. This makes it less likely to impact your baby.
- Viral Vector Vaccines (J&J):These vaccine types use a modified version of a different virus. The virus used in the J&J vaccine has been tested on women during all trimesters. In fact, a large Ebola vaccination trial confirmed its safety. So although the J&J vaccine as a whole hasn’t been largely tested on pregnant women, the virus it uses
mRNA Vaccine Pregnancy Study
Preliminary findings from April 2021 suggest that mRNA vaccines (AKA Moderna and Pfizer-BioNTech) pose no risks during pregnancy. The study used self-reported data from nearly 36,000 people who were pregnant or planned to become pregnant. Researchers ultimately concluded that there wasn’t any evidence of safety hazards to pregnant people.
The study also affirmed that those pregnant can expect the same side effects as others. These include pain in the area of the shot, fatigue, headache and muscle aches.
Although this study is ongoing, at the time of this writing, the research only reflects 11-weeks’ worth of data. To get a full picture, experts say they’ll follow up with volunteers.
Animal Studies on All 3 Vaccines
Moderna, Pfizer-BioNTech, or J&J vaccines have also been tested on pregnant animals. Studies found no safety concerns for either the mother or her babies, according to the CDC.
In summary, since pregnant women aren’t prioritized in vaccine research, there’s less data surrounding how it affects pregnancy. With that being said, based on what we know about previous vaccines, all three options appear safe. Real-world data has confirmed this so far, although we’ll learn more as additional studies are done.
Should You Get the COVID-19 Vaccine When Pregnant?
Both the CDC and ACOG say that COVID-19 vaccines shouldn’t be withheld from pregnant women. They agree that while research is still in its early phases, there’s no current data suggesting that the shot poses any risks during pregnancy.
Mirroring each other’s stances, the CDC and ACOG say getting the vaccine is a personal decision. To help make this choice, weigh the evidence about risks and benefits.
As we discussed above, the preliminary findings on vaccine safety and pregnant women were done using mRNA vaccines. Since no risks were found, some women might feel safer choosing these vaccines over the J&J/Janssen vaccine (viral vector). With that being said, viral vector vaccines have previously been used during all trimesters and proven safe. For that reason, you might be comfortable receiving any vaccine.
Other people might choose to wait for more research before getting the shot. (In this case, you should still be extra careful of COVID-19 since it’s tied to negative pregnancy outcomes).
You might also consider your personal risks for COVID-19. For example, frontline workers or people with chronic health conditions are more likely to get sick from the virus. For them, this can be an especially important factor into the risk-benefit evaluation.
If you have any questions or aren’t sure which decision to make, talk to your doctor. They can help you outline your options with the most up-to-date data.
Summary: COVID-19 Vaccine Safety While Pregnant
When the race to find a vaccine began, some experts begged that pregnant women be included in the original clinical trials. Despite this, pregnant people were excluded, as they often are when it comes to health research. This problematic pattern means we know less about how the vaccine affects pregnant people.
Current data from over 36,000 women receiving mRNA vaccines suggests that there’s no specific risks. Although there’s no studies on J&J and pregnancy, the virus the vaccine uses has been studied and proven safe during all trimesters.
To make your decision, weigh the benefits against the risks. If you’re having trouble, talk to your doctor about your options.
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