21/07/2021
ACOG Practice Advisory summarizes latest guidance for COVID-19 vaccine use in pregnant and lactating patients
May 21, 2021
Lindsey Carr
A recently updated Practice Advisory from the American College of Obstetricians and Gynecologists (ACOG) provides an overview of the latest guidance for COVID-19 vaccination in pregnant and lactating patients.
The Practice Advisory1 was developed by ACOG’s Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group in collaboration with Laura E. Riley, MD; Richard Beigi, MD; Denise J. Jamieson, MD, MPH; Brenna L. Hughes, MD, MSc; Geeta Swamy, MD; Linda O’Neal Eckert, MD; Mark Turrentine, MD; and Sarah Carroll, MPH. The Practice Advisory will reflect any changes as more data are collected about the vaccines and their use in specific populations.
Key Points
ACOG recommends that pregnant individuals have access to COVID-19 vaccines.
COVID-19 vaccines should be offered to lactating individuals.
Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available.
A discussion with their health care provider can help them make an informed decision.
Important considerations include:
the potential efficacy of the vaccine
the risk and potential severity of maternal disease, including the effects of disease on the fetus and newborn
the safety of the vaccine for the pregnant patient and the fetus.
While a conversation with a clinician may be helpful, it should not be required prior to vaccination, as this may cause unnecessary barriers to access.
Pregnancy testing should not be a requirement prior to receiving any EUA-approved COVID-19 vaccine.
Unfounded claims linking COVID-19 vaccines to infertility have been scientifically disproven. ACOG recommends vaccination for all eligible people who may consider future pregnancy.
Women under age 50 including those who are pregnant can receive any FDA-authorized COVID-19 vaccine available to them. However, they should be aware of the rare risk of TTS (thrombosis with thrombocytopenia syndrome) after receipt of the Janssen COVID-19 vaccine and that other FDA-authorized COVID-19 vaccines are available (i.e., mRNA vaccines)
COVID-19 Infection Risk in Pregnancy
Available data suggest that symptomatic pregnant patients with COVID-19 are at an increased risk of more severe illness than nonpregnant patients.2
The absolute risk for severe COVID-19 is low; however, data suggest an increased risk of ICU admission, need for medical ventilatory support (ECMO) and death reported in pregnant women with symptomatic COVID-19 infection when compared to symptomatic non-pregnant women. The Centers for Disease Control and Prevention has listed pregnancy as a risk factor for severe COVID-19 infection.
References
American College of Obstetricians and Gynecologists. Practice Advisory: Vaccinating Pregnant and Lactating Patients Against COVID-19. Revised April 28, 2021. Accessed May 20, 2021. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19
Centers for Disease Control and Prevention. Vaccination of pregnant or lactating people. Revised May 14, 2021. Accessed May 20, 2021.
This Practice Advisory is intended to be an overview of currently available COVID-19 vaccines and guidance for their use in pregnant, recently pregnant, and nonpregnant individuals.
