NHS GP, presenter and new mum, Dr Zoe Williams answers your Covid-19 vaccine FAQs on pregnancy, fertility and breastfeeding.
Are pregnant women at higher risk of developing COVID-19?
Although pregnant women were initially put in the high-risk category, this was because we didn’t have sufficient data and we tend to take additional precautions when it comes to pregnant women, whether that is regarding medicines that we prescribe or new drugs or devices.
Now we know much more about the virus and how it behaves, we know that actually pregnant women with no underlying health conditions, are no more likely to get Covid-19 than the general population.
However, women in the third trimester are at a slight increased risk of becoming severely unwell if they get Covid at that stage of pregnancy. And if they do have complications it can be more difficult to treat, so if women need to go on a ventilator for example. Also part of the treatment for severe Covid is often proning people (putting them on their belly) and obviously in the third trimester there are difficulties with both of those types of treatment, as well as limitations to what drugs might be safe to use. Therefore, the best thing to do is get vaccinated – ideally before pregnancy, but if you are pregnant, before the third trimester, to protect yourself.
Which pregnant women are being offered a COVID-19 vaccine? Is it safer to have it in a certain trimester?
Pregnancy is the same as the general population, anyone over 18 can get the vaccine. There’s no evidence to say that there are any concerns about having the vaccine in any trimester, there’s absolutely no evidence that it’s unsafe for the mum or the developing foetus. However, The Royal College of Obstetricians and Gynaecologists (RCOG) do say if you’re still not convinced then some women may choose to wait until after the third trimester, which is when the majority of the baby’s development is going on.
Their advice is to ideally get it before you’re pregnant, but if you’re having the vaccine in pregnancy you can have it at any stage of pregnancy. And as mentioned before, ideally you should ensure you’re vaccinated well before the 28-week mark, which is the start of the third trimester, as that’s when there is a slight increased risk if you were to get Covid-19.
Previously pregnant women were told not to get the vaccine – why has the advice changed?
I think this has caused quite a bit of confusion. The reason that pregnant women weren’t advised to get the vaccine initially was because we didn’t have the safety data because pregnant women were excluded from the clinical trials in the UK. So, because there wasn’t that data available to say that it was absolutely safe – even though all of the scientists said there’s no reasonable reason why it wouldn’t be safe – it was best to be cautious.
We now do have data, from the USA in particular, where the vaccines have been given to pregnant women throughout the pandemic, and more than 100,000 pregnant women have been vaccinated with the mRNA vaccines such as Pfizer and Moderna, and there have been no safety concerns.
So, even though we don’t have safety data from clinical trials, we have what we call real world safety data, so we now know that the vaccines are safe for pregnant women and there’s no reason for them to be withheld.
Will a Covid-19 injection during pregnancy affect the baby’s development?
There’s absolutely no evidence to say that it would do, there’s no plausible reason whatsoever because it’s a non-live vaccine so therefore it can’t cause Covid-19, and there are no ingredients in the vaccines that are known to be harmful to the foetus.
Is the COVID-19 vaccination safe and effective in pregnant women?
Yes, we have the safety data from the USA, so even though we don’t have UK data from clinical studies, that is real world data. For that reason it is preferable for women to have the Pfizer or Moderna vaccine, because those are the vaccines that we have data on.
In terms of effectiveness, we don’t have large clinical trials yet specifically for pregnant women, but again there’s no reason that these vaccines won’t work as well in pregnant women because they work in exactly the same way.
Does it matter which vaccine I have? Is one safer than the other?
Because in the USA they use the Pfizer and the Moderna vaccine and we’ve seen that over 100,000 pregnant women have had these two vaccines and there haven’t been any safety concerns raised, it means we can be more confident with those vaccines than the AstraZeneca one, which hasn’t been used in the USA.
There’s no issue with this vaccine or any reason to believe these vaccines are less safe in pregnancy compared to the others, but we don’t have that real world data to give us the confidence, so therefore it’s preferable for pregnant women to have the mRNA vaccines. When you book your appointment, if you are under 40 you will only be offered appointments to get the Pfizer or Moderna vaccine. If you are over 40, you will be asked if you are pregnant and then only offered appointments for Pfizer or Moderna.
