The COVID-19 vaccine and pregnancy
Monday 8 November 2021
This article was written during the Queensland response to the COVID-19 pandemic and reflects the information available at the date of publication. Please check the Australian Department of Health COVID-19 webpage for updated information and current health advice regarding COVID-19 and vaccinations in Queensland.
There is a lot of misinformation circulating online about the COVID-19 vaccine affecting fertility and being unsuitable for pregnant or breastfeeding women. Much of this information is unscientific and factually wrong, causing unnecessary worry for many.
If you need more information or have concerns about the COVID-19 vaccine and pregnancy, have a conversation with your GP, obstetrician or midwife.
Based on research and common questions we see on our social media channels, we’ve pulled together answers around the vaccine, fertility, pregnancy, and breastfeeding to give you the facts you need.
If you prefer, you can watch this video of Dr Jane, obstetrician and gynaecologist at the Sunshine Coast University Hospital, and mother of three young children, as she talks about COVID-19 vaccination and breastfeeding, the newness of the vaccines, the safety of the vaccines in pre-conception, pregnancy, and breastfeeding, COVID-19 complications in pregnancy, vaccines and fertility, COVID-19 and loss of pregnancy, increased risk of complications from COVID-19 infection while pregnant, COVID-19 infection after childbirth, vaccine side effects, and other important topics.
Possible complications of COVID-19 infection in pregnant women and their babies
Pregnant women are considered a vulnerable group for severe illness and complications from COVID-19 infection, which is why they are a priority group for COVID-19 vaccination.
Women who contract COVID-19 whilst pregnant have a higher risk of certain complications compared to non-pregnant women of the same age who contract COVID-19, including:
- An increased risk (about 5 times higher) of needing admission to hospital.
- An increased risk (about 2-3 times higher) of needing admission to an intensive care unit.
- An increased risk (about 3 times higher) of needing invasive ventilation (breathing life support).
COVID-19 during pregnancy also increases the risk of complications for the newborn, including:
- A slightly increased risk (about 1.5 times higher) of being born prematurely (before 37 weeks of pregnancy).
- An increased risk (about 3 times higher) of needing admission to a hospital newborn care unit.
Some pregnant women are more likely to have severe illness from COVID-19 compared to pregnant women without these conditions. The conditions are:
- Being overweight or obese (body mass index above 30 kg/m2)
- Having pre-existing (pre-pregnancy) high blood pressure
- Having pre-existing (pre-pregnancy) diabetes (type 1 or type 2)
A multinational study of 2,130 pregnant women in 18 countries found there was a consistent association between having COVID-19 while pregnant and higher rates of adverse outcomes such as maternal death, preeclampsia and pre-term birth compared with pregnant women without COVID-19.
Pregnant women with COVID-19 have a higher risk of certain complications compared to non-pregnant women with COVID-19 of the same age, including:
- admission to hospital
- admission to an intensive care unit
- needing invasive ventilation (breathing life support)
- morbidity and mortality
Because of the increased risk of severe illness from COVID-19 and adverse outcomes during pregnancy, it is recommended that pregnant women receive a COVD-19 vaccination as soon as possible, at any stage in their pregnancy.
Can the vaccine affect my fertility?
No. There is no evidence to suggest ANY vaccines—including the COVID-19 vaccine—have any effect on male or female fertility. For more information see the COVID-19 vaccines and fertility section below.
What COVID-19 vaccines can be given to pregnant women in Australia?
Currently in Australia, Pfizer’s COVID-19 vaccine (Comirnaty) and Moderna’s COVID-19 vaccine (Spikevax) are registered by the TGA for use in pregnant women.
The Comirnaty (Pfizer) and Spikevax (Moderna) vaccines are both mRNA vaccines and are routinely recommended for pregnant women, breastfeeding women and women planning pregnancy. Receiving a vaccine before conceiving means you are likely to have protection against COVID-19 throughout your pregnancy. You do not need to avoid becoming pregnant before or after vaccination. You are not required to have a pregnancy test before getting vaccinated.
Is it better to get the COVID-19 vaccine before, during or after pregnancy?
Although you can get vaccinated against COVID-19 at any time before, during, or after your pregnancy, the sooner you get vaccinated, the sooner you are protected. The safer you are, the safer your baby is.
There have been reports of some women waiting until they are pregnant before getting vaccinated against COVID-19, in the hope of better protecting their baby by passing on antibodies to them.
