The COVID-19 vaccine in pregnancy and breastfeeding
The vaccines watchdog, the Joint Committee on Vaccination and Immunisation (JCVI) is still urging pregnant people to have their COVID-19 vaccine as soon as possible.
This information is based on official guidelines from the Royal College of Obstetricians and Gynaecologists.
Midwife, Sophie, answers your FAQs
Out midwife Sophie answers your most frequently asked questions about Covid-19, the vaccine and pregnancy.
- COVID-19 vaccines are strongly recommended at any stage of pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for you and baby, including admission to intensive care for you and premature birth of the baby.
- With the new variant (Omicron) in circulation, you are encouraged to have your first and second doses of the COVID-19 vaccine if you have not already done so, to protect yourself and your baby.
- You are also encouraged to book a COVID-19 booster vaccine (third dose) 3 months after your second dose.
- You may wish to discuss the benefits and risks of having the vaccine with your healthcare professional and reach a joint decision based on individual circumstances.
- There is no known risk in giving COVID-19 vaccines to people who are breastfeeding. You should not stop breastfeeding to be vaccinated against COVID-19.
- You do not need to avoid pregnancy after vaccination if you are trying to get pregnant. There is no evidence to suggest that COVID-19 vaccines will affect fertility.
- Having a COVID-19 vaccine will not remove the requirement for employers to carry out a risk assessment for pregnant employees, which should follow the rules set out in this government guidance.
- Pregnant people who are unvaccinated or not fully vaccinated may choose to limit close contact with people they don't usually meet to reduce the risk of catching or spreading COVID-19. This is especially important if you are in the third trimester and when COVID-19 disease levels in the general community are high.
- Contact your maternity team if you have any concerns about the wellbeing of yourself or your baby.
What is the latest advice on COVID-19 vaccination and pregnancy?
COVID-19 vaccines are strongly recommended in pregnancy. All pregnant people in the UK aged 16 and over have now been offered a COVID-19 vaccine.
Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both you and baby, including admission to intensive care and premature birth.
The decision whether to have the vaccination in pregnancy is yours. Make sure you understand as much as you can about COVID-19 and about the vaccine. It may help to discuss your options with a trusted source such as your doctor or midwife.
What are the benefits of vaccination in pregnancy?
COVID-19 vaccines are strongly recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for you and baby, including admission to intensive care and premature birth.
More than half of people who test positive for COVID-19 in pregnancy have no symptoms at all. But some pregnant people can get life-threatening illness from COVID-19, particularly if they have underlying health conditions. In the later stages of pregnancy, people are at increased risk of becoming seriously unwell with COVID-19.
COVID-19 infection can also adversely affect the pregnancy. In pregnant people with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risks of prematurity. A recent study has also found that pregnant people who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia or need an emergency caesarean section. Their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.
Getting vaccinated can:
- reduce your risk of becoming severely ill
- reduce the risk of premature birth or stillbirth
- potentially reduce the risk of passing the COVID-19 infection on to vulnerable people at home.
When in pregnancy can I have the vaccine?
The vaccine is considered to be very safe and effective at any stage of pregnancy. There’s no evidence that you need to delay vaccination until after the first 12 weeks.
1 dose of COVID-19 vaccination gives you good protection against the original infection. 2 doses are needed to give a good level of immunity against the Delta variant of the virus. Second doses are given 8 weeks after the first dose. A booster (third dose) is recommended to provide the best protection against the most recent (Omicron) variant.
Booster vaccines can be given 3 months (91 days) after your 2nd dose.
Is there any evidence that COVID-19 vaccines cause miscarriage or stillbirth?
The Medicines and Healthcare products Regulatory Agency’s (MHRA) Yellow Card scheme 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. It has been analysing reports of miscarriage and stillbirth in pregnant people who have received the COVID-19 vaccines.
The MHRA says there is no pattern to suggest 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 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. This evidence shows that there is no increased risk of miscarriage if you have the COVID-19 vaccine.
Midwife, Juliette, answers your FAQs
Out midwife Juliette answers your most frequently asked questions about Covid-19, the vaccine and pregnancy.
Are vaccines normally used in pregnancy?
Yes. Pregnant people and people who are breastfeeding are already routinely and safely offered vaccines in pregnancy. For example, to protect against influenza (flu) 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. Find out more about vaccinations in pregnancy.
How is COVID-19 vaccination being monitored in pregnancy?
Up to 31 March 2021, in the UK, healthcare professionals who met a person who had been vaccinated in pregnancy recorded this via their UK Obstetric Surveillance Service (UKOSS) reporter for the joint UKOSS/UKTIS study. Pregnant people who had been vaccinated (up to and including 31 March 2021) could also report directly to UKTIS.
You 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 people and their babies’ outcomes can be followed up.
Does it matter which vaccine I have?
