Should I have the Covid vaccine if I’m pregnant or breastfeeding?

Are Covid 19 vaccines safe in pregnancy? And what about if you're breastfeeding or trying to conceive? Expert GP Dr Philippa Kaye has the answers...

pregnant woman looking at an iPad

STOP PRESS! July 30 2021: New data from the UK Obstetric Surveillance System (UKOSS)4 shows that more than 99% of pregnant women admitted to hospital with symptomatic Covid are unvaccinated. Other data from University of Oxford researchers5 suggests that, with the Delta variant of Covid that’s now dominant in the UK, the severity of the illness in pregnant women appears to have become worse.

“This is very concerning,” says Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford. “I cannot emphasise more strongly how important it is for pregnant women to get vaccinated in order to protect both them and their baby.”

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Everyone in the UK aged 18 and over can now be vaccinated against Covid. But what happens if you’re pregnant? Is the vaccine safe? Which vaccine should you have? And what about if you’re breastfeeding? Or trying to get pregnant?

We’re getting lots of messages from women asking these questions, particularly as the advice from the Joint Committee on Vaccination and Immunisation (JCVI) and the Royal College of Obstetricians and Gynaecologists (RCOG) about having the AstraZeneca, Pfizer or Moderna vaccine in pregnancy or while breastfeeding has changed a little over the past year as more scientific evidence about their safety and effectiveness has emerged.

So here, courtesy of our expert family GP Dr Philippa Kaye, is what we know so far….

Should I have the Covid vaccine if I’m pregnant?

Yes – the experts are now agreed that having the vaccine in pregnancy is safe for both you and your baby1, and since it’s known that pregnant women are particularly at risk of getting very ill indeed if they do get Covid, both the RCOG2 and the Royal College of Midwives (RCOG) are recommending that pregnant women to get their jabs as soon as possible.

We know that those who are pregnant with Covid are at an increased risk of becoming severely ill, and the vaccine is the safest and most effective way of protecting women and their babies
Dr Edward Morris, president, Royal College of Obstetricians and Gynaecologists

Both RCOG and the RCM do recommend that you speak to your midwife or doctor about getting the vaccine. You may want to  discuss with them any specific benefits and risks for you, based on your individual circumstances. It’s important to know, though, that don’t have to have this discussion before getting your jabs – it’s entirely up to you.

Has the advice about getting the Covid vaccine when pregnant changed?

Yes, it has a little – and RCOG has recently apologised2 for any ‘mixed messaging’ that could have left pregnant women feeling confused.

When the vaccine rollout was started in the UK, pregnant women were the only vulnerable group not prioritised for vaccination. That was because vaccine trials were not carried out on pregnant women (for obvious reasons), so there was, initially, little data on how the vaccines affect pregnant women.

However, as more evidence started to emerge – including from other countries where pregnant women were being vaccinated – official government guidancechanged. And in April 2021, the new guidelines stated that: “evidence so far reviewed by the Medicines and Healthcare products Regulatory Agency (MHRA),the UK regulatory agency responsible for licensing medicines including vaccines, has raised no specific concerns for safety in pregnancy”.

This means that, from April 2021, pregnant women were offered the Covid 19 vaccine at the same time as the rest of the population.

The new guidance3 (updated again in June 2021) says that evidence on Covid vaccines is being continuously reviewed by the World Health Organization and regulatory bodies in the UK, US, Canada and Europe. And in the US, around 100,000 pregnant women have been vaccinated – mainly with Pfizer and Moderna vaccines – and no safety concerns have been identified.

All the evidence is showing that having the Covid jab is safe during pregnancy, and I do urge you to have the vaccine to protect yourself, your baby and your family
Gill Walton, Chief Executive, Royal College of Midwives

Which Covid vaccine should I have?

Pfizer and Moderna vaccines are the preferred vaccines1,3 for pregnant women (whatever your age), according to the JCVI. And that’s not because there are any specific safety concerns about receiving the AstraZeneca vaccines in pregnancy but because there is so much evidence, from the US, that giving the Pfizer and Moderna vaccines to pregnant women has raised no safety concerns.

What if I’m pregnant and I’ve already had the 1st dose of the AstraZeneca jab?

The official advice from Public Health England3 is that, if you have already had a 1st dose of the AstraZeneca vaccine without suffering any serious side effects, you should have your 2nd dose of the same vaccine when this is offered. But you can choose to defer your 2nd dose till after the end of your pregnancy, if you prefer.

RCOG advise1 that, if you find yourself in this situation, you should talk to your midwife or doctor. They should be able to help you assess the best course of action. You may also find the RCOG decision aid for vaccination in pregnancy useful when you’re deciding what to do.

There have been no reported concerns with having the AstraZeneca vaccine in pregnancy.

What if I’ve got pregnant between my 1st and 2nd dose of the Covid vaccine?

It’s recommended that any woman who has already begun vaccination and finds that she is pregnant between their 1st and 2nd dose should still have their 2nd dose of the same vaccine, unless she had a serious side effect after the 1st dose.

If you are unsure, or wish to delay the 2nd dose until after your pregnancy, it’s strongly advised that you speak to a medical professional. You may also find the RCOG decision aid for vaccination in pregnancy useful when you’re deciding what to do.

There have been no reported concerns with having the AstraZeneca vaccine in pregnancy.

Should I have the Covid vaccine if I’m breastfeeding?

The JCVI says: “There is no known risk associated with giving non-live vaccines while breastfeeding.”

That said, there isn’t much specific data about Covid 19 vaccines and breastfeeding and you may wish to discuss this with your GP before booking your vaccination. When you go for your vaccination, you may be told that there is a lack of safety data for this specific vaccination in breastfeeding.

RCOG point out1  that, although there is lack of safety data for these specific vaccines in breastfeeding, there is no plausible mechanism by which any vaccine ingredient could pass to your baby through breastmilk. You should therefore not stop breastfeeding in order to be vaccinated against Covid.

What if I’m trying to conceive?

You can have the vaccine and continue trying to get pregnant. The UK Chief Medical Officers say:

Those who are trying to become pregnant do not need to avoid pregnancy after vaccination
UK Chief Medical Officers

In fact, the RCOG guidelines stress the potential benefits of having the vaccine if you’re trying to conceive: “Getting vaccinated before pregnancy will help prevent COVID-19 infection and its serious consequences. In some cases, women will need to make a decision about whether to delay pregnancy until after the vaccine becomes available to them.”

About our expert, Dr Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

Last updated: July 30 2021

Pic: Getty Images

References:

1. COVID-19 vaccines, pregnancy and breastfeeding. RCOG 28 May 2021
2. Covid unlocking risk for pregnant women, say doctors. BBC News July 15 2021
3. COVID-19 vaccination: a guide for all women of childbearing age, pregnant or breastfeeding. Public Health England Last updated June 14 2021
4. Pregnant women urged to get Covid jab amid rise in hospital admissions. Guardian, 30 July 2021
5. Impact of SARS-COV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort. medRxiv July 25 2021. doi: https://doi.org/10.1101/2021.07.22.21261000

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