We spoke with experts to better understand the benefits of receiving the COVID-19 vaccine while pregnant and breastfeeding.
With so much information readily accessible on whether or not to get vaccinated, it can be challenging to know what is right for you—especially when your choice affects your unborn child. Receiving vaccines during pregnancy isn’t new. Yearly flu shots are commonplace and updating vaccines, such as the tetanus shot, are encouraged, but the COVID-19 vaccines have garnered more public speculation.
Dr. Vincenzo Berghella, director of the division of maternal fetal medicine, is a staunch advocate for COVID vaccination throughout the family planning and pregnancy process. “Pregnant people worldwide have received it,” he explains. “The data from the CDC indicates it is safe and effective in preventing severe illness.” With the high infection rates of newer COVID variants, such as omicron and delta, more are getting the vaccine to protect themselves and their unborn children.
We connected with Dr. Berghella and Meredith Stein, a nurse midwife and nurse practitioner, to answer common COVID vaccine questions and address concerns during family planning, pregnant or breastfeeding stages.
What is a primary motivator you share with your patients on the fence about vaccination? Increased risk of future infertility?
Stein: I emphasize that getting vaccinated during pregnancy has not been linked to an increased risk of COVID. Meanwhile, a pregnant person without a COVID vaccine has a higher risk of negative impacts on themselves and the fetus, an increased risk for ICU admission, needing to be on a ventilator, preterm delivery and stillbirth.
Dr. Berghella: Without the COVID vaccine, if a pregnant person is diagnosed with COVID and it becomes severe, they can end up in the ICU critically ill. This level of illness can result in preterm birth, which means the baby may be either non-viable and die or be preterm and handicapped for life. So, while the vaccine is for the pregnant person, it also protects the baby. So, the only way to protect the neonate is for the pregnant person to get the vaccine during pregnancy. [Editor’s note: At the time of publication, babies are unable to receive the vaccine, and this is one of the ways to protect them from COVID.]
Many are concerned with family planning issues due to receiving the vaccine. How safe is receiving the vaccine while trying to conceive?
Stein: There are no studies to date that show a decrease in the ability to conceive a normal healthy pregnancy for vaccinated people. However, if you get COVID while trying to conceive, we know the aftermath of COVID can be unpredictable. Given that we cannot predict with 100% certainty who will or will not have significant complications from COVID (requiring hospitalization, intubation and possible death), we recommend vaccination for people trying to conceive. We balance the known risks of acquiring COVID versus the fact that none of the data collected to date has shown a negative impact on fertility with vaccination.
Is there a specific trimester that is best to receive the COVID vaccine?
Stein: There’s no specific trimester. We want to decrease the chance of somebody getting COVID in any trimester. So even if you’re in your first trimester, we still strongly recommend vaccination if you haven’t previously received it. And if you’re more than six months out from vaccination, we recommend the booster. There’s no time that we don’t recommend vaccination because we know that even if you get COVID in the first trimester, there’s still potential to impact the pregnancy negatively. The ability to access these vaccines is amazing in this country. It becomes particularly important when looking at the high COVID infection rates from the Omicron variant.
Does getting vaccinated while pregnant transmit antibodies to the fetus?
Dr. Berghella: When a pregnant person gets vaccinated against COVID, their body builds antibodies. So those antibodies are transmitted to the placenta. They then reach the baby and last for quite a while after the baby’s birth, which gives the baby partial protection from COVID.
Does lactation transmit antibodies?
Stein: It helps the baby develop antibodies. We know that if you get vaccinated close to delivery and then breastfeed afterward, you transmit antibodies through the breast milk, whether you get vaccinated in the first, second, or third trimester. If you defer getting vaccinated or boosted during your pregnancy and do it postpartum, you’re going to transmit some antibodies through the breast milk. There are two different types of antibodies, IgG and IGA. A study conducted on 31 lactating people found that receiving the vaccine during lactation boosted IgG antibodies. Data is still being analyzed on the exact amount of IgG antibodies we need and the amount in breast milk.
Dr. Berghella: Some antibodies the pregnant person makes when they get the vaccine transfer into the breast milk and then to the baby, but not as many as when they’re pregnant, and those antibodies pass through the placenta. So, it’s protective and safe. And if the parent hasn’t been vaccinated or needs a booster, it’s very safe to get while breastfeeding.
Is there something you say to pregnant people who are nervous about the vaccine that helps them understand the safety of getting it?
Dr. Berghella: We inform them to get the COVID vaccine. My wife is pregnant now, and she has not only received the COVID vaccine but the flu and Tdap(tetanus) vaccines while pregnant, as they are recommended. There is no worry around getting multiple vaccines during pregnancy, and it’s often the first thing I discuss with a patient when they are pregnant.
Stein: It’s an individualized experience. Are they nervous because they have gone down a misinformation rabbit hole? Are they nervous because they know somebody who got vaccinated and then got COVID? So, they’re not clear about why we’re recommending the vaccine. And then, we talk about how no vaccine is perfect. If you do get COVID, it’s most likely going to be a much less severe case. For example, if you’re unvaccinated, you can get a severe case that may land you in the ICU. Vaccination doesn’t take your risk to zero, but it’s better if you have a mild case than a severe case. Some people are uncomfortable with any vaccinations, COVID vaccinations or otherwise. If someone does have any questions or changes their mind down the road, we want to welcome a conversation. Ultimately, the most important thing is not to make these people feel alienated from health care.
Editor’s Note: Pregnant individuals can receive a COVID vaccine at any of our vaccination locations. Philadelphia residents may register to receive a vaccine here or find our mobile vaccine unit schedule here. New Jersey residents may schedule their vaccines here.