COVID-19 Vaccines and Pregnancy: Conversation Guide
Key Recommendations and Messaging for Clinicians
- The American College of Obstetricians and Gynecologists (ACOG) strongly recommends that pregnant individuals be vaccinated against COVID-19.
- Vaccination may occur in any trimester, and emphasis should be on vaccine receipt as soon as possible to maximize maternal and fetal health.
- For patients who do not receive any COVID-19 vaccine, the discussion should be documented in the patient’s medical record. During subsequent office visits, obstetrician–gynecologists should address ongoing questions and concerns and offer vaccination again.
- COVID-19 vaccines may be administered simultaneously with other vaccines, including within 14 days of receipt of another vaccine. This includes vaccines routinely administered during pregnancy, such as the influenza and Tdap vaccines.
The following messages are intended to help guide conversations with pregnant patients:
Risk Associated With COVID-19 Infection During Pregnancy
- COVID-19 infection during pregnancy is associated with increased risk of maternal severe illness, admission to an intensive care unit, mechanical ventilation, and death.
- There is a known increased risk of complications from COVID-19 in pregnant patients with underlying health conditions (e.g., diabetes, obesity, increasing age, and cardiovascular disease).
- There is an increased risk of preterm delivery, and there may be an increased risk of stillbirth.
- There is increased risk of infection and death for certain racial and ethnic populations.
Safety of COVID-19 Vaccines
- None of the COVID-19 vaccines available for use under emergency use authorization or U.S. Food and Drug Administration (FDA) license causes infertility or spontaneous abortion.
- There is no evidence of adverse maternal or fetal effects from vaccinating pregnant individuals with the COVID-19 vaccine, and a growing body of data demonstrates the safety of such use.
- Injection site and systemic events (side effects) are common (e.g., pain at the site of injection, fever, muscle pain, joint pain, headaches, fatigue, and other symptoms may be present after vaccination).
- Acetaminophen is recommended for pregnant women who experience fever or if desired for other side effects.
- These side effects are a normal part of the body’s reaction to the vaccine and developing antibodies to protect against COVID-19 illness.
- Ongoing safety monitoring is occurring through many government and nongovernment programs.
Efficacy of COVID-19 Vaccines
- The effectiveness of COVID-19 vaccines is similar in pregnant and non-pregnant individuals of similar age for prevention of COVID-19 infection and hospitalizations.
- All currently available COVID-19 vaccines have demonstrated high efficacy among their respective clinical trial endpoints.
- COVID-19 vaccines decrease the risk of severe COVID-19 disease.
- Even if the patient gets sick after being vaccinated, their chance of becoming severely ill are extremely low.
- The majority of hospitalized patients are individuals who did not receive a COVID-19 vaccine.
Safety and Efficacy for the Newborn
- There are accumulating data demonstrating that antibodies are passed to the fetus when a pregnant person is vaccinated.
- IgG antibodies after maternal vaccination in the third trimester have been shown in observational studies. However, no data are available to demonstrate whether this prevents COVID-19 disease in neonates.
- mRNA vaccines are available to children aged 6 months and older.
Special Considerations for Communities of Color
- Access to and confidence in COVID-19 vaccines are of critical importance for all communities, but willingness to consider vaccination varies by patient context, in part because of historic and continued injustices and systemic racism that have eroded trust in some communities of color. When discussing COVID-19 vaccines with an individual who expresses concerns, it is critical to:
- Be aware of historical and current injustices perpetrated against communities of color.
- Actively listen to and validate expressed fears and concerns.
- Continue to care for patients who decide not to be vaccinated, to share resources, and to encourage the continued use of prevention measures.
For patients who do not receive a COVID-19 vaccine, the discussion should be documented in the patient’s medical record. During subsequent office visits, obstetrician–gynecologists should address ongoing questions and concerns and offer vaccination again.
For more information on vaccinating pregnant women against COVID-19, see ACOG’s Practice Advisory.