Fast Facts on COVID Infection and Vaccination While TTC and During Pregnancy and Lactation!

Shannon M. Clark, MD
January 6, 2022
Fast Facts on COVID Infection and Vaccination While TTC and During Pregnancy and Lactation!

Are you TTC, pregnant or lactating?

If you are pregnant, planning or trying to conceive, or lactating, then you might have questions about how COVID infection and vaccination can affect you and your baby. So here are some fast facts from reliable resources!

COVID infection is pregnancy

One of the most important things to know is that symptomatic COVID-19 infection in pregnancy is an independent risk factor for:

  • ICU admission: 3-fold increase
  • needing mechanical ventilation
  • extracorporeal membrane oxygenation (ECMO): 2 to 4 fold increase
  • death: 1.7 fold increase
  • increased risk of preterm birth and stillbirth

We know that COVID-19 can have detrimental effects on the pregnant person and fetus.

COVID vaccines are available!

The good news is that the available COVID-19 vaccines can help decrease all of the above in pregnancy. The role of the COVID-19 vaccine is not to keep someone from getting COVID-19 infection, but instead to reduce the risk of fatality, hospitalization and the severity of illness.

Who should get vaccinated?

The CDC, ACOG, and SMFM all agree that all eligible persons who are TTC, pregnant or lactating should receive a COVID-19 vaccine series. ObGyns and other health care practitioners should lead by example by being vaccinated and encouraging eligible patients to be vaccinated as well. While a conversation with a clinician may be helpful, it is not a requirement prior to vaccination, nor is having a pregnancy test necessary prior to vaccination.

Do I need to delay pregnancy after receiving the vaccination and when in pregnancy is best to get vaccinated?

There is no need to delay pregnancy following vaccine administration, and there are no trimester-specific indications for vaccination in pregnancy at this time. This means that the COVID-19 vaccination can be given in any trimester and emphasis should be on vaccine receipt ASAP to get YOU protected!

If you got pregnant after receiving your first shot of a COVID-19 vaccine that requires 2 doses, you should get your second shot as scheduled to get as much protection as possible. At this time, the mRNA vaccines are preferred in pregnancy, ie Pfizer or Moderna. Individuals who receive either the Pfizer or Moderna vaccine for their primary vaccines series should complete their two-dose series with the same vaccine product.

What if I am pregnant and have a fever after getting the vaccine?

If you experience fever following vaccination, you can take acetaminophen (Tylenol). Acetaminophen has been proven to be safe for use in pregnancy and does not appear to impact antibody response to COVID-19 vaccines.

How should the COVID-19 vaccine be timed in relation to other vaccines during pregnancy?

COVID-19 vaccines and other vaccines commonly given in pregnancy (i.e. flu and Tdap) can be given on the same day, as well as within 14 days.

Do I need a booster shot or additional dosage?

ACOG, SMFM, and CDC all recommend that those persons who are TTC, pregnant or lactating receive a booster. If you have a primary vaccine series with Pfizer, you can get a booster with Pfizer or Moderna 5 months after the second dose. If you had a primary vaccine series with Moderna,  If you had a primary single-dose vaccine with J&J, you can get a booster with Pfizer or Moderna 2 months after that single dose.

Will COVID-19 vaccination adversely affect a baby who is breast/chest feeding?

There continues to be circulating misinformation regarding COVID-19 vaccination during lactation. There was a social media post circulating about a rash in an infant after the mother received the 1st dose of the COVID-19 vaccine in lactation.

Dr. Savannah Malm, @rx0rcist on IG and Tik Tok and PharmD, IBCLC, and I teamed up to summarize what is known about COVID-19 vaccination during lactation and effects in infants!

  • In a prospective cohort study, 84 breastfeeding (BF) persons were immunized with 2 doses of the Pfizer vaccine. Mothers were an avg. of 10.3 months postpartum & 42% were exclusively BF. No infants experienced a serious adverse reaction. 4 infants developed a fever, but appeared to have upper respiratory tract infections.
  • No adverse effects were noted in 18 BF infants whose mothers were vaccinated with Pfizer vaccine.
  • In a cohort study of 180 women who received an mRNA vaccine, some reported side effects in infants. The most common events after 2nd dose were irritability (10.3% & 10.4% for Pfizer & Moderna), poor sleep (7.8% & 8.3% for Pfizer & Moderna), and more drowsiness in children whose mothers received Moderna than Pfizer (6.4% & 0%). It is not known if these side effects were caused by the vaccine.
  • 20 BF mothers received 2 doses of a CoronaVac or Sinovac vaccine. None of their BF infants had any adverse effects reported.
  • An on-line survey of 4455 BF mothers who received the Pfizer or Moderna vaccine found that 7.1% reported an adverse effect in the infant. The most frequent symptoms were increased sleepiness & increased fussiness, both at about 3% of infants, with the frequency greater after the 2nd dose. Less frequently reported side effects inc. fever, rash, diarrhea, vomiting, changes in feeding frequency, and other misc. symptoms. All were numerically, but not statistically, more frequent after the 2nd dose.
  • A preprint study found that in BF infants of 50 women who received an mRNA vaccine during pregnancy/lactation, none had any serious adverse effects. A few reports of minor sleep changes and GI symptoms were reported after the 1st dose, but 88% reported no infant side effects. None of the infants had any reported symptoms after 2nd dose.

Data does show a positive benefit to infants with vaccination in lactation via transfer of protective antibodies. One of the most important things to know is that CORRELATION DOES NOT EQUAL CAUSATION.

Get more info!

Go to my instagram account @babiesafter35 for more info on all things COVID-19 infection and vaccination in TTC, pregnancy and lactation. I have 24 highlights dedicated to various topics and share valuable info from other accounts I trust! My goal is to provide information to help you make the best decisions for you and your fertility journey!

Shannon M. Clark, MD

Shannon M. Clark, MD

Shannon M. Clark, MD, MMS is a double board certified ObGyn and Maternal-Fetal Medicine Specialist, and founder of Babies After 35. In her roles as a clinician, educator and researcher at UTMB-Galveston, she focuses on the care of people with maternal and/or fetal complications of pregnancy. Dr. Clark has taken a special interest in pregnancy after the age of 35, which according to age alone, is considered a high-risk pregnancy.

Follow Shannon on TikTok @tiktokbabydoc, Facebook @babiesafter35, and Instagram @babiesafter35.

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