Worried About Getting The COVID Vaccine While Pregnant? Read This

Photo: Gerardo Vieyra/NurPhoto/Getty Images.
People tend to dole out a lot of unsolicited advice to pregnant people, and sometimes it can be hard to cut through the noise in order to make the right decisions. When it comes to the COVID-19 vaccines, anti-vaxxers have been aggressive in spreading disinformation about getting vaccinated during pregnancy, playing on people’s guilt and desire to have a healthy baby and trying to scare them, despite overwhelming evidence that the vaccine is safe for pregnant people and their babies. This disinformation has been part of the reason vaccine acceptance among pregnant women in the U.S. was only 45% according to a survey by the Harvard T.H. Chan School of Public Health from earlier this year, lower than the worldwide statistic of 52%.
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Count me as one of the 45%. At 32 weeks pregnant now, I’m happy and relieved that I made the decision to get the shot after speaking with several doctors at my practice and reading the available studies. I got my first Moderna shot at 25 weeks and the second one at 29 weeks, and it was extremely uneventful: After the first shot on March 27, I had a bit of pain in my upper arm that went away by the next day, even though the red bump stuck around for a while because I had a rare side effect called “COVID arm,” likely due to my sensitive skin. I received my second shot at 9 a.m. on Saturday, April 24, and felt nothing unusual until I woke up in the middle of the next night with a lot of muscle pain and chills, symptoms that mean my immune system is working and responding to the vaccine. The pain kept me up, and I slept for most of the next day, as a result of both the insomnia and intense fatigue. It was a good excuse to lay around doing nothing and take a long bath, and about 30 hours after the dose I was back to normal. Additionally, two separate checkups after each of the shots showed that my baby’s heart was, indeed, beating and everything was going well. (In fact, I suspect he’s kind of excited about getting immunity passed down to him — he’s been a lot more active recently!)
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But while I was lucky enough to have encouraging doctors, know that the science is on my side, and have an uneventful vaccination itself, the unsolicited advice I received throughout the process kept me from being as calm about this experience as I could have been. All the more worrying is that I can see how someone else — perhaps somebody who is more easily convinced, or less into reading all the available studies when making a decision — would have gotten swayed to remain unvaccinated. It made me believe even more firmly that when making a decision about your body (whether about the COVID vaccine or anything, really), it’s important to listen to the available science, not family members or friends who may have heard false information from somebody else.
And, whatever you do, please do not get your information from random people on the internet. Posting “should I get the vaccine?” on a parenting app will result in lots of responses like, “it’s an experimental vaccine and it could hurt your baby!!” Instead, if you are pregnant and thinking about getting vaccinated, it’s better to go straight to the source. Ahead are some common questions and misconceptions that will help you make the right decision for yourself. 

How do medical experts know that the COVID vaccine is safe when you’re pregnant?

