With COVID-19 vaccines widely available across the U.S., you may be debating whether or not you should get the shot during pregnancy.
Here’s everything parents and parents-to-be should know about the COVID-19 vaccines, including why it's so critical for pregnant women to get an updated vaccine as soon as possible, especially as new variants circulate this fall and winter.
Can I get the COVID-19 vaccine if I’m pregnant or breastfeeding?
Yes, you can and you should.
Leading experts including the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) strongly recommend that all who are eligible, including pregnant and lactating women, get the COVID-19 vaccine.[1]
Tens of thousands of pregnant women have gotten vaccinated, and we have good evidence showing that the vaccines are safe and effective when you're expecting, the CDC notes.
"Safety data about vaccination in pregnancy is rapidly accumulating, with more women being vaccinated and no safety concerns have been detected despite the large number of pregnant women being vaccinated. Globally, the recommended COVID-19 vaccine, and numerous other vaccines, have been proven to be safe and effective in preventing COVID-19 in pregnant women," researchers wrote in a May 2023 review published in the journal Obstetrics & Gynecology Science.
The risks of contracting COVID-19 while pregnant — including increased risk of preterm birth and other adverse outcomes for your baby — are higher than the potential risks of getting the vaccine while pregnant, says the CDC.
Compared to women who are not pregnant, expectant moms have an increased risk of severe illness and hospitalization from COVID-19, according to the CDC. The vaccines offer protection against serious illness, including from the variants circulating during the current cold and flu season, and increase the chances that you would experience mild symptoms if you do get infected.
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The vaccines also builds protective antibodies for your baby until he is old enough to get vaccinated himself.
In short, "the COVID-19 vaccine is important for those who are planning to become pregnant, those who are pregnant, and their babies," says Shannon Smith, M.D., a board-certified OB/GYN and partner at Brigham Faulkner OB/GYN Associates in Boston, Massachusetts, and a member of the What to Expect Medical Review Board.
The following vaccines have received full approval for pregnant and breastfeeding women from the Food & Drug Administration (FDA) for the prevention of COVID-19:
Pfizer-BioNTech (marketed as Comirnaty)
Moderna (marketed as Spikevax)
In October 2023, the FDA also approved an updated version of the Novavax for the 2023-2024 season for emergency use for children and adults ages 12 and up.
Unlike the Pfizer and Moderna vaccines, which are mRNA vaccines, the Novavax vaccine is a subunit protein vaccine. Subunit protein vaccines contain antigens that stimulate the immune system to launch a protective response against a virus.
All the vaccines has been shown to be effective against COVID-19, particularly when it comes to preventing serious illness and death, in large-scale clinical trials.
Should I get a COVID-19 booster if I’m pregnant or breastfeeding?
All pregnant and breastfeeding people should be vaccinated against COVID-19, recommend the CDC, ACOG, and the Society for Maternal-Fetal Medicine.
Whether you've received previous vaccines or not, adults (and children 5 years and older) are now considered up-to-date on their immunizations when they've received one updated COVID-19 vaccine.
You can get an updated COVID-19 vaccine as long as it's been at least two months since your last COVID-19 shot, says the CDC. Children 6 months to 4 years old need multiple doses of one of the pediatric COVID-19 vaccines designed for them.
These recommendations are different than past guidelines, which included getting a series of primary shots and a booster. As of September 2023, the CDC has moved away from the booster approach. Now, COVID-19 shots will likely be treated similarly to flu shots, where people can simply get an updated shot that's targeted against the latest strain or strains each fall.
The updated vaccines are monovalent vaccines, meaning they only target the current circulating strain of COVID-19.[2] These latest vaccines are thought to offer the best protection against COVID-19 this fall and winter, since the original strain of COVID-19 and earlier variants are no longer in circulation.
The COVID-19 vaccine is still free for most people in the U.S., and most health insurance plans will cover the vaccine at no cost to you, according to the CDC.
If you don't have insurance or your plan doesn't cover the vaccine, you can get a free shot from a local health center; state, local, tribal, or territorial health department; or a pharmacy participating in the CDC’s Bridge Access Program. (Any other children you have can receive a free shot from a local provider enrolled in the Vaccines for Children program.)
Is the COVID-19 vaccine safe if you’re pregnant or breastfeeding?
We have good evidence showing that the COVID-19 vaccines are safe and effective if you're pregnant or breastfeeding, and people should feel confident getting their shot at any point during pregnancy and beyond, the CDC says.
There have been many myths about the COVID-19 during pregnancy, including rumors that the vaccine increases risk of miscarriage or could cause infertility. These myths and others are untrue and are not rooted in science.
Leading experts note that mRNA vaccines like the ones from Pfizer-BioNTech and Moderna have been studied for years, and we have plenty of strong data about their safety.
"If you look at the literally — literally — tens and tens and tens of thousands of women who have been followed by the CDC who were vaccinated when they were pregnant, there's no indication whatsoever that there's any increase of any adverse issues in a pregnant woman who was vaccinated compared to a pregnant woman who wasn't vaccinated," said Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and Chief Medical Advisor to the President, in an interview with What to Expect founder Heidi Murkoff. "It's really one of those things that's kind of not a close call. It really is pretty clear that pregnant women should get vaccinated."
Through May 2023, the CDC followed vaccinated pregnant women through three safety monitoring systems: the V-safe After Vaccination Health Checker monitoring health check-in system, the V-safe COVID-19 Pregnancy Registry, and the Vaccine Adverse Event Reporting System (VAERS). (They'll continue to monitor people through a new version of V-safe that will allow users to share their experiences with the most recently updated vaccines.) Approximately 23,000 pregnant women were followed through V-safe.
A June 2023 systematic review that looked at 71 studies involving more than 17 million pregnant women worldwide, published in the journal Vaccine, found no safety concerns associated with getting the COVID-19 vaccine during pregnancy.
These reviews came after numerous major studies published similar findings. A report in the New England Journal of Medicine found no safety concerns for 35,691 pregnant participants aged 16 to 54 years old who received an mRNA vaccine. Rates of miscarriage, preterm birth, and low birth weight babies among participants in the program were consistent with studies of pregnant women before the pandemic.
Another analysis of data from the V-safe pregnancy registry assessed vaccination early in pregnancy (before 20 weeks) and did not find an increased risk of miscarriage. Among nearly 2,500 pregnant women who received an mRNA COVID-19 vaccine before July 19, 2021, reported rates remained similar to pre-pandemic averages.
Emerging research also suggests that being vaccinated during pregnancy might offer added protection for newborns, who can't get vaccinated themselves until age 6 months.
A small study conducted by the National Institute of Allergy and Infectious Diseases, published in the journal PLoS One, found that pregnant and breastfeeding women who received a COVID-19 vaccine generated antibodies against the virus. Five months after giving birth, these antibodies were present in the majority of infants whose mothers had been vaccinated.
Other research shows similar findings. A small study published in the American Journal of Obstetrics and Gynecology found that the antibodies made after pregnant and breastfeeding women received an mRNA COVID-19 vaccine were also found in their breast milk and in baby’s umbilical cord blood, and another small study found that vaccinated nursing moms had antibodies in their breast milk.
What's more, a large JAMA Internal Medicine study published in June 2022 found additional evidence that babies may gain passive protection from vaccination during pregnancy. In the study, the researchers found that newborns were less likely to test positive for COVID-19 in the first four months of life if their mothers were vaccinated while pregnant.
Infants whose mothers received a second or booster dose in their second or third trimester were 33 percent less likely to test positive during the Omicron wave; the benefits were even more pronounced during the Delta period, when infants of mothers vaccinated during pregnancy were 71 percent less likely to test positive.
What do I need to know about the Johnson & Johnson vaccine?
As of May 2023, the Johnson & Johnson vaccine is no longer available in the United States. Previously, it had been limited to certain adults for whom the other vaccines aren’t accessible or clinically appropriate and to those who wouldn’t get the COVID-19 vaccine otherwise, due the risk of a rare blood clot disorder called thrombosis with thrombocytopenia syndrome (TTS).
If you wanted to get immunized against COVID-19 but you and your health care team have decided that the Pfizer or Moderna shots aren't appropriate for you, Novavax is another option to discuss with your health care provider.
Novavax is a protein subunit vaccine, meaning it protects against COVID-19 by exposing the immune system to viral proteins. The newest version of the shot, which has been updated to meet the latest COVID-19 strains, received FDA emergency use approval in October 2023.
Regardless of what you choose, it's worth getting your updated COVID-19 vaccine during pregnancy as soon as possible to stay protected this fall and winter. If you have questions or concerns, talk with your doctor.
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