The Joint Committe on Vaccination and Immunisation (JCVI) advises that it is preferable for all pregnant people 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 275,000 pregnant women in the US and UK and the data have not raised any safety concerns.
If you have already had one dose of AstraZeneca (before you became pregnant or earlier on in pregnancy), you are advised to complete vaccination with a second dose of AstraZeneca – see below for more information.
I have already had one dose of the AstraZeneca vaccine before or earlier in my pregnancy. I am now pregnant and due my second dose. What should I do?
The UKHSA published an update to the Green Book on Immunisation on 14 December 2021. This confirms that pregnant people who have already received a dose of AstraZeneca vaccine can have AstraZeneca for their second dose or 1 of the mRNA vaccines (Pfizer or Moderna). Evidence suggests that those who receive mixed schedules make a good immune response.
Pfizer and Moderna vaccines are the preferred vaccines for eligible pregnant people of any age. This is because of more extensive experience of their use in pregnancy. There are no reported concerns with the AstraZeneca vaccine in pregnancy, but there is less published data with this vaccine.
You are strongly recommended to complete your primary vaccination course with a second dose of any available vaccine to make sure you have maximum protection against COVID-19.
Is COVID-19 vaccination safe and effective for pregnant women and their babies?
Robust real-world data from the United States – where over 177,000 pregnant women have been vaccinated mainly with mRNA vaccines, such as Pfizer-BioNTech and Moderna – have not raised any safety concerns.
Therefore, the Joint Committee on Vaccination and Immunisation (JCVI) advises that the Pfizer-BioNTech or Moderna mRNA vaccines should be offered to pregnant women in the UK, where available.
The UK Health Security Agency (UKHSA) (formally Public Health England) have reported that more than 84,000 pregnant women in England have received at least one dose of COVID-19 vaccination.
Public Health Scotland have reported that more than 19,000 pregnant women have received a vaccine, with no serious adverse effects recorded. New safety data published on 25 November 2021 by the UKHSA showed that in August 2021, 22% of women who gave birth were vaccinated.
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 are not ‘live’ vaccines so cannot cause COVID-19 infection
COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant people 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 people 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 which is why COVID-19 vaccine in pregnancy is so strongly recommended.
What do we know about the impact of COVID-19 vaccination on babies born to women who have been vaccinated 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.
Studies have shown that protective antibodies developed from vaccination can transfer from mother to baby across the placenta, and after birth through breast milk, helping with the baby’s immunity to COVID-19. The degree of protection this provides to the baby is unknown at present and more research is needed.
No increased risk of miscarriage, preterm birth or stillbirth caused by vaccination
The data available shows that if a pregnant person has the COVID-19 vaccine they are not at an increased risk of having adverse pregnancy outcomes. Research from across 13 studies in 5 countries, involving more than 100,000 people vaccinated in pregnancy, shows having the vaccine does not increase the risk of miscarriage, preterm birth or stillbirth. Nor does it increase the risk of a small-for-gestational age baby, or the risk of congenital anomalies.
One of these studies was from St George’s, University of London and published in the American Journal of Obstetrics and Gynecology (AJOG) on 9 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 anomalies 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 pregnancy 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.
What are the possible adverse effects from COVID vaccines?
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 in non-pregnant people. 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 you 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.
What should I do if I develop a reaction to the vaccine?
Like all medicines, vaccines can cause adverse 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 any vaccination you should seek medical advice urgently:
- a new, severe headache which is not helped by usual painkillers or is getting worse
- an unusual headache which seems worse when lying down or bending over or may be accompanied by:
- blurred vision, nausea and vomiting
- difficulty with your speech
- weakness, drowsiness or seizures
- new, unexplained pinprick bruising or bleeding
- shortness of breath, chest pain, leg swelling or persistent abdominal pain
Are there any vaccine clinical trials or studies taking place in the UK?
Two trials of COVID-19 vaccines in pregnant women in the UK have launched and another is planned.
- A clinical trial by the vaccine manufacturer Pfizer launched across several National Institute for Health Research (NIHR) sites in the UK in May 2021. Women who participate in this study will be randomly assigned to receive either the vaccine or a placebo (this is a randomised controlled trial, or RCT). Those who received the placebo will then be offered the vaccine once they give birth, so that all the women participating will have received the vaccine either in pregnancy or shortly after giving birth. The role of this study (COVID-19 Vacc Maternal Immunisation) is to provide more robust information on the vaccine immune response in pregnancy, as well as safety reporting and the potential transfer of maternal antibodies to infants.
- A government-funded clinical trial investigating best COVID-19 vaccine dose interval for pregnant women was launched in England in August 2021. The study is being led by St George’s, University of London, and will gather more robust data on how best to protect pregnant women and their babies from COVID-19. The clinical trial will investigate the immune response to vaccination at different dose intervals, monitoring the protection provided by the vaccine for pregnant women and their babies.
