The American College of Obstetricians and Gynecologists (ACOG) and other leading medical organizations urged all eligible pregnant persons to be vaccinated against COVID-19, particularly in light of rising case rates in many areas of the world, expected holiday travel, and emergence of the Omicron variant. In a joint statement, the groups pointed to data showing the safety and efficacy of the vaccines during pregnancy and the lack of impact on fertility.
The groups also stated that pregnancy and reproductive potential alone do not qualify an individual for a medical exemption from a vaccine mandate because there are no known risks associated with vaccination during pregnancy. Vaccination during pregnancy also is strongly and universally recommended by the CDC, ACOG, Society for Maternal-Fetal Medicine (SMFM), and other organizations.
ACOG added the following booster recommendations to its practice guidance:
- A booster dose is recommended for pregnant and lactating individuals and people up to 6 weeks postpartum for mRNA and Johnson & Johnson’s vaccines in people aged 18 years and older
- Any approved COVID-19 vaccine product may be used for the booster dose; patients do not have to receive the same product as their initial vaccine or vaccine series
- Individuals who received the Johnson & Johnson vaccine should receive a COVID-19 booster at least 2 months following their initial vaccine
- Individuals who received an mRNA vaccine should receive a booster at least 6 months following their initial vaccine series
- Moderately to severely immunocompromised people should receive a third dose of the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines at least 28 days after the completion of the initial mRNA COVID-19 vaccine series. There is insufficient data on whether immunocompromised people who received the Johnson & Johnson vaccine also have an improved antibody response following an additional dose of the same vaccine.
- COVID-19 vaccines may be administered simultaneously with other vaccines. This includes vaccines routinely administered during pregnancy, such as influenza and Tdap.
As of December 16, 2021, the CDC now recommends that individuals receive an mRNA COVID-19 vaccine over Johnson & Johnson’s COVID-19 vaccine. Individuals who are unable or unwilling to receive an mRNA vaccine will continue to have access to Johnson & Johnson’s vaccine.
“Pregnant individuals are at increased risk of severe COVID-19 infection, ICU admission, and death, as well as adverse pregnancy outcomes,” the experts noted. “As the leading organizations representing experts in maternal care, we continue to strongly urge all eligible individuals—especially those who are considering pregnancy, pregnant, recently pregnant, and lactating—to be vaccinated against COVID-19.”
Safety Data in Pregnant Persons
Administration of the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines during pregnancy is not associated with an increased risk of miscarriage, according to surveillance data published in JAMA.
“This report found no increased risk of spontaneous abortion among those who were vaccinated,” commented Denise J. Jamieson, MD, MPH, who was not affiliated with this study. Dr Jamieson is coauthor of the ACOG practice guidance on COVID-19 vaccination in pregnancy and a member of the ACOG Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group.
“This study adds to the growing body of literature on the safety of COVID-19 vaccination when administered early in pregnancy,” said lead author of the surveillance report, Elyse Kharbanda, MD, who is a senior investigator at HealthPartners Institute.
“The same data are equally reassuring when it comes to infants born to vaccinated individuals, and in fact vaccination during pregnancy may extend a protective benefit to newborns after delivery,” the experts noted in the joint statement.
Countering Low Vaccination Rates
“As the pandemic continues, we remain extremely concerned by the low vaccination rates among pregnant individuals,” the groups wrote. Concerted efforts to increase vaccination rates are particularly important in communities of color that are disproportionately impacted by the virus and in which vaccination decisions may be shaped by historical and cultural considerations.
When speaking with patients about the COVID-19 vaccines, Dr Jamieson discusses the potential efficacy of the vaccine; the potential risk and severity of maternal COVID-19 disease, including the effects of disease on the fetus and newborn; and the safety of the vaccine for the pregnant patient and the fetus.
“I explain that there is no evidence of adverse maternal or fetal effects from vaccinating pregnant individuals with COVID-19 vaccine and there is excellent evidence that these vaccines work to protect pregnant persons from severe disease from COVID. There is also a growing body of data that demonstrate the safety of these vaccines in pregnancy,” said Dr Jamieson, who is also James Robert McCord Professor and chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine in Atlanta, Georgia.
“We encourage our members to counsel their patients to get vaccinated with confidence and cultural humility and help ensure patients receive a unified message from their clinicians in support of the safety and efficacy of the COVID-19 vaccines,” the organizations concluded.
In addition to ACOG, the joint statement was issued by the American Academy of Family Physicians, American College of Nurse-Midwives, American Society for Reproductive Medicine, Association of Women’s Health, Obstetric and Neonatal Nurses, National Hispanic Medical Association, National Medical Association, National Rural Health Association, Nurse Practitioners in Women’s Health, Society for Maternal-Fetal Medicine.
American College of Obstetricians and Gynecologists. COVID-19 vaccination during pregnancy is key to saving lives, medical experts urge. December 6, 2021. Accessed December 7, 2021. https://www.acog.org/news/news-releases/2021/12/covid-19-vaccination-during-pregnancy-is-key-to-saving-lives-statement