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COVID-19 Vaccine in Pregnancy and Breastfeeding

Last Updated: 7/27/21

 

Plain Language Summary:

Similar to other medications, pregnant and/or breastfeeding women have not been widely included in studies to determine how well COVID-19 vaccines work or how safe they are. Based on research on women who chose to take the vaccine, we believe the risks that come with vaccination are low. The risk and benefit of the vaccine should be compared to each mother’s individual risk for getting COVID-19 as well as how well she is expected to tolerate the disease. Each mother and provider should discuss what choice fits their situation best.

 

BREASTFEEDING and the COVID-19 Vaccine: 

 

The use of these new vaccines in breastfeeding mothers was not studied in clinical trials, but our understanding is growing from secondary research. We believe the current COVID-19 vaccinations to be safe for lactating women and their breastfeeding babies. Lactating women should be given the option to receive a COVID-19 vaccine.  In these situations, physicians and breastfeeding mothers in consultation will have to weigh the relative risks of the vaccine to that of the infection with COVID-19 in that specific mother.

 

What we know:

 

  1. No vaccine mRNA has been found in breastmilk after vaccination.  
    Reported from a study on 7 individuals who received the Moderna mRNA vaccine.
  2. Neutralizing antibodies were found in milk as soon as 7 days after vaccination.
    A study including 31 lactating women who took either the Moderna or Pfizer mRNA vaccines had anti-SARS-CoV-2 IgG and IgA present in their milk. A second study of 7 women found antibodies up to 80 days after vaccination (later time periods were not evaluated). This study also found that pasteurization caused only a minimal loss in these antibodies.
  3. The vaccine is not known to impact milk supply.
    In a survey of 4,455 vaccinated mothers who primarily received the Moderna or Pfizer mRNA vaccines, 98% reported no impact on lactation.
  4. Breastfed babies of mothers who received the vaccine exhibit minimal to no symptoms.
    In a survey of 4,455 vaccinated mothers who primarily received the Moderna or Pfizer mRNA vaccines, 93% reported no child symptoms. Of those that reported symptoms, the most common were increases in sleep and fussiness.

 

We believe current COVID-19 vaccines to be safe for breastfeeding mothers and their infants. This evaluation includes Pfizer, Moderna, and Johnson & Johnson vaccines.

 

 The World Health Organization, Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), the Academy of Breastfeeding Medicine, the Center for Disease Control and Prevention (CDC), and even the UK’s Joint Committee on Vaccination and Immunization (JCVI) all also support the use of the vaccine in breastfeeding women similar to their non-breastfeeding peers. 

 

Statement for LMIC Countries:

While we have not evaluated many vaccines available in low- and middle-income countries, we believe that the risk of COVID-19 infection in a lactating person outweighs the risk of mRNA or adenovirus vaccines.

 

Frequently Asked Questions (breastfeeding):

 

I have more questions about the COVID-19 Vaccines. Where can I get more information?   

 

How do COVID-19 vaccines work?

 

Is the Johnson & Johnson vaccine safe?

  • We believe even the additional risks associated with the Johnson & Johnson vaccine will outweigh the risks of a COVID-19 infection in a lactating mother.
  • See the section on the Johnson & Johnson vaccine at the end of our article COVID-19 Vaccines, Mechanisms, and Breast Milk Antibodies

 

How do antibodies in milk help infants?

 

I have COVID-19. How do I safely breastfeed?

 

 

PREGNANCY and the COVID-19 Vaccine:

 

Consensus is growing among prominent bodies that pregnant individuals are at high risk for severe illness with COVID-19, therefore vaccination may be of additional benefit. As of July 12, 2021, over 130,000 pregnant individuals have received a vaccine. The CDC is enrolling these participants to monitor the safety of the vaccine in them and their children. So far, no adverse effects have been published.

For pregnant women, the Society for Maternal-Fetal Medicine (SMFM) has issued the statement below supporting the use of Covid-19 vaccinations in pregnant women.  Below is a partial paragraph from their statement:

" SMFM strongly recommends that pregnant and lactating people have access to the

COVID-19 vaccines and that they engage in a discussion about potential benefits and

unknown risks with their healthcare providers regarding receipt of the vaccine.”

 

The American College of Obstetricians and Gynecologists (ACOG) also released a statement supporting the vaccine in pregnancy and lactation. Here are the highlights:

  • ACOG recommends that pregnant and/or lactating individuals have access to COVID-19 vaccines and related information regarding safety, efficacy, and any deficiencies in information.
  • While a conversation with a clinician may be helpful, it should not be required prior to vaccination, as this may cause unnecessary barriers to access.
  • Women under age 50 including pregnant individuals can receive any FDA-authorized COVID-19 vaccine available to them. However, they should be aware of the rare risk of thrombosis with thrombocytopenia syndrome (TTS) after receipt of the Janssen COVID-19 vaccine and that other FDA-authorized COVID-19 vaccines are available (i.e., mRNA vaccines).
  • Importantly, claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them. ACOG recommends vaccination for all eligible people who may consider future pregnancy.
     

The Centers for Disease Control and Prevention (CDC) updated their statement to support the use of the vaccines during pregnancy and lactation:

“Based on current knowledge, experts believe that COVID-19 vaccines are unlikely to pose a risk to the pregnant person or fetus… Any of the currently authorized COVID-19 vaccines can be administered to pregnant or lactating people; ACIP does not state a product preference. However, pregnant, lactating, and post-partum people aged <50 years should be aware of the rare risk of TTS after receipt of the Janssen COVID-19 vaccine and the availability of other FDA-authorized COVID-19 vaccines (i.e., mRNA vaccines).”

 

As of Feb 19. 2021, the World Health Organization (WHO) recommends COVID-19 vaccination for pregnant women based on benefit-risk assessment per individual case and does not recommend restricting or furthering pregnancy/ and/or breastfeeding-related activities solely due to the COVID-19 vaccination. Further, they concede that high-risk groups or those with unavoidable COVID-19 exposure may be vaccinated after consultation with their medical provider. While the recommendation for Pfizer and Moderna vaccines are separate, they majorly currently come to the same conclusion.


Pregnancy Summary:
The above opinions are basically supported by years of safety data with most but not all vaccines, and from studies worldwide. At this point, since many of the new vaccines do not contain live viruses and are not infectious, the InfantRisk Center supports the opinion from the SMFM, ACOG, CDC, and WHO that current Covid-19 vaccines are safe for pregnant women.  Ultimately, the risk of infection in that patient must be weighed against the minimal risk of the vaccine.

 

 

Thomas Hale, PhD

Kaytlin Krutsch, PharmD, MBA, BCPS

 

Written with the research support of Malaika Shinwari.