While there is some early evidence that COVID-19 antibodies pass into the breastmilk and cord blood of vaccinated mothers, which may offer some protection to the baby (called passive immunity), this has not yet been studied in depth and the levels of protection are currently unknown.
According to the Centres for Disease Control and Prevention (CDC) in America: “Vaccination of pregnant people builds antibodies that might protect their baby. When pregnant people receive an mRNA COVID-19 vaccine during pregnancy, their bodies build antibodies against COVID-19, similar to non-pregnant people. Antibodies made after a pregnant person received an mRNA COVID-19 vaccine were found in umbilical cord blood. This means COVID-19 vaccination during pregnancy might help protect babies against COVID-19. More data are needed to determine how these antibodies, similar to those produced with other vaccines, may provide protection to the baby.”
A Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) statement says: “It is recommended to have a COVID-19 vaccine as soon as you are offered one. Pfizer or Moderna vaccines can be given at any stage of pregnancy. Two doses of Pfizer or Moderna vaccine provides good protection against COVID-19, including against the Delta strain. It is recommended to have 2 doses of the vaccine, 3-6 weeks apart.”
Factors to consider when deciding the timing of COVID-19 vaccination during pregnancy
Timing in relation to other vaccines:
- There should be an interval of at least seven days between a dose of the COVID-19 vaccine and any other vaccine. This applies to both doses.
- This may affect the timing of the two vaccines medical professionals routinely recommend during pregnancy:
- Influenza vaccine, which can be given at any time.
- Whooping cough vaccine, which is ideally given between 20 and 32 weeks of pregnancy. The influenza and the whooping cough vaccines can be given together on the same day.
- If you want to get the COVID-19 vaccine, talk to your immunisation provider about making a schedule for each vaccine dose you will receive during pregnancy. This will avoid any unnecessary delays.
- If you have any questions about this information, ask your immunisation provider, doctor, pharmacist or midwife.
- If you are breastfeeding: vaccination is recommended for breastfeeding women. You do not need to stop breastfeeding before or after vaccination. Either Pfizer, Moderna or AstraZeneca vaccine is considered safe. The mRNA in Pfizer or Moderna is rapidly broken down in the body and does not appear to pass into breastmilk. The viral vector in AstraZeneca cannot cause infection.
- If you are planning a pregnancy, you can receive a COVID-19 vaccine at any time.
- If you have an increased risk of being exposed to COVID-19, or of having severe illness, you should consider having a COVID-19 vaccine during pregnancy.
- You can choose to have a COVID-19 vaccine at any time during pregnancy; your immunisation provider can help you to decide the best time.
Making the decision – a summary
- seven days apart from any other vaccine
- 3-6 weeks between two doses of either the Comirnaty (Pfizer) or the Spikevax (Moderna).
What are the COVID-19 vaccines made of?
The bulk of the vaccines are water. Besides their active ingredients (see below), they also contain lipids (fats), salts, sugars, and acetic acid (which makes vinegar sour) or amino acids (the building blocks of proteins). Multi-dose vaccines such as the AstraZeneca vaccine, where the vial may be used for multiple doses, contain preservatives to prevent bacterial contamination.
Two of the vaccines in use in Queensland have mRNA as their active ingredient—Pfizer (Comirnaty) and Moderna (Spikevax). mRNA is messenger RNA, which forms a part of your cells’ normal functioning and gives your cells instructions on how to make most of the proteins your body requires. This particular mRNA gives your cells instructions to make a small piece of the spike protein that is found on the surface of the virus that causes COVID-19. Your immune system recognises that this bit of protein does not belong and begins to produce antibodies against it, and therefore against the virus itself.
For much more detailed information on exactly what everything in each COVID-19 vaccine is, see our blog: What’s really in a COVID-19 vaccine?
What do we know about COVID-19 vaccine safety in pregnancy?
The Comirnaty (Pfizer) and Spikevax (Moderna) vaccines have been shown to be safe in pregnant women, based on accumulated real-world evidence from other countries. Studies show that the side effects following vaccination were very similar in pregnant women when compared to non-pregnant women.
No safety concerns have been identified for women who received these vaccines during pregnancy.
