ACOG Practice Advisory summarizes latest guidance for COVID-19 vaccine use 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

1. 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
2. Centers for Disease Control and Prevention. Vaccination of pregnant or lactating people. Revised May 14, 2021. Accessed May 20, 2021.https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#pregnant