COVID Vaccination During Pregnancy and Lactation

The California Department of Public Health this past week released updated guidelines that patients with certain health conditions make them eligible to receive the COVID vaccine as soon as March 15, 2021. Pregnancy is among those health conditions which increase the risk of COVID infection including the risk for illness and hospitalization and the risk for adverse outcomes such as preterm birth. The COVID-19 vaccines currently available represent a tremendous scientific achievement which have thus far exceeded expectations for effectiveness in preventing serious illness. Ultimately, decision making regarding COVID-19 vaccination during pregnancy is not straightforward and therefore should be personalized.

All vaccines offered in the United States undergo extensive testing and meticulous oversight and this includes the currently available mRNA vaccines from Pfizer and Moderna. However the safety trials for mRNA vaccines deliberately did not include pregnant or breastfeeding individuals. A small number of people (18) became pregnant during the vaccine safety trials and, as of early February 2021, 20,000 pregnant healthcare workers received the vaccine without any evidence of adverse outcomes to date. When studied in animals, the Moderna vaccine was not associated with infertility or shown to cause pregnancy problems. Further studies in pregnant people are planned but it is unclear when this information will become available.

The American College of Obstetricians and Gynecologists (ACOG) along with the Society for Maternal-Fetal Medicine and many other leading women’s healthcare organizations have published recommendations that COVID-19 vaccines should not be withheld from pregnant or breastfeeding individuals. Although safety has not been directly established, these vaccines do not contain live virus and the mRNA particles used are degraded within hours or days by the muscle cells at the site of injection making the risk of crossing the placenta or breastmilk very unlikely. And, significantly, immunity that a pregnant or breastfeeding individual generates from vaccination can cross the placenta, or breastmilk, providing some immunity to a newborn.

A simplified way to view the choice regarding vaccination based on current availability is:

Get vaccinated as soon as the vaccine is available to you: You might decide this if you are pregnant and also have other high risk conditions such as obesity or high blood pressure, or perhaps you have a high risk of exposure to COVID-19 due to work or family.

Wait until after you give birth to get the vaccine: You might choose this if pregnancy is your only risk factor for severe disease AND you are able to control your exposure by limiting interactions with people outside of your bubble and continue to use protective measures e.g. social distancing and mask-wearing.

Wait for a traditional vaccine similar to the flu shot or Tdap: These vaccines are close to being approved in the US but are still limited by the traditional exclusions of pregnant and lactating people in their safety trials.

If patients choose to get vaccinated they can participate in the CDC’s vaccination health checker called V-safe or the University of Washington’s COVID Vaccine Pregnancy and Lactation registry.

How to get notified and access vaccine appointments

***It is important to note that the providers at Golden Gate Ob/Gyn are unable to assist with appointment prioritization or scheduling exceptions***

California residents can check for vaccine eligibility and notification with

County by county eligibility notification sign-ups:

San Francisco
San Mateo
Santa Clara

Another option to find out about eligibility and schedule appointments is to create a patient portal with any of the local major healthcare providers. Patients will not be able to schedule appointments until they become eligible, but what we found out with healthcare worker vaccinations is that it helps to have a patient portal already established. It’s also important to note that appointment availability will be linked to vaccine supply, so even if an individual is eligible it may take days or weeks to obtain an appointment. Everyone who wants the vaccine will eventually receive it.

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John Muir
Dignity Health


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