- There are plans for a pragmatic trial of different vaccines in pregnant women, and full details of that trial will be available shortly.
Midwife, Amina, answers your FAQs
Our midwife Amina answers your most frequently asked questions about Covid-19, the vaccine and pregnancy.
About the booster
Are pregnant people being given booster vaccines?
Yes. On 12 December 2021, the government announced that all adults in the UK, including pregnant people, should book a COVID-19 booster vaccine (third dose) by the end of the year. Booster vaccines can be given 3 months (91 days) after your 2nd dose.
The Royal College of Obstetricians and Gynaecologists strongly encourage all pregnant people to have the COVID-19 booster vaccination as it provides the best protection against the virus for you and your baby.
High-risk pregnant people with underlying medical conditions causing immunosuppression will be eligible to have a fourth vaccine dose after the initial COVID-19 booster (third dose). If you have an underlying medical condition causing immunosuppression and have not yet received your initial booster (third dose), you are recommended to get your booster as soon as possible if your second COVID-19 vaccine was more than 3 months ago.
I had AstraZeneca for my first two vaccines, should I have AstraZeneca as my booster vaccine?
The JCVI is advising the Pfizer or Moderna vaccines are given for the booster doses, 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 JCVI still advises that pregnant people 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, midwife or GP.
Should I leave an interval between having my COVID-19 vaccine or booster and other vaccines such as flu and whooping cough?
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 time, although separating the vaccines by a day or two will avoid confusion over any side-effects.
If you are trying to get pregnant
Should I have a COVID-19 vaccine if I plan to become pregnant?
Yes, this is strongly recommended. Getting vaccinated before pregnancy will help prevent COVID-19 infection and its serious consequences.
You do not have to avoid trying to get pregnant for any amount of time after vaccination.
I am trying to get pregnant. I have had the first dose of COVID-19 vaccine, should I delay pregnancy until after the second dose?
1 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 strongly recommended to pregnant people. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for you and baby, including admission to intensive care and premature birth.
You do not need to avoid getting pegnant until after your second dose of the COVID-19 vaccine.
If you find out you are pregnant after you have had 1 dose of the vaccine (between doses), you are strongly advised to have your second dose 8 weeks after your first dose. The vaccine is considered safe and effective at any stage of pregnancy and there’s no evidence that you need to delay vaccination until after the first 12 weeks.
It is 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.
Think about 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 help you decide what to do next.
Does the COVID-19 vaccine affect fertility?
There is no evidence to suggest that COVID-19 vaccines will affect your 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.
Likewise, there is no evidence that immunity to the spike protein could lead to fertility problems.There is no evidence that women who have been vaccinated have gone on to have fertility problems. Most people who contract COVID-19 will develop antibodies to the spike and there is no evidence of fertility problems in people who have already had COVID-19.
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).
What if I find out I am pregnant after I have had the COVID-19 vaccine?
If you receive a dose of the vaccine before finding out you are pregnant, or unintentionally while you are pregnant, 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 1 dose of the vaccine (between doses), you are strongly advised to have your second dose 8 weeks after your first dose. There’s no evidence that you need to delay vaccination until after the first 12 weeks.
COVID-19 vaccines are strongly recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for you and baby, including admission to intensive care and premature birth.
Second doses are given 8 weeks 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.
Think about your personal exposures to and risks from COVID-19 when making your decision. You can discuss these risks with a doctor or your midwife, and you may want to use the RCOG and RCM decision tool to help you decide.
If you're having IVF treatment
Can I have the vaccine during IVF treatment?
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). This will help you be able to tell if any symptoms, such as fever, are caused by 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.
Is the COVID-19 vaccine safe if I am undergoing immune suppressing therapy during IVF?
None of the COVID-19 vaccines used in the UK are ‘live’ vaccines, and so cannot cause COVID-19 infection, even if you are taking immune suppressing treatments. However, the vaccine may provide less protection because these treatments may reduce the level of anti-COVID antibodies produced by the body in response to the vaccine.
You may prefer 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.
If you are breastfeeding
Can I have a COVID-19 vaccine if I am breastfeeding?
COVID-19 vaccines are strongly recommended if you are breastfeeding. 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.
Going to work
What is the advice on going to work if I am pregnant and have been vaccinated?
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 COVID-19 in pregnancy. Employers are still required to carry out a risk assessment whether an employee has been vaccinated or not.
Vaccination is your decision
It’s completely understandable to worry about vaccine safety when you’re pregnant. There is also a lot of misinformation about vaccination in pregnancy.
COVID-19 vaccines are strongly recommended in pregnancy and is the best way to protect you against the known risks of COVID-19 in pregnancy for you and baby.
However, whether to have the vaccination in pregnancy is ultimately your decision.
Resources to help with decision making
Vaccination is strongly recommended in pregnancy, but the decision whether to have the vaccine is your choice. You may find the following resources helpful: