It was good news when two COVID-19 vaccines were approved. There were over 70,000 participants in the Pfizer and Moderna trials, but two unique populations were left out: pregnant or breastfeeding women. Should these women get the COVID vaccine?
Pregnant and breastfeeding women have many questions about the vaccines. They want to know if it is safe for them to get vaccinated. Can a mom continue breastfeeding? If a nursing mom is vaccinated, can her breast milk protect her infant against COVID?
Parentology looked at the recommendations from leading health care organizations and health care providers.
Recommendations from ACOG
The American College of Obstetrics and Gynecology (ACOG) issued a practice advisory.
- “COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on the Advisory Committee on Immunization Practices (ACIP)-recommended priority groups.”
- “COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP.”
Infant Risk Center’s Advice
The Infant Risk Center of Texas Tech University Health Sciences Center, the world’s leading research center for medication safety during pregnancy and lactation, posted on their site that they believe the risk for this population will “probably be low.”
“Therefore, while we wait for more information, each mother and provider should discuss what choice fits their situation best. 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.”
The Academy of Breastfeeding Medicine Weighs In
The Academy of Breastfeeding Medicine (ABM) also issued an advisory statement on its website.
- “Individuals who are lactating should discuss the risks and benefits of vaccination with their health care provider, within the context of their risk of contracting COVID-19 and of developing severe disease. Health care providers should use shared decision making in discussing the benefits of the vaccine for preventing COVID-19 and its complications, the risks to mother and child of cessation of breastfeeding, and the biological plausibility of vaccine risks and benefits to the breastfed child.”
- “During lactation, it is unlikely that the vaccine lipid would enter the bloodstream and reach breast tissue. If it does, it is even less likely that either the intact nanoparticle or mRNA transfer into milk. In the unlikely event that mRNA is present in milk, it would be expected to be digested by the child and would be unlikely to have any biological effects.
- “While there is little plausible risk for the child, there is a biologically plausible benefit. Antibodies and T-cells stimulated by the vaccine may passively transfer into milk. Antibodies transferred into milk may therefore protect the infant from infection with SARS-CoV-2.”
What Health Care Providers Are Advising
What do health care providers recommend for pregnant or breastfeeding women and the COVID vaccine? Do a risk-benefit approach. Pregnant women are at greater risk for a severe case of COVID and can pass the virus to their unborn baby.
“In my profession as an OBGYN, we certainly need to take precautions when necessary, but in this case, any potential risks the vaccine may pose to pregnant people and those providing breast milk to their infants are much less than the very real risks facing those who contract COVID,” Dr. Chitra Akileswaran, Vice-Chair of Obstetrics and Gynecology at Alameda Health System, and Co-Founder/Chief Medical officer of parenting startup Cleo tells Parentology. “We have to trust our experts, who all suggest that pregnant people and those providing breast milk to their infants are strongly urged to consider receiving the COVID vaccine.”
Akileswaran points to the research to support her recommendation.
“Findings suggest that COVID in pregnancy is more likely to result in preterm birth and to lead to severe disease with more life-saving interventions required. While we have yet to see the longer-term impacts of an expecting parent contracting COVID on their children, we have reason to be optimistic that the vaccine is a net benefit for a pregnant or breastfeeding person. Of course, this is a personal decision and should be made together with your Ob/Gyn or midwife.”
Akileswaran thinks we need to look at the bigger picture when providing recommendations on whether the COVID vaccine is appropriate for this population.
“This is also, importantly, a public health imperative,” Akileswaran says. “The health of our society depends on our ability to achieve immunity at a population level. This is even more critical for certain segments of the population. Some individuals are both at higher risk of contracting the virus and at higher risk of having serious life impacts as a result of it — health-wise, socially, and economically.”
In Akileswaran’s role as a physician at Alameda Health System in Oakland, CA, she works with patients who face housing instability, job insecurity, concurrent substance use, face violence at home, and/or have many people depending on them for support. These same patients are disproportionately likely to contract COVID because they don’t have the privilege of sheltering-in-place or social distancing due to being essential workers or living in crowded environments.
“The vaccine is not just for you, it’s for the people who are unable to protect themselves around you,” Akileswaran says. “Therefore, I hope all will seriously consider receiving it.”
Dr. Ava Williams, board-certified in Internal Medicine with expertise in chronic care, health and wellness, disease management, and preventive care, is a primary care doctor at Doctor Spring. She also recommends pregnant and breastfeeding mothers consider getting vaccinated and wants women to be aware of some potential reactions to the vaccine, including fever and an allergic reaction.
“Fevers, in general, are bad for pregnant women, but they can take Acetaminophen. Also, since this is a fairly new vaccine, and as with other vaccines, there’s a risk of developing severe allergic reactions. This has happened on very rare occasions. “
Pregnant Women COVID Vaccine — Sources
American College of Obstetricians and Gynecologists – Vaccinating Pregnant and Lactating Patients Against COVID-19
Infant Risk – COVID-19 Vaccinations
Academy of Breastfeeding Medicine – Considerations For COVID-19 Vaccinations In Lactation
Doctor Spring
Cleo