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COVID-19 vaccines are recommended in pregnancy. All pregnant women and girls in the UK aged 16 and over have now been offered a COVID-19 vaccine.
On 16 April 2021, the Joint Committee on Vaccination and Immunisation advised that all pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, in line with the age group roll out.
Previously their advice was that pregnant women at high risk of exposure to the virus or with high risk medical conditions should consider having a COVID-19 vaccine in pregnancy.
Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.
The decision whether to have the vaccination in pregnancy is your choice. Make sure you understand as much as you can about COVID-19 and about the vaccine and you may want to discuss your options with a trusted source like your doctor or midwife.
According to the government’s advice for pregnant employees, employers must carry out a risk assessment for pregnant employees taking into consideration the RCOG/RCM Guidance on Coronavirus in pregnancy. Employers are still required to carry out a risk assessment whether an employee has been vaccinated or not.
Robust real-world data from the United States – where over 160,000 pregnant women have been vaccinated mainly with mRNA vaccines, such as Pfizer-BioNTech and Moderna – have not raised any safety concerns.
Therefore, the JCVI advises that it is preferable for the Pfizer-BioNTech or Moderna mRNA vaccines to be offered to pregnant women in the UK, where available.
The UK Health Security Agency (formally Public Health England) have reported that more than 82,000 pregnant women in England have received at least one dose of COVID-19 vaccination and Public Health Scotland have reported that more than 19,000 pregnant women have received a vaccine, with no serious adverse effects recorded.
The initial clinical trials which showed that COVID-19 vaccines are safe and effective did not include pregnant women. As the COVID-19 vaccines were not tested in pregnant women, we cannot say for sure that they work as well in pregnant women as they do in other adults. However, more recent studies showed that pregnant women who had the vaccine made antibodies against COVID-19, suggesting that the vaccine is effective in pregnancy. Recent studies also showed that pregnant and non-pregnant women had similar mild side-effects from vaccination.
COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccine causes harm to the pregnancy or to fertility.
The COVID-19 vaccines that we are using in the UK are not ‘live’ vaccines and so cannot cause COVID-19 infection in you or your baby. Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough). Pregnant women are offered other non-live vaccines, such as those against flu.
Studies have shown that protective antibodies from vaccination do cross the placenta, helping with the baby’s immunity to COVID-19. We know that catching COVID-19 during pregnancy can cause severe illness in a pregnant woman, especially in the third trimester – that’s why we recommend the COVID-19 vaccine in pregnancy.
As these are new vaccines, there are no studies yet on the long term effects on babies born to women who had a COVID-19 vaccine in pregnancy, but as COVID-19 vaccines are not ‘live’ vaccines they cannot cause infection, and other non-live vaccines have been given to women in pregnancy for many years without any safety concerns.
The mRNA vaccines (Pfizer and Moderna) are also quickly broken down once they have been injected – within a few days of vaccination there will be no vaccine mRNA left.
The data available shows that if a pregnant woman has the COVID-19 vaccine she is not at an increased risk of having adverse pregnancy outcomes. Research from across six studies in four countries, involving more than 40,000 pregnant women, shows having the vaccine does not increase the risk of miscarriage, preterm birth, stillbirth, nor does it increase the risk of a small-for-gestational age baby, or the risk of congenital abnormalities.
One of these studies was from St George’s, University of London and published in the American Journal of Obstetrics and Gynaecology (AJOG) on 12 August 2021. The research compared pregnancy outcomes for women who had received the COVID-19 vaccine and those who had not. They found there were no significant differences between the two groups, with no increase in stillbirths or premature births, no abnormalities with development and no evidence of babies being smaller or bigger.
More research is being done, monitoring both the mother and baby’s health during and for a year after the baby’s birth. We know that the vaccine is safe in pregnancy, but this is the next step in looking at the level of protection that the vaccine provides, what the best interval between doses is, and monitoring the immune response of both the mother and baby after the vaccine.
The Yellow Card scheme run by the Medicines and Healthcare products Regulatory Agency (MHRA) is the UK system for collecting and monitoring information on safety concerns, such as suspected side effects or adverse incidents involving medicines and medical devices, including vaccines.
The MHRA have reported that the numbers of reports of miscarriage and stillbirth are low in relation to the number of pregnant women who have received COVID-19 vaccines to date (more than 55,000) and how commonly these events occur in the UK outside of the pandemic.
They say there is no pattern from the reports to suggest that any of the COVID-19 vaccines used in the UK, or any reactions to these vaccines, increase the risk of miscarriage or stillbirth. Sadly, miscarriage is estimated to occur in about 20 to 25 in 100 pregnancies in the UK and most occur in the first 12 to 13 weeks of pregnancy (the first trimester). Stillbirths are sadly estimated to occur in about 1 in 200 pregnancies in the UK.
We also have research from six studies worldwide which show the rates of miscarriage were the same in those who had received a COVID-19 vaccine during pregnancy as in the general population.
In non-pregnant individuals, the COVID vaccines are known to have mild and short-lasting side effects, such as a fever or muscle ache lasting a day or two. Reports of serious side effects, such as allergic reaction or clotting problems, have been very rare.
Regarding serious blood clots, the JCVI has stated that "there are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine". This means that someone is not necessarily at higher risk of this serious side effect just because they have a higher risk of other blood clots, for example because they are pregnant. Because this side effect is so rare, we can't know the exact risk in pregnancy.
This information on the AstraZeneca vaccine may be less relevant for pregnant women now that the JCVI recommends that the Pfizer-BioNTech or Moderna vaccines are offered in pregnancy, where available.
The government has also advised that individuals under the age of 40 should be offered an alternative vaccine to the AstraZeneca vaccine, based on the risk/benefit ratio for that age group.
COVID-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.
More than half of women who test positive for COVID-19 in pregnancy have no symptoms at all but some pregnant women can get life-threatening illness from COVID-19, particularly if they have underlying health conditions. In the later stages of pregnancy, women are at increased risk of becoming seriously unwell with COVID-19.
COVID-19 infection can also affect the pregnancy. In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. A recent study has also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.
The benefits of vaccination include:
potentially reducing transmission to vulnerable household members.
The vaccine is considered to be safe and effective at any stage of pregnancy. There’s no evidence that delaying until after the first 12 weeks is necessary.
One dose of COVID-19 vaccination gives you good protection against infection, but with the most recent (Delta) variant of the virus, two doses are needed to give a good level of immunity. Second doses are given 8 weeks after the first dose and we recommend that you receive two doses before giving birth, or before you enter the third trimester, when the risk of serious illness with COVID-19 is greatest.
The JCVI advises that it is preferable for all pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna mRNA vaccines, where available. This is because these vaccines have been given to over 148,000 pregnant women in the US and the data have not raised any safety concerns. Women who have already had one dose of AstraZeneca (before they became pregnant or earlier on in pregnancy), are advised to complete vaccination with a second dose of AstraZeneca – see below for more information.
Pregnant women who commenced vaccination with AstraZeneca are advised to complete with the same vaccine. The second dose will be important for longer lasting protection against COVID-19.
There have been very rare reports of serious blood clots after a second dose of the AstraZeneca vaccine. The official national publication on vaccines (the Green book) advised on 7 May 2021 that: “Pfizer and Moderna vaccines are the preferred vaccines for eligible pregnant women of any age, because of more extensive experience of their use in pregnancy. Pregnant women who commenced vaccination with AstraZeneca, however, are advised to complete with the same vaccine”.
There are no reported concerns with the AstraZeneca vaccine in pregnancy, but there is less experience in pregnancy with this vaccine, than with the Pfizer and Moderna vaccines, which has led to the JCVI recommending a preference for Pfizer-BioNTech or Moderna.
The safety of mixing different vaccines is being investigated in an ongoing trial (the ComCov trial), which does not include pregnant women. Initial data from the study, published on 12 May 2021, showed that mixing vaccines appeared to be safe overall. However, there was an increase in short-lasting side effects such as fever for individuals who were given two different vaccines compared to individuals who had two doses of the same vaccine. Further information from this trial is expected later this year.
Currently you can choose whether to have the second dose of AstraZeneca in pregnancy (as typically given), or defer until after pregnancy - however a second dose is recommended to ensure maximum protection against COVID-19.
If you are unsure about receiving the second dose of AstraZeneca, you should arrange to speak to an obstetrician or midwife or GP and use the RCOG's decision aid on vaccination in pregnancy to support your choice.
Up to 31 March 2021, in the UK, healthcare professionals who met a woman who had been vaccinated in pregnancy recorded this via their UK Obstetric Surveillance Service (UKOSS) reporter for the joint UKOSS/UKTIS study. Pregnant women who had been vaccinated (up to and including 31 March 2021) could also report directly to UKTIS via their telephone line 0344 892 0909 (open 9-5pm Mon-Fri).
Pregnant women can register directly with the MHRA Yellow Card Vaccine Monitor.
Another reporting mechanism for healthcare professionals is the PHE Inadvertent Vaccination in Pregnancy (VIP) system.
As of April 2021, pregnancy status is recorded in the national vaccination programme to make sure pregnant women and their babies’ outcomes can be followed up.
All adults over the age of 18 are now being invited to have a COVID-19 booster vaccine. This will be delivered in age group order, the eldest and those who are at additional risk will be offered first.
The JCVI advises that the booster vaccine dose should be offered three months after the second vaccine dose. We encourage all pregnant women eligible for the COVID-19 booster vaccination to have it when they are offered as it provides the best protection against the virus for you and your baby.
Pregnant women are not currently being routinely offered the COVID-19 booster vaccine. This is because the majority of pregnant women will have received their second COVID-19 vaccine during the summer months and six months has not passed since they had it. The JCVI wishes to gather more information about when a booster dose might be needed for younger healthy people, including pregnant women.
The JCVI has said:
“As most younger adults will only have received their second COVID-19 vaccine dose in late summer or early autumn, the benefits of booster vaccination in this group will be considered at a later time when more information is available. In general, younger, healthy individuals may be expected to generate stronger vaccine-induced immune responses from primary course vaccination compared to older individuals. Pending further evidence otherwise, booster doses in this population may not be required in the near term.
JCVI will review data as they emerge and consider further advice at the appropriate time on booster vaccinations in younger adult age groups, children aged 12 to16 years with underlying health conditions, and women who are pregnant.”
We will continue to work with the JCVI and the Department of Health and Social Care to ensure they have the up-to-date research around COVID-19 in pregnancy..
You can have the COVID-19 vaccine or booster at the same time as other vaccines such as the flu jab or the whooping cough vaccine. Sometimes it will not be possible to have the vaccines together for logistical reasons. If they aren’t given together then they can be administered at any interval, although separating the vaccines by a day or two will avoid confusion over any side-effects.
The JCVI is advising the Pfizer or Moderna vaccines are given for the booster dose, irrespective of the vaccine used for the initial two doses. This is based on initial findings from the COV-BOOST trial which is ongoing. So if you’ve completed two courses of the AstraZeneca vaccine, you will be able to have a Pfizer or Moderna booster vaccine.
The advice still stands from the JCVI that pregnant women who received AstraZeneca for their first dose are advised to continue with AstraZeneca for their second dose. This is because the second dose is important for longer lasting protection against COVID-19, and there is less evidence around mixing types of vaccine for the first and
second doses. If you are unsure about receiving the second dose of AstraZeneca, you should arrange to speak to an obstetrician or midwife or GP.
Two trials of COVID-19 vaccines in pregnant women in the UK have launched and another is planned.
COVID-19 vaccines are recommended to breastfeeding women. There is no plausible mechanism by which any vaccine ingredient could pass to your baby through breast milk. You should therefore not stop breastfeeding in order to be vaccinated against COVID-19.
Women who are trying to become pregnant do not need to avoid pregnancy after vaccination.
Getting vaccinated before pregnancy will help prevent COVID-19 infection and its serious consequences.
One dose of COVID-19 vaccination gives you good protection against infection, but it is thought that this is not long-lasting and may not protect you for the whole of pregnancy.
COVID-19 vaccines are recommended to pregnant women. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.
If you find out you are pregnant after you have had one dose of the vaccine (between doses), you are advised to have your second dose 8 weeks after your first dose. The vaccine is considered to be safe and effective at any stage of pregnancy and there’s no evidence that delaying until after the first 12 weeks is necessary.
We recommend that you complete the course of vaccination before giving birth, or before you enter the third trimester, when the risk of serious illness from COVID-19 is greatest.
Your decision should take into account your personal exposures to and risks from COVID-19. You can discuss these risks with a doctor or your midwife, and you may want to use the RCOG and RCM decision tool to assist you in deciding what to do next.
Yes, you can have the COVID vaccine during IVF treatment. The British Fertility Society recommends considering the timing of your vaccine, taking into account that some people may experience minor side effects in the few days after vaccination that you do not want to have during treatment. It may be sensible to separate the date of vaccination by a few days from some treatment procedures (for example egg collection and embryo transfer in IVF) so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure. Your medical team will be able to advise you about the best time for your situation. If you have the vaccine at this time, you will help to protect yourself and your baby from the effects of COVID-19 infection in pregnancy.
A minority of women going through IVF receive immune suppressant therapy. None of the COVID vaccines used in the UK are ‘live’ vaccines, and so cannot cause COVID-19 infection, even in women taking immune suppressing treatments. However, the vaccine may provide less protection as these treatments may reduce the level of anti-COVID antibodies produced by the body in response to the vaccine. It might be preferable, therefore, to delay having the vaccine until the effects of any immune therapy have worn off; or delay your IVF treatment until a few weeks after you’ve had your vaccine. You should discuss the pros and cons of these approaches with your fertility specialist.
There is no evidence to suggest that COVID-19 vaccines will affect fertility. There is no biologically plausible mechanism by which current vaccines would cause any impact on women's fertility. Animal studies of the Pfizer and Moderna vaccines showed that administering these vaccines in rats had no effect on fertility. Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.
Likewise, the theory that immunity to the spike protein could lead to fertility problems is not supported by evidence. Most people who contract COVID-19 will develop antibody to the spike and there is no evidence of fertility problems in people who have already had COVID-19. As more evidence becomes available on the safety of each vaccine (from following up people for longer), we will update our advice.
More information on COVID-19 vaccines, fertility and fertility treatment is available from the British Fertility Society (BFS) and Association of Reproductive and Clinical Scientists (ARCS).
If you receive a dose of the vaccine before finding out you are pregnant, or unintentionally while you are pregnant, you should be reassured that the vaccine is safe and effective at any stage of pregnancy.
If you find out you are pregnant after you have had one dose of the vaccine (between doses), you are advised to have your second dose 8 weeks after your first dose. There’s no evidence that delaying until after the first 12 weeks is necessary.
Second doses are given 8 after the first dose and we recommend that you complete the course of vaccination before giving birth, or before you enter the third trimester, when the risk of serious illness from COVID-19 is greatest.
Pregnant women and women who are breastfeeding are already routinely and safely offered vaccines in pregnancy, for example to protect against influenza and whooping cough. Many of these vaccines also protect their babies from infection. These vaccines, like the COVID-19 vaccines, are non-‘live’ vaccines, which are generally considered safe in pregnancy. However, specific evidence regarding the safety of the COVID-19 vaccination in pregnancy is not yet available.
Like all medicines, vaccines can cause side effects. These are usually mild and do not last long. Very common side effects in the first day or two after your vaccine include: pain or tenderness in your arm where you had your injection, feeling tired and headaches, aches and chills.
You may also have flu like symptoms and experiences episodes of shivering or shaking for a day or two. If you develop a fever (your temperature is 38C or above) you can rest and take paracetamol, which is safe in pregnancy.
You can report any suspected side effects through the Yellow Card scheme, which allows the Medicines and Healthcare Regulatory Agency (MHRA) to monitor side effects and ensure vaccines are safe.
If you are concerned about your symptoms, you can contact your GP or maternity team for further advice.
There have been reports of an extremely rare clotting problem associated with people receiving the Oxford AstraZeneca vaccine. If you experience any of the following from around 4 days to 4 weeks after vaccination you should seek medical advice urgently: