ACOG Recommends COVID Vaccine While Pregnant or Breastfeeding

Pregnant and lactating people were excluded from the early clinical trials of the COVID-19 vaccines. However, studies and vaccination data collected from these populations in the past year has shown that the vaccine appears to be both safe and effective.

Studies conducted in 2021 showed that the chance of severe infection with COVID-19 is higher during pregnancy. This finding, combined with studies demonstrating the vaccine's safety have led the CDC to conclude that the benefits of the COVID-19 vaccine outweigh any known risks for pregnant and breastfeeding people.

Can the COVID-19 Vaccine Harm a Breastfed Baby?

While pregnant and lactating people were not included in initial COVID-19 clinical trials, the safety and efficacy of the vaccine has since been studied in this population. or on the effect of mRNA vaccines on the breastfed infant or on milk production, the CDC states that “mRNA vaccines are not thought to be a risk to the breastfeeding infant.” Studies have confirmed that antibodies from mRNA COVID-19 vaccines pass into breast milk, potentially giving protection to breastfed infants.

Thus, the CDC and ACOG recommend the the vaccine for people who are breastfeeding. Preference is given to the mRNA vaccines, although Johnson & Johnson's vaccine may be considered in certain circumstances.

This means making a decision based on very limited information. But some reassurance may come from a practice advisory issued on December 13, 2020, by the American College of Obstetricians and Gynecologists (ACOG). It states that the mRNA vaccines are not live virus vaccines, and don’t use an adjuvant to enhance vaccine efficacy. This means they don’t enter the nucleus, or alter human DNA in the vaccine recipient. As such, they can’t cause any genetic changes.

The ACOG believes that “COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP [Advisory Committee on Immunization Practices].” In other words, they’re on the same page as the CDC—it’s up to the individual whether they get the vaccine or not.

Obviously, there are still unknowns regarding the vaccine during pregnancy and in lactating people. But the ACOG says “theoretical concerns regarding the safety of vaccinating lactating individuals do not outweigh the potential benefits of receiving the vaccine.” The organization adds that there is no need to avoid starting or continuing with breastfeeding if you get the vaccine.

New Parents Don’t Need More Pressure 

International board certified lactation consultant Leigh Anne O’Connor, IBCLC, LCCE, says she’s concerned that the lack of data about the safety of the vaccine in breastfeeding people will put additional pressure on them at a time when they’re already physically and mentally exhausted.

But O’Connor believes that from the data that’s available, the benefits outweigh the risks. “Little or none of the components of the vaccine will pass into the baby through the mom's milk,” she says. “Plus, there is the suggestion that the baby will gain additional immunity from the breastfeeding parent. Parents have to make an informed decision—they have to know if they are at risk for having complications from a vaccine or have risks that make having COVID-19 more serious for them.”

It’s new territory, and it’s important to talk through your decision with your midwife, OB/GYN, pediatrician, or family doctor to rule out any risk factors. “If there are no other risks, then the vaccine is likely safe,” O’Connor says.

Sherry Ross, MD, OB/GYN, and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, agrees. “The new COVID-19 vaccine has brought some much-needed light amidst the darkness of the pandemic,” she says. “Even though there is no scientific data available on the safety and effectiveness of the COVID-19 vaccine in pregnant and breastfeeding women, the OB/GYN experts at the ACOG are making some calculated guidelines for this high risk group.”

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