What if I decide not to have the vaccine until after my baby is born?
It’s absolutely a personal choice, my advice is to arm yourself with all the information and the facts so that you’re making that decision based on the available evidence rather than fear.
There’s been a lot of fear-mongering, a lot of scariness, a lot of fake news out there, so go to reliable sources such as the Government and NHS websites. The RCOG website has all the latest up to date information, they’ve got a Q&A session, and they also have some videos from obstetrician consultants who work with the Royal College, so that’s probably the best source of information for pregnant women. They also have a decision-making tool which has all the key information, so you can work your way through that aid and it asks you questions to help you make your decision based on the evidence.
There’s also the British Fertility Society, they have lots of content and information for people who may have any concerns around fertility.
My advice is, if you’re not sure if you want to have the vaccine now or wait until after your baby is born, whatever decision is right for you, that’s your choice, but whatever you do don’t do nothing, don’t be afraid and don’t do nothing – make sure you seek the information you need.
What are the side effects from Covid-19 vaccines?
The side effects haven’t shown to be any worse in pregnant women than they are in the general population, most of the side effects are short lived and mild. The commonest side effects are things like a mild fever, soreness at the injection site, muscle aches and pains or headaches lasting 1-2 days.
What are the benefits of vaccination in pregnancy?
First and foremost, it’s protecting you as the individual from Covid-19 and in particular from getting severely unwell with Covid-19. But there’s also been a reduction in the risk of still birth and prematurity for the baby as well.
It’s been seen that there’s a doubling in risk of still births and premature births in people who’ve been infected with Covid-19, so there are benefits of the vaccine to both the mum and the unborn child.
It also reduces the risk of transmitting Covid to those around you, you’re less likely to transmit the virus to members of your household, family, friends, work colleagues etc.
How is the Covid-19 vaccination being monitored in pregnancy?
The UK has launched one trial so far, two more are planned, so by doing clinical trials related to the vaccine in pregnancy we will get that really important data. But in the meantime we know from around the world, in particular the data from the USA, that vaccination in pregnant women is both safe and effective.
If pregnant women are interested in being involved in this research the best way to do it is to go onto the NIHR website where they may be able to be involved in a study.
Can I have a COVID-19 vaccine if I am breastfeeding?
Yes, absolutely. There’s no known risk in giving Covid-19 vaccines to women who are breastfeeding, they will be offered the vaccine along with the general public.
There have been women with concerns about breastfeeding, wondering whether to stop breastfeeding if they have the vaccine, but women absolutely shouldn’t think or feel like they have to stop breastfeeding, it’s fine to continue after having the vaccination.
Should I have a COVID-19 vaccine if I plan to become pregnant?
Yes – ideally it would be best to be vaccinated before you got pregnant, but there’s no need to delay pregnancy.
For people who are trying to get pregnant the best thing to do is get the vaccine as soon as possible. You can have the vaccine and continue to try to get pregnant immediately afterwards, there’s no risks there.
Can I have the vaccine during IVF treatment?
Yes you can have the vaccine during IVF treatment as well. The British Fertility Society again have loads of information on that. It’s worth having a chat with the doctors who are doing your fertility treatment because it might be that it’s best to separate the vaccine from certain parts of the treatment by a few days. Mostly just in case you get side effects around the time that you’re in key stages of your IVF.
There’s just a little caveat to that in that sometimes IVF treatment involves immunosuppressant therapy – treatment to suppress your immune system – again there’s no reason to not have the vaccine because they’re non-live, but it might mean that if you have the vaccine at the time when you’re having that therapy the vaccine might not work as well, so always have a chat with your doctor first.
Does the COVID-19 vaccine affect fertility?
No, there’s no evidence whatsoever to say that the Covid-19 vaccine affects fertility. This is an important thing to raise because there have been rumours that have been spread around, but those rumours are not based on fact and are not based on science, they are just rumours.
The science says there’s no plausible reason whatsoever why the Covid-19 vaccine would impact on fertility. It’s safe to go ahead and have the vaccine without any issues with fertility.