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COVID-19 Vaccination During Pregnancy is Safe and Protective

Backed by solid data, clinicians can work to overcome vaccine hesitancy due to fears about negative pregnancy outcomes.

Vaccination is a critical part of ending the pandemic phase of COVID-19. However, an unfortunate result of disinformation spread about COVID-19 vaccines is that some people fear vaccination will lead to fertility or pregnancy difficulties. As women of reproductive age generally are at lower risk for COVID-19 complications than are those middle aged and elderly, some pregnant women, or those contemplating pregnancy, may be skipping the vaccine under the erroneous assumption that they’re making the best choice for their own health and that of their baby.

Not only have the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) issued statements emphasizing the need for pregnant women to get vaccinated due to increased risk from COVID-19, a recent study underscored the fact that there is no link between the COVID-19 vaccine and poor fetal outcomes.

Scientists at Yale University co-authored the retrospective cohort study, which was released by the US Centers for Disease Control and Prevention (CDC). The study looked at data on more than 40,000 women whose pregnancies began anywhere from May through October 2020. Out of this group, 10,064 (21.8%) opted to receive at least 1 COVID-19 vaccine dose of either Pfizer, Moderna, or Johnson & Johnson between December 2020 and July 2021, typically in their second or third trimester of pregnancy. The authors found that receiving at least 1 COVID-19 vaccine during pregnancy was not linked to preterm birth, defined as earlier than 37 weeks gestation (adjusted hazard ratio 0.91; 95% confidence interval 0.82-1.01) or to small-for-gestational-age babies, defined as at less than the 10th percentile for weight (adjusted hazard ratio 0.95; 95% confidence interval 0.87-1.03).

After taking into account the fact that some women had 1 vaccine and others had 2, and that some were vaccinated during their second trimester and others not until their third, the scientists continued to find no amplification of risk of preterm birth or SGA at birth compared with unvaccinated pregnant women. Risk assessment for women vaccinated during their first trimester could not be calculated because so few women fell into this category.

The subject data came from Vaccine Safety Datalink, a partnership between the CDC and various healthcare organizations nationwide, and represented women in locations as diverse as California, Colorado, Minnesota, Oregon, Washington, and Wisconsin. The subjects ranged in age from 16 to 49, represented a diversity of races and ethnicities, and had a variety of health conditions such as obesity, asthma, and a history of smoking. All of the women birthed singleton babies.

Clinicians have a responsibility to impart to their pregnant or potentially pregnant patients that the real risk to their health comes from contracting COVID-19, not from getting the COVID-19 vaccine. “We do know that women with symptomatic COVID-19 during pregnancy have a more than twice the risk for intensive care unit admission, invasive ventilation, and a 70% increased risk for death compared with nonpregnant women with symptomatic infections,” Heather Lipkind, MD, associate professor of obstetrics, gynecology & reproductive sciences at Yale University School of Medicine and an author of the study, told Contagion. “I can tell you what I do in my practice, which is to speak openly and honestly with patients about what is known about vaccine safety and the risk of COVID-19 in pregnancy. I also discuss the recommendations from CDC, ACOG, and SMFM.”

Despite the plethora of information supporting vaccination in pregnant women, statistics show that pregnancy, or the prospect of pregnancy, continues to give some women pause. In the US, a total of 42.6% of people who were pregnant between December 14, 2020 and January 15, 2022 were vaccinated before or during pregnancy, compared with the 63.4% of the population in general that had been vaccinated as of January 23, 2022. Vaccination rates before and during pregnancy further break down along racial lines, with 58.4% of pregnant Asian women vaccinated, 43.6% of white women vaccinated, 38.3% of Hispanic women vaccinated, and 26.7% of Black women vaccinated.