Pregnant and lactating people were not included in initial COVID vaccine trials, which has made it an uphill battle for some doctors to convince pregnant people that the vaccine is safe. But in late April, the Centers for Disease Control and Prevention (CDC) announced that it recommends pregnant people get the vaccine in its strongest-worded language so far. The CDC cited preliminary data from the largest study on the subject yet, published in the New England Journal of Medicine on April 21, which found no “obvious safety signals” among the 35,691 pregnant people followed in the peer-reviewed research. The study relied on self-reported data collected from December 14 to February 28, and participants ranged in age from 16 to 54. “No safety concerns were observed for people vaccinated in the third trimester or safety concerns for their babies,” CDC Director Rochelle Walensky, MD, said last month. “As such, CDC recommends pregnant people receive COVID-19 vaccines.”
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The CDC also warns that COVID is much worse for pregnant people than non-pregnant people, advising that pregnant people are at a much higher risk of severe illness, hospitalization, being on a ventilator, and death if they become infected with COVID than non-pregnant people. Pregnant people with COVID are also at an increased risk for preterm birth and may be at an increased risk for other adverse pregnancy outcomes. 
“For those reasons, I am very pro-vaccine,” OB-GYN Sharon Kressel, MD, tells Refinery29. Dr. Kressel is one of the doctors I have seen at Reiter, Hill & Johnson, who has since moved on to become the lead OB-GYN at Liv by Advantia Health in Washington, D.C.; her comment was just one of several I have received encouraging me to get the vaccine after querying various doctors at the practice. However, both doctors and the CDC recognize that getting vaccinated is a personal choice. When deciding whether to get the shot, the agency asks you to consider: your chance of exposure to COVID-19, the risks of severe illness, the known benefits of vaccination, and the “limited but growing evidence about the safety of vaccinations during pregnancy.”
The NEJM study used data from V-safe, a CDC monitoring app that sends you text messages post-vaccine to monitor for adverse effects; the V-safe pregnancy registry, aimed at tracking effects in pregnant patients in the long term; and the Vaccine Adverse Event Reporting System (VAERS). The CDC says the data is preliminary but reassuring. As of May 11, over 110,000 pregnant people have enrolled in V-safe, and “interpretation of the data thus far has not shown an increased risk of adverse pregnancy outcomes above baseline in unvaccinated populations,” says Dr. Kressel. 
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While there is still limited data available on COVID vaccines during pregnancy, many doctors are now comfortable saying that they do not pose a risk for pregnant people or their babies because of how these vaccines work. For example, they do not appear to affect the placenta, which is usually the first thing doctors examine if something goes wrong with a pregnancy. A Northwestern University study recently published in the Obstetrics & Gynecology journal that looked at women who were vaccinated while pregnant found no evidence that the vaccines affected their placentas. “We don’t see any signals that suggest the placenta is getting injured from the vaccine,” co-author Emily Miller, MD, assistant professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine maternal fetal medicine physician, told the Chicago Tribune. “This builds upon rapidly emerging data that emphasizes that the vaccine is not dangerous during pregnancy.” However, another Northwestern study showed that placentas of pregnant people who contract COVID do show evidence of injury.
There are more clinical trials and studies underway, and vaccine manufacturers are also collecting data from pregnant people: Pfizer is currently running a study of its vaccine in 4,000 pregnant women.

What are the benefits of getting the COVID vaccine when you’re pregnant?

The first benefit is obvious: Just like non-pregnant vaccinated people, you will get protection from the virus. But you could also protect your baby from COVID at a time when the COVID vaccines are not yet available to babies and young children. There’s a lot of evidence that pregnant people not only show a robust immune response to the COVID vaccines, but can pass antibodies to their newborns. In fact, babies have already been born who had COVID antibodies after their mothers had received the vaccine. A study published in late March in the American Journal of Obstetrics & Gynecology looked at 131 patients, of whom 84 were pregnant, 31 were lactating, and 16 were not pregnant, all of whom received either Pfizer or Moderna. It found that the vaccines were highly effective in producing antibodies to COVID in pregnant and lactating people, and it confirmed what other studies had found, which is that vaccinated pregnant people can pass on antibodies to their fetuses through the placenta and their babies through breastfeeding.
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And this month, a small study was published that confirmed the vaccine produces a strong immune response in pregnant and lactating people, and is likely to provide at least some protection against two dangerous COVID strains. The research also suggested that vaccinated pregnant people can pass protective antibodies to their fetuses through the bloodstream and to their infants through breast milk.

When is the best time to get the vaccine while pregnant?

There’s not yet a ton of research on the best time to get it, but doctors suggest doing so well before delivery. Research from Northwestern found that people who were vaccinated earlier in their third trimester had a higher likelihood of passing antibodies to their babies than those who got their shot closer to delivery. “This just gives extra fuel for people who are on the fence or just think, Maybe I’ll wait until after I deliver,” Dr. Miller told Northwestern Now News. “We strongly recommend you get the vaccine while pregnant. But if you’re fearing vaccination might harm the baby, these data tell us quite the opposite. The vaccine is a mechanism to protect your baby, and the sooner you get it, the better.”

Can the COVID vaccine give you COVID? Can the COVID vaccine change your DNA?

