The American Society for Reproductive Medicine (ASRM) continues to affirm its support of the recommendation for COVID-19 vaccination for all women trying to conceive, woman who are currently pregnant, and women who are lactating. This recommendation is made considering the known risks and benefits of the mRNA vaccines from Moderna and Pfizer and the severe health risks associated with COVID-19 infection during pregnancy. This opinion is consistent with the position of the American College of Obstetricians and Gynecologists (AGOG), and that of the Society for Maternal Fetal Medicine (SMFM). 

Health Risks of COVID-19 for Pregnant Women

While experts continue to gather data on both COVID-19 and its impacts on health, we do know that pregnancy is a risk factor for severe illness if infected by the COVID-19 virus. Pregnant women with symptomatic COVID-19 infection are more likely to require Intensive Care Unit (ICU) admission and treatment and mechanical ventilation and ventilatory support than not pregnant woman with COVID-19 infection. Current data also demonstrated that pregnant women with symptomatic COVID-19 infection are at increased risk of death compared to their non-pregnant peers. 

Adverse pregnancy outcomes from COVID-19 infection are a concern in every trimester. The most common symptom of COVID-19 infection is a fever. In the first trimester, a fever can cause birth defects of the brain and spine (neural tube defects). There are health risks for both the woman and the baby in the second and third trimesters if infected with the COVID-19 virus. In the second trimester, pregnant women with COVID-19 may be at increased risk for preeclampsia and preterm labor. In the third trimester, COVID-19 impacts the women the most resulting in higher ICU admission rates than in women who are not pregnant. 

How the COVID-19 Vaccine Works 

The Pfizer and Moderna vaccines both use mRNA, or messenger RNA, a genetic material that contains instructions for making proteins. These vaccines do NOT contain live virus, and therefore, CANNOT infect the recipient (your gestational carrier). The vaccine works by helping the body’s cells produce an identifying protein for the virus which is recognized by the immune system and triggers the body’s defense mechanism to make protective antibodies. This protects the recipient if they are exposed in the future because the body recognized the identifying protein of the virus and attacks it. In addition, these mRNA vaccines are NOT thought to cause an increased risk of first or second trimester loss, stillbirth, or congenital anomalies. 

Recommendation 

Very few vaccines are ever tested on pregnant women, including both approved COVID-19 vaccines being used in the U.S. However, at my practice and in most fertility clinics and OB/GYN offices across the country, we recommend pregnant women and those seeking to become pregnant get vaccinated when eligible and the opportunity is available to them. This recommendation follows the guidance of ASRM, ACOG and SMFM. 

The known health risks to a pregnant woman for herself and the baby should she contract the COVID-19 virus are far greater than the current known risks of receiving the Pfizer and Moderna COVID-19 vaccines. And, although vaccination with the Pfizer and Moderna vaccines is up to 95% effective against the development of COVID-19, it does not confer 100% immunity. Preventive strategies for avoiding exposure and COVID-19 infection including, universal masking, social distancing, and frequent sanitizing measures are still recommended. 

As with all medical information, please discuss the specific recommendations for your family planning and your gestational carrier’s health with your health care providers.