A mess of changing, sometimes contradictory, vaccine guidelines this year has made it confusing to tell whether you can or should get a COVID-19 shot—especially if you’re pregnant. Both the FDA and the CDC have placed (differing) guardrails around the shot amid a larger climate of vaccine skepticism propped up by HHS Secretary Robert F. Kennedy Jr. But what these murky recommendations largely obscure is the data, which overwhelmingly supports the use of COVID-19 vaccines during pregnancy, as evidenced by a massive analysis set to be presented this weekend at an American Academy of Pediatrics conference.
For this review, Nikan Zargarzadeh, MD, a maternal fetal care researcher at Harvard University, analyzed the data of more than 1.2 million pregnant women (included in studies from the start of the COVID-19 pandemic through the fall of 2023) and found that COVID-19 vaccination was both safe and beneficial. Those vaccinated had a 58% lower risk of getting infected with the virus and increased protection against dangerous pregnancy outcomes—25% lower risk of stillbirth, 17% lower risk of having a baby with birth defects, and 34% lower risk of preterm birth before 28 weeks, which is the result Dr. Zargarzadeh tells SELF she finds most compelling. “This kind of severe preterm birth can cause many complications for the baby and a large emotional burden for families.” In fact, prematurity is the leading cause of infant mortality. So a greater than 30% reduction in risk is an especially significant benefit.
Meanwhile, the review also showed there was no uptick in cases of maternal pregnancy complications (like hypertension, preeclampsia, and gestational diabetes) among those who received the COVID-19 vaccine versus those who didn’t. (Previous data also suggests there are no differences in side effects from the shot between pregnant and non-pregnant folks.)
Taken together, these results reconfirm the longstanding recommendation by several major medical organizations, including the American College of Obstetrics and Gynecology (ACOG), that pregnant women receive the COVID-19 shot. “There’s no question among medical experts that this is the right choice for pregnant people and that it’s safe at any point in the pregnancy,” Shannon Dowler, MD, an Asheville, North Carolina-based family physician and a member of the board of directors of the American Academy of Family Physicians, tells SELF.
The above analysis didn’t investigate the cause of these upsides, but plenty of prior research sheds light on potential reasons. As Dr. Zargarzadeh puts it, much of these vaccine benefits likely come down to the pregnant person steering clear of COVID. “There is evidence that when a woman is infected with COVID in pregnancy, it negatively affects the placenta, which is what nourishes the fetus,” Dr. Dowler explains. (Indeed, research has shown that catching COVID while pregnant increases your risk of stillbirth.) Avoiding COVID by way of the shot, then, may help shield the placenta from damage and in turn safeguard the fetus.
As with any other infection, COVID-19 also ups your chances of getting a fever, Dr. Zargarzadeh notes, which brings ample risks for a fetus during pregnancy. (It’s the reason you should never “tough out” a fever while pregnant, contrary to President Trump’s recent announcement, and should use acetaminophen (a.k.a. Tylenol) to reduce it.) So, some of the pregnancy-related upsides of the shot may be explained by mom avoiding a fever.
Pregnant people are also more susceptible to severe COVID outcomes because of a dampened immune response, designed to keep their bodies from attacking the fetus. “They can get very sick, and wind up in the intensive care unit on a ventilator,” Dr. Dowler points out. “You can imagine the impact that would have on a growing baby.” So, lowering the risk of hospitalization and major illness for the pregnant person is another way in which the COVID-19 vaccine can lead to safer, healthier pregnancies and births.
Not to mention the potential benefits of COVID-19 vaccination during pregnancy after childbirth. Though the current review didn’t explore this facet, prior research has shown that women who get vaccinated during pregnancy pass some of their virus protection to their babies, Dr. Dowler says, “so they’re born with some immunity.” This can help shield them from catching the virus—which more often leads to serious complications and hospitalization in newborns—up until the time when they qualify to get the vaccine themselves, at six months old.
Unclear recommendations have unfortunately put access and insurance coverage into jeopardy this year. Both typically hinge on the CDC’s final word about which vaccines are recommended and for what groups, but that decision, released September 19, is vague, suggesting that everyone consult their doctor about the vaccine and utilize “shared clinical decision-making.” Plus, the CDC page covering vaccination during pregnancy lists “no guidance/not applicable” for COVID-19, leaving pregnant folks in a bit of a gray area.
Ultimately, your access and coverage may vary depending on the state you live in and where you go to receive the vaccine. Regarding states, differences in laws could affect whether pharmacists are able to distribute vaccines (to anyone, pregnant or not) under the CDC’s new “shared clinical decision-making” recommendation; that extra caveat may also leave the door open for insurers to deny coverage for some people. (It’s worth noting that several states on the West Coast and in the Northeast have banded together to develop their own vaccine recommendations, which could ease access and coverage.)
But the good news is, none of the shifts in vaccine recommendations prevent a doctor from offering the shot to anyone, pregnant women included. (Doctors are fully qualified to participate in the CDC’s suggested “clinical decision-making.”) And pregnancy typically entails multiple doctors’ visits, so Dr. Dowler recommends asking if you can get the shot during one of these checkpoints—if your provider doesn’t bring it up first. Ultimately, that means your ability to get it may depend on the discretion of your doctor. But, Dr. Dowler says, “my guess is that the vast majority of maternity care providers are not going to want you to leave the office without it.”
