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Weighing the Risks: Questions Surrounding Pregnancy and COVID-19, the Vaccine, and Booster


Weighing the Risks: Questions Surrounding Pregnancy and COVID-19, the Vaccine, and Booster

As a pregnant woman herself, Dr. Adrianne Colton shares her personal story and addresses common concerns about whether to get the vaccine or booster while pregnant or breastfeeding.

Pregnancy is a unique experience full of so many variables that can leave you feeling unprepared. Whether it is your first pregnancy, or you’ve been pregnant before and are trying to predict how similar (or different!) this pregnancy is going to be from your previous one(s), finding reliable information can be intimidating. Add to that the newest threat that pregnancy has been thrown, COVID-19, and everything can start to feel overwhelming. As if that wasn’t enough, now there are more limits on support people who can be present for your OB appointments and delivery, not to mention visitors and well-wishers who want to welcome your newborn. The whole experience can feel isolating as well.

I understand. I am also pregnant. My husband and I started this journey just as the vaccine was becoming available to healthcare providers. So, as many of you are doing, we also weighed the risks and benefits of being vaccinated versus risking COVID-19 infection on our future fertility, the risk of the vaccine or infection during pregnancy, and the risk to both our future baby and me. Ultimately, we felt the decision was clear: COVID infection conferred more risk of severe complications than vaccination.

I received my first COVID-19 Pfizer-BioNTech vaccine series in December 2020 and January 2021. It was such an unusual feeling walking into the vaccination site in our hospital. I felt euphoric, as if I was finally doing something to protect myself and my family and patients from this COVID-19 beast. My symptoms with the first dose were overall mild. My arm was very sore, I was tired, and I ended up having a rather large lymph node under my arm for about 48 hours. And then I was back to my normal activities, which really hadn’t been impacted much other than I felt like lying on the couch and watching Netflix – but who doesn’t feel like that normally?!

My second dose was easier in some ways, as my expectations were based on seeing how others had responded. I had more fatigue, an achy body, and fever/chills for 24 hours. Then it was back to business as usual, caring for my 2.5-year-old son and working. In hindsight, having seen so many people with COVID infections, I will take those rough 24 hours any day over weeks of sickness and recovery.

Three months later, I was happy to announce we were expecting another child! And at 30 weeks, when the booster became available to me, I did my research again. I turned to trusted resources that guide me in my care for my patients: the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, both of which recommended booster vaccination for pregnant women who had completed a vaccine series six or more months prior.

I received my Pfizer-BioNTech COVID-19 booster shot at 30 weeks pregnant and opted to get the Tdap and flu vaccines as well. I’m happy to report that the booster was the easiest of the three COVID-19 vaccinations I received!

Having seen so many people with COVID19, we at VPFW feel strongly about the importance of vaccination during pregnancy and welcome questions and concerns from our patients regarding the COVID-19 vaccine. Here are answers to some of the many questions we receive from our patients.

What are the risks for pregnant people with COVID-19?

With ongoing data collection, we are seeing that pregnant persons are at a much higher risk of COVID-19 complications than those who are not pregnant. This includes both pregnancy and pregnancy-independent complications. Pregnant mothers infected with COVID-19 are at an increased risk for pre-eclampsia, preterm birth, gestational diabetes, and low birth weight, with ongoing concern for increased risk of stillbirth. They are also at a higher risk for ICU admission, intubation, and death than non-pregnant people.

A person who gets COVID-19 during pregnancy is…

  • 3 times as likely to have ICU admission
  • 2 times as likely to have intubation
  • 4 times as likely to have ECMO (heart lung machine)
  • 7 times as likely to die

…as a non-pregnant person who gets COVID-19.

A person who gets COVID-19 during pregnancy is…

  • 6 times as likely to have ICU admission
  • 14 times as likely to have intubation
  • 15 times as likely to die
  • 4 times as likely to have preeclampsia
  • 4 times as likely to have a preterm birth
  • 2 times as likely to have gestational diabetes
  • 2 times as likely to have a baby with low birth weight

…as a pregnant person who doesn’t get COVID-19 during pregnancy.

Is it safe to take the COVID-19 vaccine during pregnancy?

Yes. Numerous studies show that the vaccine is safe and effective for

  • women pursuing pregnancy,
  • women who are pregnant,
  • and women who are breastfeeding.

Information regarding the vaccine in pregnant patients is being collected and analyzed through multiple tracking mechanisms including Vaccine Adverse Event Reporting System (VAERS), V-Safe, and Vaccine Safety Datalink (VSD). As one of over 160,000 pregnant persons to receive the COVID-19 vaccine thus far, I myself enrolled in V-Safe to contribute to the collection of data on pregnant women which can be analyzed as part of the ongoing studies.

