The Centers for Disease Control and Prevention (CDC) says that if you’re pregnant, you can get the COVID-19 vaccine. But they aren’t going as far as saying you should. Hardly anyone is. One the one hand, there’s no reason to believe that the vaccine is dangerous during pregnancy, and it could help bring the COVID-19 pandemic to an end. On the other hand, there isn’t a ton of evidence that it’s safe for pregnant people either.
What the decision comes down to is this: Is it riskier to get the vaccine and potentially experience side effects that harm yourself or your baby, or is it riskier to hold off on vaccination and potentially get infected with COVID-19?
One thing is certain: COVID-19 is particularly dangerous during pregnancy. Pregnant women with the disease are 22 times more likely to die than pregnant women who aren’t infected, according to a JAMA Pediatrics study of more than 2,100 women from 18 countries. Infected pregnant women are more likely to experience preeclampsia (a high blood pressure-related pregnancy complication), about three times more likely to have a severe infection, and five times more likely to be admitted to the ICU.
A CDC study of about 400,000 women found similar results. Compared to those who weren’t expecting, pregnant women with symptomatic COVID-19 were more likely to be admitted to an ICU, be intubated, need an artificial lung to remove carbon dioxide from their blood, and die.
COVID-19 is bad for the baby too. When a mom has the disease, her child is more likely to be born premature, which increases the baby’s risk of breathing problems, infection, bleeding in the brain, jaundice, and issues with the intestines, heart, and eyes. In the JAMA study, babies born to moms with COVID-19 were more than twice as likely to have at least three severe complications, such as sepsis or anemia that needs transfusion. Of the women who were positive for COVID-19 during labor, 13 percent of their babies also tested positive.
The bottom line: COVID is especially dangerous during pregnancy. So how does the vaccine compare?
First, you have to factor in your personal risk of getting infected in the first place. If your household is either extremely cautious or those who are going out are fully vaccinated, then your risk of exposure is low. In this case, waiting until after birth to get your shot is less dangerous. But if any unvaccinated members of your household are going into public indoor spaces — or if you yourself are — you’re at higher risk of exposure, which strengthens the case for getting vaccinated.
Looking at COVID-19 rates in your area offers another clue about what to do. If they’re high, vaccination starts to look like a better and better idea. Check out how your county is faring with the “Risk Level” map from the New York Times COVID-19 tracker.
The available COVID vaccines are extremely effective at preventing infection, and they’re even better at preventing hospitalization and death. With the available data, it seems that the vaccines are equally effective in pregnant people compared to the general population, according to the American College of Obstetricians and Gynecologists (ACOG).
However, there isn’t a satisfactory amount of data available yet for vaccine effectiveness or safety during pregnancy. The COVID-19 vaccine trials, like trials for most vaccines, excluded pregnant people. The reasoning behind this is that pregnant people may react differently to the vaccines, therefore skewing trial results. It’s also done out of an abundance of caution for protecting both the parent and the fetus.
That’s not to say we don’t have any data. Pregnant people who received the Pfizer or Moderna vaccine had similar rates of pregnancy loss, preterm birth, small size for gestational age, and neonatal death as mothers pre-pandemic, according to a study of nearly 36,000 pregnant people. At least 120,000 people in the US have received the vaccine during pregnancy, according to figures from the CDC. Health officials analyzing this data haven’t spotted any pregnancy-related complications yet. This suggests that there probably aren’t any additional risks, or if there are, they are exceedingly rare, at least in the short term.
The CDC website says: “Based on how these vaccines work in the body, experts believe they are unlikely to pose a risk for people who are pregnant.” COVID vaccine studies on pregnant animals did not turn up any safety concerns.
On the flip side, there could be benefits to getting the vaccine while pregnant. Pregnant people who get vaccinated in their third semester can pass antibodies to their babies through umbilical cord blood, according to a study of 122 pregnant women. The antibodies can be passed to the baby as early as 16 days after the first vaccine dose. (The study didn’t include women who received the Johnson & Johnson vaccine, but it’s similar to many existing vaccines that are generally safe during pregnancy.)
It’s unknown whether those antibodies are enough to protect the baby against COVID-19, according to ACOG. But young children probably won’t be able to get vaccinated for several more months, and even then the vaccines are only being studied in kids 6 months and older. So, any chance of protection for babies from cord blood or breast milk is more than they’re going to get elsewhere.
It’s difficult to give a no holds barred endorsement for the COVID-19 vaccine during pregnancy. After Rochelle Walensky, director of the CDC, said, “CDC recommends that pregnant people receive the COVID-19 vaccine,” the agency walked back her statement. After all, no one wants to be the person who recommends the vaccine during pregnancy if there does end up being a nasty complication.
But the thing is, that doesn’t look likely to happen. And we know that COVID-19 can kill pregnant people. So unless a pregnant person’s risk of exposure is low, they should probably should get it. If you’re pregnant, talk to your doctor, of course. But advocate for getting vaccinated. If they give you the green light, get ready to build up your immunity, and maybe your baby’s immunity too.