Pregnancy, Breastfeeding, and COVID-19 Vaccines: Seven Things to Know

September 30, 2021 | Ericka McGowan

Mother cradling baby to her shoulderOn Aug. 11, 2021, CDC updated its guidance on COVID-19 vaccination for pregnant or breastfeeding individuals. We’ve answered seven common questions about the new guidance and what it means for state and territorial health officials as they push to vaccinate more Americans.

What changed in CDC’s new recommendations?

The agency now formally recommends vaccination for everyone ages 12 and older, including those who are currently pregnant, breastfeeding, or may become pregnant in the future. Previous guidance had permitted vaccination during pregnancy but stopped short of a formal recommendation.

Why now?

New analysis of data from CDC’s v-safe pregnancy registry found no increased risk of miscarriage among pregnant recipients of an mRNA vaccine before 20 weeks of pregnancy, which complements evidence of safely administering vaccines late in pregnancy. The new analysis fills what was previously a gap in safety data up to 20 weeks of pregnancy. Scientists reviewed data from the v-safe pregnancy registry of people enrolled before 20 weeks of pregnancy. No increased risk for miscarriage among people who received the mRNA vaccine in pregnancy was found.

What do we know about pregnancy and COVID-19 severity?

Clinicians have reported a growing number of COVID-19 cases in pregnant people as the Delta variant has become the dominant strain in the United States, and pregnant people face greater risk of severe illness and preterm birth if infected. There is also data to suggest that COVID-19 infection can raise the risk of preterm birth, stillbirth, and other negative birth outcomes.

What do we know about vaccine uptake among pregnant people?

The latest CDC data shows only approximately 24% of pregnant people have received at least one dose of a COVID-19 vaccine, putting this group well below the 75% rate across all U.S. adults who have received at least one dose.

Why do pregnant people seem to be especially vaccine hesitant?

Studies have linked vaccine refusal among pregnant people to concerns over vaccine safety, most often citing their exclusion from clinical trials and, as a result, the lack of safety data. Low vaccine uptake in this population is also indirectly a product of age. Pregnant or not, adults within the typical childbearing age groups (18-49 in the above-mentioned CDC statistics) have lower rates of vaccine uptake than the overall population.

Why are we hearing concerns about COVID-19 vaccines and infertility?

This widely debunked myth originated when two former scientists petitioned the European Medicines Agency to withhold emergency authorization for the Pfizer-BioNTech vaccine, citing concerns over the SARS-CoV-2 spike protein the vaccines are designed to target. The authors greatly overstated the similarities between the spike protein and another protein essential to placenta development, suggesting vaccination with mRNA vaccines could result in infertility. Despite having been proven completely false, the myth has spread widely, particularly on social media.

What do these recommendations mean for those who are breastfeeding?

People who were breastfeeding were not included in clinical trials for the vaccines so safety data remains limited, but COVID-19 vaccines cannot cause infection in parent or baby. The mechanism of the COVID-19 vaccines and experience from other vaccines given during breastfeeding suggest it is safe for mother and baby to get a COVID-19 vaccine while breastfeeding. Recent reports have also shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breastmilk, which could help protect their babies.

With intensive care unit beds in some states nearing capacity as the Delta variant surges, it is critical that all eligible Americans be vaccinated for COVID-19 to achieve protection from severe infection. This is especially true for pregnant people and their babies as they face heightened risks if infected. The updated guidance may help ease safety concerns among some Americans who are pregnant, recently pregnant, or may become pregnant, and should be communicated widely.