The medical community has found that COVID-19 vaccination does not increase risk of miscarriage or adverse pregnancy outcomes. It has the same side effect profile in pregnant and non-pregnant persons, and it prevents hospitalizations and severe disease in pregnancy.

Additionally, at a time when we are so focused on doing anything we can to keep our baby (or babies!) safe, there is also evidence that the vaccine helps mount an immune response and development of antibodies that pass through the placenta and breastmilk to aid your baby in fighting future COVID-19 infection. The effectiveness of these antibodies in preventing illness or infection in newborns is ongoing.

Can COVID-19 be transmitted from mother to baby during pregnancy?

This is an area of ongoing study. Most newborns of persons who had COVID-19 during pregnancy do not have COVID-19 when they are born. However, some infants have tested positive shortly after birth, and it is still unclear if these infections were acquired during pregnancy, during delivery, or after birth. The majority of newborns testing positive have had mild or no symptoms, although some reports show severe illness in newborns.

The CDC has ongoing updated information and resources on how to care for your newborn if you are in isolation due to COVID-19 infection. This includes information on timing of your isolation period based on symptoms, or lack thereof, as well as advice on how to breastfeed or pump if you choose to while you are in isolation.

Which COVID vaccine is best for pregnant women?

Per the Centers for Disease Control, either of the two mRNA vaccines (Pfizer and Moderna) are recommended for pregnant women. Both provide a high level of protection from COVID-19 illness. (Please note: this answer has been edited since the CDC updated their recommendation to Pfizer and Moderna vaccines over the Johnson & Johnson vaccine due to a rare blood clotting issue that has been associated with the Johnson & Johnson vaccine.)

Here’s a great video to help you visualize how the mRNA vaccines work.

Common side effects experienced after each of the vaccines include pain at the injection site, fever, muscle pain, joint pain, headaches, and fatigue. All are signs of your body mounting an immune response that aids in developing antibodies for defense against COVID-19. These are normal responses. Short-term acetaminophen (Tylenol) use is considered safe during pregnancy if these symptoms occur.

Can you get the COVID vaccine at any point during your pregnancy?

Yes. The COVID-19 vaccine is recommended and can be received at any point during pregnancy. Ideally, a person planning to conceive should receive the vaccine prior to pregnancy in order to reduce the risk for complications related to COVID-19 infection during pregnancy. However, the earlier the vaccine is received in pregnancy, the earlier that person is protected against pregnancy-related complications associated with COVID-19 infection.

Does the COVID vaccine cross the placenta to the baby?

None of the currently available vaccines reach or cross the placenta, but they do encourage the development of protective antibodies that can cross the placenta to help protect your baby.

Does the COVID vaccine affect fertility?

No. There is no increased risk of miscarriage or infertility associated with the vaccine. The miscarriage rate in the general population – COVID infection/ vaccination aside – is around 25-30% (1 in 4). This rate has not changed since the implementation of vaccination in women pursuing pregnancy.

The American Society for Reproductive Medicine has now recommended that those people undergoing fertility treatment get vaccinated.

Should pregnant women get the booster shot?

Yes. The American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine recommend pregnant people who received the vaccine series at least six months ago should get the booster shot.

At what point during pregnancy should pregnant women get the booster shot?

Receiving an earlier booster in pregnancy can lower the chance of a breakthrough infection, reducing the above risks associated with COVID-19 infection and pregnancy. Furthermore, the booster encourages the development of different types of antibodies – those that pass through the umbilical cord as well as those that pass through breastmilk. The earlier the booster is received during pregnancy, the more time there is for the blood-borne type of antibodies to develop, which are overall longer lasting than those passed through breastmilk.



Centers for Disease Control: Breastfeeding and Caring for Newborns if You Have COVID-19 >

American College of Obstetricians and Gynecologists: COVID-19 Vaccines and Pregnancy: Conversation Guide >

American College of Obstetrics and Gynecologists: COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care >

American Society for Reproductive Medicine: UPDATE No. 16 – Reproductive Facts Regarding COVID-19 Vaccination >

MotherToBaby Fact Sheet: COVD-19 Vaccines >

If you would like to speak to someone about COVID-19 vaccination during pregnancy, you can contact, whose experts are available to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday–Friday, 8am–5pm (local time). Call 1-866-626-6847, chat live or send an email: MotherToBaby.

To schedule an appointment with a VPFW provider, you can call us at 804-897-2100 or set an appointment online.

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