A Guide To The Covid-19 Vaccine If You're Pregnant Or Breastfeeding

Advice for those who are pregnant or breastfeeding has shifted. Here's what you need to know.

People who are either pregnant and deemed high-risk from Covid-19, or breastfeeding, have now been given the go-ahead to have the Covid-19 vaccine in the UK – despite previously being told they shouldn’t have it.

Although it seems like positive news, there hasn’t been a change in evidence in terms of the safety of such vaccines for these groups.

It’s likely to be a confusing U-turn for those who were explicitly told they couldn’t have the vaccine and were gearing up to batten down the hatches for months while carrying their baby, and possibly years after, if breastfeeding.

So what do you need to know?

What’s the advice for pregnant women?

There are two vaccines on offer in the UK: the Pfizer/BioNTech vaccine and the Oxford University/AstraZeneca vaccine, which was approved this week. The aim of the UK vaccine programme is to prevent people from dying after contracting Covid-19 or becoming severely ill, and to protect health and social care staff.

The Joint Committee on Vaccination and Immunisation (JCVI), which is responsible for prioritising who gets the vaccine, says although available data does not indicate safety concerns or harm to pregnancy, there is insufficient evidence to recommend routine use of Covid-19 vaccines during pregnancy.

However, pregnant people who are considered high risk – either because of their health or their job – will be offered one of the two Covid-19 vaccines on offer. It’s up to them if they decide to take it or not.

These people are prioritised for Covid immunisation for a few reasons. Firstly, those with underlying health conditions may already be at a very high risk of experiencing serious complications from Covid-19 – and we know that in the third trimester, the virus can be particularly dangerous.

The most likely relevant groups who would be vaccinated in pregnancy are:

  • Solid organ transplant recipients
  • Those with severe respiratory conditions including cystic fibrosis and severe asthma
  • Those who have homozygous sickle cell disease
  • Those receiving immunosuppression therapies sufficient to significantly increase risk of infection
  • Those receiving dialysis or with chronic kidney disease (stage 5)
  • Those with significant congenital or acquired heart disease

Pregnant women who are frontline health or social care workers, including carers in a residential home, can also opt for vaccination because they have a higher risk of exposure to Covid-19. However they should still be offered occupational protection during pregnancy, regardless of their vaccination choice. For example, health care workers in the third trimester should not be working with Covid-19 patients.

If you’re pregnant and in one of these two groups, speak to your obstetrician or doctor about vaccination. They can go through the benefits and risks with you. Your conversation will be personal to your situation, however your doctor should discuss the lack of safety data for these specific vaccinations, but also acknowledge that there is no known risk associated with giving other non-live vaccines (meaning there is no live virus in the vaccine) to pregnant women.

It’s worth noting that most pregnant women still won’t receive the Covid-19 vaccine. Gill Walton, chief executive of the Royal College of Midwives (RCM) said in the meantime, all pregnant women should take up the offer of the free flu vaccination, so they’re protected against flu viruses circulating this winter.

What if you’re breastfeeding?

Anyone who is breastfeeding can have the vaccine, according to the updated guidance, regardless of whether they’re deemed high risk or not. Again, it’s optional. There is still a lack of safety data for these specific vaccinations in breastfeeding, according to the Royal College Of Obstetricians and Gynaecologists (RCOG).

In the US, the Society for Maternal-Foetal Medicine reports that there is no reason to believe the vaccine affects the safety of breastmilk.

Antibodies formed from vaccines given during pregnancy do pass into the breastmilk and then to the baby to help prevent infections. But since the vaccine does not contain the actual virus that causes Covid-19, there is no risk of breastmilk containing the virus, it says.

The Society, along with the American College of Obstetrics and Gynaecologists, recommend breastfeeding individuals should be offered the vaccine “as theoretical concerns do not outweigh potential benefits”.

Clare Murphy, chief executive of the British Pregnancy Advisory Service (BPAS), welcomed the decision, saying: “We know some women have felt forced to choose between continuing to feed their baby in the way that works best for them and receiving the vaccine, and this new guidance should mean women can now make their own choices, based on their own personal circumstances and health needs.”

You should speak to your doctor about any questions you may have if you’re breastfeeding and intending to have the vaccine.

What about those trying for a baby?

Previously, women were advised not to come forward for vaccination if they may be pregnant or were planning a pregnancy within three months of the first dose. Under the new advice, those who are trying to become pregnant do not need to avoid vaccination.

Murphy, of BPAS, said she hopes the update will provide additional reassurance to women who find out they are pregnant shortly after receiving the vaccine.

“Unplanned pregnancy is common in the UK, but unplanned is not synonymous with unwanted – and we have been concerned that the guidance advising against use in pregnancy may cause unnecessary anxiety and result in the termination of otherwise wanted pregnancies,” she said.

“It’s vital that women receive good, evidence-based information to enable them to make their own vaccination and reproductive choices and this updated guidance reflects that approach.”

When will we know more about vaccine safety for these groups?

So far, it’s understood neither vaccine has been tested on pregnant or breastfeeding individuals in clinical trials. HuffPost UK has contacted Oxford University to confirm this.

Pfizer told HuffPost UK it is in the process of conducting developmental and reproductive toxicity (DART) studies with its Covid-19 vaccine. This is done prior to enrolling pregnant women and women of childbearing potential who are not actively avoiding pregnancy in clinical trials.

RCOG is working with the Department of Health and Social Care (DHSC) to set up a Covid-19 vaccine registry. The aim is to ensure that adequate safety data are collected for all women in these groups who are given one of the approved Covid-19 vaccines.

“We are recommending that pregnant women who might be eligible for vaccination should receive it through their maternity unit, or notify their local maternity unit when it is received,” says RCOG.

“This is so that maternity staff can report it to the UKOSS/UKTIS vaccine registry, including reporting of follow-up post-vaccination of the women and their babies.”

RCOG has also teamed up with the RCM to ask the UK government to fund research studies to establish the suitability of any approved Covid-19 vaccines in pregnant and breastfeeding women.

“The UK has a world-leading research and development sector to support a national effort to research the vaccine’s suitability for use in pregnancy and we are calling for research trials, supported by the Vaccine Taskforce, to begin urgently to get evidence on safety,” says RCOG.

“The outcomes of this research will be vital for the over 800,000 women each year who conceive, as well as the many women planning a pregnancy.”