No and no.
The Moderna and Pfizer-BioNTech vaccines are mRNA vaccines that do not contain the live virus that causes COVID, so they cannot give you the virus. And, mRNA vaccines do not interact with your DNA or cause genetic changes because the mRNA does not enter the nucleus of the cell, which is where the DNA is. “The cell breaks down and gets rid of the mRNA soon after it is finished using the instructions,” says the CDC. 
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“The mRNA vaccines have the mRNA inside a special coating,” Abisola Olulade, MD, a San Diego-based physician, tells Refinery29. “This coating protects the mRNA from enzymes in the body that may break it down. The mRNA is what the body uses to make the antibodies that protect you from COVID. Since only part of the viral protein (spike protein) is made, it doesn’t do harm to the person vaccinated and after the protein is made the cell breaks down the mRNA strand and gets rid of it using enzymes in the cell. It never enters the part of the cell that contains genetic material or DNA (the nucleus), and so it cannot alter someone’s genetics. This statement is completely false. The vaccines do not interact with or alter our DNA in any way. The vaccines also don’t cause COVID.” 
The Johnson & Johnson vaccine is a viral vector vaccine, which means it works a bit differently, adds Dr. Olulade. But viral vector vaccines have also been given to pregnant people with no negative outcomes.
“The antibodies generated by the Johnson & Johnson vaccine are made from DNA instead of mRNA,” explains Dr. Olulade. “In this case, the DNA is enclosed in an adenovirus vector. The adenovirus serves as a carrier for the DNA. The adenovirus is modified and cannot cause infection. In the case of this vaccine, the adenovirus does push the DNA into the nucleus of our cells, which is what the cell uses to make mRNA, which is then used to make antibodies that protect against COVID. People may think that this means that it can alter our own DNA, but this is simply not true. The simplest way to explain this is to remind ourselves that we are infected with adenoviruses all the time. They cause the common cold. No one would think that getting a cold will change your DNA. It does not and the vaccine does not.” 
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Will my vaccine side effects be stronger if I’m pregnant?

In short, probably not. The side effects pregnant people have reported from getting the mRNA COVID vaccines, as documented in the NEJM research above, are pretty comparable to those non-pregnant people are experiencing. The CDC and doctors recommend taking Tylenol if you experience a fever because fever has been associated with adverse pregnancy outcomes; my doctors told me this, too, although I didn't end up getting a fever.
In the large-scale study published in the NEJM, after the second dose of either Pfizer or Moderna — when most people report feeling the most major side effects — pregnant people were slightly more likely to report injection-site pain and fatigue than non-pregnant people. (To be fair, we are more likely to report fatigue in general. I’m so tired!) However, pregnant people were less likely to report headaches, muscle pain, chills, or fever, something that hasn’t yet been fully explained. About 71% of respondents reported fatigue after their second dose of either vaccine, while 55% experienced headache, 54% experienced muscle aches (this one hit me hard), 27% felt nauseous, and 8% measured a heightened temperature.

Will the COVID vaccine cause miscarriage or pre-term birth?

Among the around 4,000 people who participated in the V-safe pregnancy registry, 827 participants completed their pregnancy. Of those, about 86% had a live birth and 14% experienced a pregnancy loss. Among those who had given birth, about 9% of the births were preterm, 3% had babies that were small for their gestational age, and 2% had congenital anomalies. There were no neonatal deaths. Experts say this data is consistent with rates in the general population. “I think the results are actually quite reassuring as the proportion of the pregnancy outcomes such as pregnancy loss and health effects to the newborn are really quite consistent with what we’d expect in the background rate of the population,” Dr. Walensky told NEJM editors.
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Has there been enough testing on the COVID vaccine? It seems to have been developed so quickly.

“The vaccine has been tested in tens of thousands of people and also given to millions of people,” says Dr. Olulade. “This is an unfortunate myth. Another common statement is that we don’t know what is in it. This is also untrue. We do know what is in it. The ingredients are listed on the CDC’s website for all to see. It was not developed ‘too quickly’; mRNA technology has been around for decades. Experts all over the world have examined the data, and the consensus is that these vaccines are safe, they are effective, and they have the potential to save you and your child’s life. The fact that COVID-19 is caused by a coronavirus also helped because we have studied other coronaviruses before, like SARS. [These types of vaccines] have also been studied before for flu, Zika, rabies, and CMV [cytomegalovirus].”

Will the vaccine affect my baby in the future?

“It cannot alter DNA or genes,” says Dr. Olulade. “There is no evidence that vaccines can cause birth defects or alter a fetus’ DNA. All pregnancies do carry some risk of birth defects in general and so if a baby is born in an unexpected way, it doesn't mean that the vaccine is what caused it.” 

Will the COVID vaccine affect my future pregnancy?

There has been a lot of misinformation spread about the COVID vaccine and fertility. The CDC says there is no evidence that the COVID vaccine causes fertility problems, so if you are trying to become pregnant or want to get pregnant in the future, you don’t need to avoid the vaccine.

Still have questions?

If you are pregnant and have questions about the COVID vaccine, speak with your healthcare provider and/or contact MotherToBaby, a free and confidential service, on their website or at 1-866-626-6847.

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