COVID Vaccine in Maternity Care

Key messages

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 both women and babies, including admission of the woman to intensive care and premature birth of the baby.
In the UK, all adults including pregnant women are urged to book a COVID-19 booster vaccine (third dose) three months after their second dose.
With the new variant (Omicron) in circulation, we strongly encourage pregnant women to have their first and second doses of the COVID-19 vaccine if they have not already done so, to protect themselves and their baby.
Women may wish to discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances.
Women not stop breastfeeding in order to be vaccinated against COVID-19.
Women trying to become pregnant do not need to avoid pregnancy after vaccination and 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.

Q. 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 it is preferable for the Pfizer-BioNTech or Moderna mRNA vaccines to 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 do not contain ingredients that are known to be harmful to pregnant women 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 women 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.

Q. 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 both women and babies, including admission to intensive care and premature birth.

More than half of women who test positive for COVID-19 in pregnancy have no symptoms at all but some pregnant women can get life-threatening illness from COVID-19, particularly if they have underlying health conditions. In the later stages of pregnancy, women are at increased risk of becoming seriously unwell with COVID-19.

COVID-19 infection can also adversely affect the pregnancy. In pregnant women 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 women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia or need an emergency caesarean. Their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

The benefits of vaccination include: