Pregnancy, Breastfeeding, Fertility and Coronavirus Communications Toolkit

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that pregnant women should be offered COVID-19 vaccines at the same time as people of the same age or risk group.

COVID-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission of the woman to intensive care and premature birth of the baby

Women may wish to discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances. However, as for the non-pregnant population, pregnant women can receive a COVID-19 vaccine even if they have not had a discussion with a healthcare professional.

Evidence on COVID-19 vaccines is being continuously reviewed by the World Health Organization and the regulatory bodies in the UK, USA, Canada and Europe.

Pfizer and Moderna vaccines are the preferred vaccines for pregnant women of any age who are coming for their first dose.

You should not stop breastfeeding in order to be vaccinated against COVID-19.

Women trying to become pregnant do not need to avoid pregnancy after vaccination and there is no evidence to suggest that COVID-19 vaccines will affect fertility.

Anyone who has already started vaccination and is offered a second dose whilst pregnant, should have a second dose with the same vaccine unless they had a serious side effect after the first dose.

Having a COVID-19 vaccine will not remove the requirement for employers to carry out a risk assessment for pregnant employees, which should follow the rules set out in this government guidance.

Frequently Asked Questions

Who can be vaccinated?

You can be vaccinated against coronavirus (COVID-19) if you're aged 16 or over and:

  • you're pregnant or think you might be
  • you're breastfeeding

you're trying for a baby or might get pregnant in the future

Is COVID-19 disease serious in pregnancy?

Although the overall risk from COVID-19 disease in pregnant women and their new babies is low, in later pregnancy some women may become seriously unwell and need hospital treatment.

Pregnant women with COVID-19 have a higher risk of intensive care admission than women of the same age who are not pregnant. Women with COVID-19 disease are also 2 to 3 times more likely to have their babies early than women without COVID-19.

Pregnant women with underlying clinical conditions are at even higher risk of suffering serious complications from COVID-19.

What are the risk factors for contracting COIVD-19 if you are pregnant?

If you have underlying medical conditions such as:

  • immune problems
  • diabetes
  • high blood pressure
  • heart disease
  • asthma

Or if you are:

  • overweight
  • over the age 35
  • in your third trimester of pregnancy (over 28 weeks)
  • of black and Asian minority ethnic background

You are at more risk from COVID-19 than women of the same age who are not pregnant.

Should I get vaccinated if I am planning on getting pregnant?

There is no need to avoid pregnancy after COVID-19 vaccination. There is no evidence that COVID-19 vaccines have any effect on fertility or your chances of becoming pregnant.

Should I get the vaccine if I am pregnant?

COVID-19 vaccines offer pregnant women the best protection against COVID-19 disease which can be serious in later pregnancy for some women.

The first dose of COVID-19 vaccine will give you good protection. You need the second dose to get longer lasting protection. You do not need to delay this second dose.

If you have already had a first dose of COVID-19 vaccine without suffering any serious side effects, you can have your second dose with the same vaccine when this is offered.

If your first dose was the AstraZeneca (AZ) vaccine you should also consider the information in the COVID-19 vaccination and blood clotting leaflet.

Should I get the vaccine if I am breastfeeding?

The benefits of breastfeeding are well-known.

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the USA and the World Health Organization.

What are the side effects of the COVID-19 vaccine?

Like all medicines, vaccines can cause common side effects. It may be helpful to make sure you know what to expect after you have the vaccine, especially if you have had your baby or have other children to look after.

No vaccines are 100% effective, so it is important to continue to follow current national guidance.

To protect yourself and your family, friends and colleagues, you MUST still:

  • practise social distancing
  • wear a face mask
  • wash your hands carefully and frequently
  • open windows to let fresh air in
  • follow the current guidance

Which vaccine will I receive?

If you're pregnant and have not had a COVID-19 vaccine yet, it's preferable for you to have the Pfizer or Moderna vaccine.

This is because these vaccines have been more widely used during pregnancy in other countries and no safety concerns have been identified.

If you've already had the AstraZeneca vaccine for your 1st dose and did not have any serious side effects, you should have it again for your 2nd dose.

I have already had one dose of the AstraZeneca vaccine prior to or earlier in my pregnancy. I am now pregnant and due my second dose. What should I do?

Pregnant women who commenced vaccination with AstraZeneca are advised to complete with the same vaccine. The second dose will be important for longer lasting protection against COVID-19.

There have been very rare reports of serious blood clots after a second dose of the AstraZeneca vaccine. The official national publication on vaccines (the Green book) advised on 7 May 2021 that: “Pfizer and Moderna vaccines are the preferred vaccines for eligible pregnant women of any age, because of more extensive experience of their use in pregnancy. Pregnant women who commenced vaccination with AstraZeneca, however, are advised to complete with the same vaccine”.

There are no reported concerns with the AstraZeneca vaccine in pregnancy, but there is less experience in pregnancy with this vaccine, than with the Pfizer and Moderna vaccines, which has led to the JCVI recommending a preference for Pfizer-BioNTech or Moderna.

The safety of mixing different vaccines is being investigated in an ongoing trial (the ComCov trial), which does not include pregnant women. Initial data from the study, published on 12 May 2021, showed that mixing vaccines appeared to be safe overall. However, there was an increase in short-lasting side effects such as fever for individuals who were given two different vaccines compared to individuals who had two doses of the same vaccine. Further information from this trial is expected later this year.

Currently you can choose whether to have the second dose of AstraZeneca in pregnancy (as typically given),or defer until after pregnancy - however a second dose is recommended to ensure maximum protection against COVID-19.

If you are unsure about receiving the second dose of AstraZeneca, you should arrange to speak to an obstetrician or midwife or GP and use the RCOG's decision aid on vaccination in pregnancy to support your choice.

Will the vaccine give me or my baby COVID-19?

The vaccines cannot give you or your baby COVID-19.

You'll be able to discuss the benefits and potential risks of having a COVID-19 vaccine in pregnancy at your vaccination appointment.

You can also speak to a GP or your maternity team for advice.

How do I book my vaccination appointment(s)?

If you're aged 18 or over (or will turn 18 within 3 months), you can book your COVID-19 vaccination appointments online.

If you're under 40, you'll only be shown appointments for the Pfizer/BioNTech or Moderna vaccines.

If you're 40 or over, you'll be asked if you're pregnant to make sure you're only shown appointments for these vaccines.

If you're aged 16 or 17, the NHS will contact you when it's your turn to get the vaccine. You cannot book your appointment online.

Will the vaccine impact my fertility?

There is no evidence that the Covid-19 vaccines have any effect on fertility or your chances of becoming pregnant.

There's no need to avoid getting pregnant after being vaccinated.

Can I have the COVID-19 vaccine if I am breastfeeding?

You cannot catch COVID-19 from the vaccines and cannot pass it to your baby through your breast milk.

If you're breastfeeding, the vaccines you can have depends on your age:

  • if you're 40 or over, you can have any of the COVID-19 vaccines
  • if you're under 40 and do not have a health condition that increases your risk of getting seriously ill from COVID-19, it's preferable for you to have the Pfizer/BioNTech or Moderna vaccine

The Pfizer or Moderna vaccines are preferable in people under 40 because of an extremely rare blood clotting problem linked to the AstraZeneca vaccine.

What is the advice on going to work if I am pregnant and have been vaccinated?

According to the government’s advice for pregnant employees, employers must carry out a risk assessment for pregnant employees taking into consideration the RCOG/RCM Guidance on Coronavirus in pregnancy. Employers are still required to carry out a risk assessment whether an employee has been vaccinated or not.

What is known about the impact of COVID-19 vaccination on babies born to women who have been vaccinated in pregnancy?

As these are new vaccines, there are no studies yet on the long-term effects on babies born to women who had a COVID-19 vaccine in pregnancy, but as COVID-19 vaccines are not ‘live’ vaccines they cannot cause infection, and other non-live vaccines have been given to women in pregnancy for many years without any safety concerns.

The mRNA vaccines (Pfizer and Moderna) are also quickly broken down once they have been injected – within a few days of vaccination there will be no vaccine mRNA left.

The data available shows that if a pregnant woman has the COVID-19 vaccine she is not at an increased risk of having adverse pregnancy outcomes. Research from across six studies in four countries, involving more than 40,000 pregnant women, shows having the vaccine does not increase the risk of miscarriage, preterm birth, stillbirth, nor does it increase the risk of a small-for-gestational age baby, or the risk of congenital abnormalities.

One of these studies was from St George’s, University of London and published in the American Journal of Obstetrics and Gynaecology (AJOG) on 12 August 2021. The research compared pregnancy outcomes for women who had received the COVID-19 vaccine and those who had not. They found there were no significant differences between the two groups, with no increase in stillbirths or premature births, no abnormalities with development and no evidence of babies being smaller or bigger.

More research is being done, monitoring both the mother and baby’s health during and for a year after the baby’s birth. We know that the vaccine is safe in pregnancy, but this is the next step in looking at the level of protection that the vaccine provides, what the best interval between doses is, and monitoring the immune response of both the mother and baby after the vaccine.

Is there any evidence that COVID-19 vaccines cause miscarriage or stillbirth?

The Yellow Card scheme run by the Medicines and Healthcare products Regulatory Agency (MHRA) is the UK system for collecting and monitoring information on safety concerns, such as suspected side effects or adverse incidents involving medicines and medical devices, including vaccines.

The MHRA have reported that the numbers of reports of miscarriage and stillbirth are low in relation to the number of pregnant women who have received COVID-19 vaccines to date (more than 55,000) and how commonly these events occur in the UK outside of the pandemic.

They say there is no pattern from the reports to suggest that any of the COVID-19 vaccines used in the UK, or any reactions to these vaccines, increase the risk of miscarriage or stillbirth. Sadly, miscarriage is estimated to occur in about 20 to 25 in 100 pregnancies in the UK and most occur in the first 12 to 13 weeks of pregnancy (the first trimester). Stillbirths are sadly estimated to occur in about 1 in 200 pregnancies in the UK.

Research from six studies worldwide show the rates of miscarriage were the same in those who had received a COVID-19 vaccine during pregnancy as in the general population.

I am currently trying to get pregnant. I have had the first dose of COVID-19 vaccination, should I delay pregnancy until after the second dose?

One dose of COVID-19 vaccination gives you good protection against infection, but it is thought that this is not long-lasting​ and may not protect you for the whole of pregnancy.

COVID-19 vaccines are recommended to pregnant women. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.

If you find out you are pregnant after you have had one dose of the vaccine (between doses), you are advised to have your second dose 8 weeks after your first dose. The vaccine is considered to be safe and effective at any stage of pregnancy and there’s no evidence that delaying until after the first 12 weeks is necessary.

It is recommended that you complete the course of vaccination before giving birth, or before you enter the third trimester, when the risk of serious illness from COVID-19 is greatest.

Can I have the vaccine during IVF treatment?

Yes, you can have the COVID vaccine during IVF treatment. The British Fertility Society recommends considering the timing of your vaccine, taking into account that some people may experience minor side effects in the few days after vaccination that you do not want to have during treatment. It may be sensible to separate the date of vaccination by a few days from some treatment procedures (for example egg collection and embryo transfer in IVF) so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure.

Your medical team will be able to advise you about the best time for your situation. If you have the vaccine at this time, you will help to protect yourself and your baby from the effects of COVID-19 infection in pregnancy.

Is the Covid vaccine safe if undergoing immune therapy during IVF?

A minority of women going through IVF receive immune suppressant therapy. None of the COVID-19 vaccines used in the UK are ‘live’ vaccines, and so cannot cause COVID-19 infection, even in women taking immune suppressing treatments.

However, the vaccine may provide less protection as these treatments may reduce the level of anti-COVID antibodies produced by the body in response to the vaccine. It might be preferable, therefore, to delay having the vaccine until the effects of any immune therapy have worn off; or delay your IVF treatment until a few weeks after you’ve had your vaccine. You should discuss the pros and cons of these approaches with your fertility specialist.

What if I find out I am pregnant after I have had the COVID-19 vaccine?

If you receive a dose of the vaccine before finding out you are pregnant, or unintentionally while you are pregnant, you should be reassured that the vaccine is safe and effective at any stage of pregnancy.

If you find out you are pregnant after you have had one dose of the vaccine (between doses), you are advised to have your second dose 8 weeks after your first dose. There’s no evidence that delaying until after the first 12 weeks is necessary.

COVID-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.

Second doses are given 8 weeks after the first dose and we recommend that you complete the course of vaccination before giving birth, or before you enter the third trimester, when the risk of serious illness from COVID-19 is greatest.

Are vaccines normally used in pregnancy?

Pregnant women and women who are breastfeeding are already routinely and safely offered vaccines in pregnancy, for example to protect against influenza and whooping cough. Many of these vaccines also protect their babies from infection. These vaccines, like the COVID-19 vaccines, are non-‘live’ vaccines, which are generally considered safe in pregnancy. However, specific evidence regarding the safety of the COVID-19 vaccination in pregnancy is not yet available.

What should I do if I develop a reaction to the vaccine?

Like all medicines, vaccines can cause side effects. These are usually mild and do not last long. Very common side effects in the first day or two after your vaccine include: pain or tenderness in your arm where you had your injection, feeling tired and headaches, aches and chills.

You may also have flu like symptoms and experiences episodes of shivering or shaking for a day or two. If you develop a fever (your temperature is 38C or above) you can rest and take paracetamol, which is safe in pregnancy.

You can report any suspected side effects through the Yellow Card scheme, which allows the Medicines and Healthcare Regulatory Agency (MHRA) to monitor side effects and ensure vaccines are safe.

If you are concerned about your symptoms, you can contact your GP or maternity team for further advice.

There have been reports of an extremely rare clotting problem associated with people receiving the Oxford/AstraZeneca vaccine. If you experience any of the following from around 4 days to 4 weeks after vaccination you should seek medical advice urgently:

  • a new, severe headache which is not helped by usual painkillers or is getting worse
  • an unusual headache which seems worse when lying down or bending over or may be accompanied by:
  • blurred vision, nausea and vomiting
  • difficulty with your speech,
  • weakness, drowsiness or seizures
  • new, unexplained pinprick bruising or bleeding
  • shortness of breath, chest pain, leg swelling or persistent abdominal pain 

Are there any vaccine clinical trials or studies are taking place in the UK?

Two trials of COVID-19 vaccines in pregnant women in the UK have launched and another is planned.

A clinical trial by the vaccine manufacturer Pfizer launched across several National Institute for Health Research (NIHR) sites in the UK in May 2021. Women who participate in this study will be randomly assigned to receive either the vaccine or a placebo (this is a randomised controlled trial, or RCT). Those who received the placebo will then be offered the vaccine once they give birth, so that all the women participating will have received the vaccine either in pregnancy or shortly after giving birth. The role of this study (COVID-19 Vacc Maternal Immunisation) is to provide more robust information on the vaccine immune response in pregnancy, as well as safety reporting and the potential transfer of maternal antibodies to infants.

A government-funded clinical trial investigating best COVID-19 vaccine dose interval for pregnant women was launched in England in August 2021. The study is being led by St George’s, University of London, and will gather more robust data on how best to protect pregnant women and their babies from COVID-19. The clinical trial will investigate the immune response to vaccination at different dose intervals, monitoring the protection provided by the vaccine for pregnant women and their babies.

There are plans for a pragmatic trial of different vaccines in pregnant women.​​​​​​​ 

Further information and resources

If you would like to discuss COVID-19 vaccination please contact your midwife, doctor, or nurse.

Royal College of Obstetricians and Gynaecologists key information and Q&As

COVID-19 vaccination in pregnancy decision aid from the Royal College of Obstetricians and Gynaecologists (PDF, 643kb) 

Find out more about COVID-19 vaccine side effects

GOV.UK: COVID-19 vaccine advice if you're pregnant, may get pregnant or are breastfeeding

Royal College of Obstetricians and Gynaecologists: COVID-19 vaccines, pregnancy, breastfeeding and fertility

NHS UK guidance and information about pregnancy, breastfeeding, fertility and Coronavirus​​​​​​​

Resources for healthcare professionals and organisations

Posters and Leaflets
COVID-19 Pregnancy guide leaflet English
COVID-19 Pregnancy guide Poster English
COVID-19 Pregnancy guide leaflet Bengali
COVID-19 Pregnancy guide leaflet Urdu
COVID-19 Pregnancy guide leaflet Romanian
COVID-19 Pregnancy guide leaflet Polish

Videos
British Sign Language COVID-19 Pregnancy guide video
How COVID-19 affects pregnant women

Social Media Assets
Pregnancy Fact Check image
Pregnant? Have your COVID-19 vaccine image - White
Pregnant? Have your COVID-19 vaccine image - Muslim
Pregnant? Have your COVID-19 vaccine image - Black-caribbean
Pregnant? Have your COVID-19 vaccine image - Asian