RANZCOG says: “Yes, mRNA vaccines such as the Pfizer vaccine have been shown to be safe in pregnant women, based on accumulated real-world evidence from other countries. Pregnant women are a priority group for COVID-19 vaccination and should be routinely offered Pfizer (Comirnarty) or Moderna (Spikevax) vaccine at any stage of pregnancy. You can find more information here
Benefits of getting the COVID-19 vaccine
The Comirnaty (Pfizer) and Spikevax (Moderna) vaccines can be given at any stage of the pregnancy and will protect you against the severity of the COVID-19 disease.
This means, if you have the COVID-19 vaccine, and later get infected with COVID-19, the severity of illness that you experience is likely to be significantly reduced.
COVID-19 vaccines and fertility
There is no evidence suggesting that male or female fertility problems are a side effect of ANY vaccine—including the COVID-19 vaccines.
There is no evidence that receiving a COVID-19 vaccine has any impact whatsoever on fertility, conception or carrying a baby to term.
Australia’s Therapeutic Goods Administration (TGA) would not approve a vaccine unless it was safe and effective, and this consideration includes impacts on fertility. The TGA continues to monitor vaccines’ safety after they are approved for use in Australia.
Getting yourself or your child or teenager vaccinated will not impact your or their future fertility.
According to a joint statement issued by the UK’s Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, there are no believable biological ways that the current COVID-19 vaccines would cause any impact on fertility.
The Centres for Disease Control and Prevention (CDC) in the USA, had this to say on the matter:
“Professional medical organizations serving people of reproductive age, including adolescents, emphasize that there is no evidence that COVID-19 vaccination causes a loss of fertility. These organizations also recommend COVID-19 vaccination for people who may consider getting pregnant in the future.
“Professional societies for male reproduction recommend that men who want to have babies in the future be offered COVID-19 vaccination. There is no evidence that vaccines, including COVID-19 vaccines, cause male fertility problems.”
COVID-19 vaccines and loss of pregnancy
Research conducted by researchers from Yale University, the Centre for Health Research Kaiser Permanente Northwest, and HealthPartners Institute in the USA into 105,446 pregnancies found no association between COVID-19 vaccination and miscarriage.
Another study led by the Norwegian Institute of Public Health into COVID-19 vaccination during pregnancy and first-trimester miscarriage analysed data from several national health registries in Norway and “found no evidence of an increased risk for early pregnancy loss after Covid-19 vaccination and adds to the findings from other reports supporting Covid-19 vaccination during pregnancy.”
Pregnancy and other (non-COVID-19) vaccines
Recommended vaccines have been safely and routinely given to millions of pregnant women over many years.
Some vaccines are recommended for use during pregnancy and some are not, and your healthcare provider is the best source of information about what is best for you and your baby before, during and after pregnancy.
The flu and whooping cough (pertussis) vaccines are routinely recommended during pregnancy because the vaccines have been shown to be safe and effective in protecting mother and baby from harmful outcomes from these two potentially life-threatening diseases. They have both safely been used by millions of pregnant women over many years.
The CDC reports that “there is a large body of scientific studies that supports the safety of flu vaccine in pregnant people and their babies, and CDC continues to gather data on this topic.”
The flu vaccine has been given safely to millions of pregnant women worldwide over many years. Influenza vaccinations have not been shown to cause harm to pregnant women or their babies. Multiple studies confirm normal growth and health in babies with no excess in birth defects, cancers or developmental problems including learning, hearing, speech and vision.
The whooping cough vaccine has been used routinely in pregnant women in the United Kingdom (UK) and the United States (US) since 2012 and careful monitoring of this practice indicates that the vaccine is safe for pregnant women and their unborn babies.
In addition, large studies from the US and the UK looking at birth outcomes following pertussis vaccination during pregnancy have found no evidence of increased risk for stillbirth, premature birth, death of the baby within 28 days of birth, foetal distress, caesarean delivery, or low birth weight.
Please book in for your vaccine as soon as you can to protect you and your baby. If you have any other concerns or questions, please speak to your doctor.
Use the COVID-19 Vaccine Clinic Finder to find a clinic near you that suits your needs by answering some simple questions. You can also book for yourself, your children, or someone else.
Here are some other resources that may be helpful.
- COVID-19 vaccination decision guide for women who are pregnant, breastfeeding or planning pregnancy
- Statement from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists: COVID-19 Vaccination in Pregnant and Breastfeeding Women and those planning pregnancy
- Preparing for COVID-19 vaccination
- After your COVID-19 vaccination.
- COVID-19 vaccines: everything you need to know
- What's really in a COVID-19 vaccine?
- Queensland Health
- Department of Health