Although many folks are looking forward to receiving the highly-anticipated COVID vaccine, there are others who are meeting this opportunity with trepidation rather than anticipation  — specifically women who are pregnant or thinking of becoming pregnant. And why is this? Primarily it’s because up until this point,  there has been limited published data about the COVID vaccine and pregnancy. Pregnant women were intentionally left out (due to historical and ethical reasons) of these initial studies looking at the safety and efficacy of the vaccine, though as the trials progressed, a small number of enrolled women did become pregnant and no adverse outcomes have yet been reported in this group. So with all this in mind, let’s talk about what we do know.

 The COVID vaccine is safe

Though it seems that these vaccines were created quickly, the science behind these vaccines has been known and tested by scientists for decades. The perception also that the trials proceeded (perhaps too) quickly needs to be qualified by the fact that the data was obtained during a pandemic which allowed for massive amounts of information about the safety and efficacy of the vaccine to be collected in record time. This vaccine has been tested with the same rigors and held to the same standards as any other vaccine on the market – the setting just allowed this to happen much more quickly, much to our benefit.

With safety assured, it is important to point out that there can still be some short-lived vaccine side effects associated with the COVID vaccine, similar to that which we see for others (such as the flu vaccine which is given routinely in pregnancy). These symptoms include body aches, headache, fatigue, and fever, all generated by our own healthy immune system’s response to the vaccine – it’s actually a good sign that the body is mounting a robust response against any future foreign invader! These effects can easily and safely be managed in pregnant women with acetaminophen if needed.

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Will the vaccine affect my fertility?

There is no data to support that the vaccine will negatively affect your ability to get pregnant, now or in the future. The vaccine molecules are degraded within days after they have done the work of priming the immune system to fight off any future COVID infections. There is nothing left of the vaccine itself within a week of getting it, so you do not have to worry about “holding onto” any foreign substances that may impact fertility. There is also nothing to suggest that these vaccines affect the cycling of hormones or ovulation, sperm generation, or the fertilization or implantation process in any way.

Based on what we know so far, including the years of data of other widely used vaccines in pregnancy including the flu vaccine and Tdap, there is no reason to believe that the COVID vaccine should cause any harmful effects on the mother or baby. In fact, you can argue that the potential benefit of getting the vaccine and avoiding a COVID infection could positively impact the chances of having a healthy pregnancy. Pregnancy itself increases your risk to develop a more serious case of COVID, where increased rates of hospitalizations and ICU admissions have been seen in pregnant women. A healthy mother equates with a greater chance of having a healthy baby, and historically the regular use of most vaccines in pregnancy helps to assure just this.

If pregnant, when is it best to be vaccinated?

There is no data that shows that waiting to be vaccinated until later in pregnancy is any safer than in the earlier stages. However, decisions about when to be vaccinated should be discussed with your health care provider. Considerations about the risks versus benefits of receiving the vaccine rest on several factors, including the level of active viral transmission in the community, the efficacy of the vaccine itself, and potential risks to the mother or baby. Mothers with underlying health conditions (such as diabetes or hypertension) potentially have increased health risks associated with COVID, so a more timely vaccination schedule may be considered.

In terms of benefits to the baby, we do know that antibodies produced in mothers in response to vaccines also cross the placenta and can protect the infant – this is called passive immunity.  You can imagine that infants, whose immune systems are not entirely developed at birth, who are born to vaccinated mothers will already have antibodies and therefore some protection from COVID. This same concept is applied to giving mothers the Tdap vaccine during pregnancy to allow their infants some passive immunity to whooping cough (a life-threatening condition in a baby) when they are born.

Which vaccine should I get?

There are two general types of vaccines available right now: a 2-dose mRNA vaccine (one made by Moderna, and another by Pfizer-BioNTech), and a 1-dose viral vector vaccine (made by Johnson & Johnson/Janssen). The mRNA vaccine does not contain any live virus, and directly delivers to our cells genetic information that encodes a small piece of the COVID virus. Our cells use this information to create a copy of the coronavirus Spike Protein, and this is what mounts our immune response against the virus. Even though this is a novel vaccination method that has not yet been used widely until now, the technology has been applied for years in cancer research.

Alternatively, the virus vector vaccine uses a different and modified harmless virus to deliver a piece of the COVID virus particle (the Spike Protein) to our cells. Our body then creates an immune response against the coronavirus. Janssen has used this same delivery system with its Ebola vaccine which has been tested on women in all three trimesters, and no adverse pregnancy-related outcomes were reported. Animal (nonhuman) studies have also been completed using all three of the COVID vaccines (both the mRNA and virus vector models), and no negative outcomes were reported, for what that is worth.

So which one to choose if you are pregnant? Again, the long-term safety and efficacy data in pregnant women has not yet been established, though studies for all three vaccines are ongoing and are showing reassuring results. Most health officials recommend that you take whichever you are offered due to the good safety profiles of all the available vaccines. Though they differ in mechanism, there is not one vaccine type that stands out as superior to the other as they all provide virtually 100% prevention of serious COVID infections and/or hospitalizations.

Bottom Line: Should pregnant women get vaccinated?

Ultimately, this is a personal choice, though a pregnant woman owes it to herself to be as informed as possible. Since pregnant women were not included in the initial safety and efficacy studies of the COVID vaccine, it is generally recommended that they have a discussion with their health care provider to help weigh the risks versus benefits of getting vaccinated.

However, what we do know about the overall safety and efficacy of this vaccine suggests that pregnant women would greatly benefit from getting it.  Finally, there is also no reason to think that receiving the vaccine early in pregnancy is any less safe than receiving it later in pregnancy, and you should not wait to get the vaccine if you are actively trying to conceive. Several medical groups, including ACOG (American College of Obstetricians and Gynecologists) and the Society for Maternal-Fetal Medicine have also backed these recommendations and are encouraging pregnant women and those trying to conceive, to get the vaccine when it is available to them.