Having  COVID-19 Vaccine if you are planning to conceive

 

When the initial Pfizer/BioNTech vaccine was first released the advice was as follows:

 

  • if you are planning to get pregnant in the next 3 months, you should delay your vaccination
  • if you know you are not pregnant you can start the two-dose course now and you should avoid getting pregnant until at least 2 months after the second dose
  • if you have had the first dose and then become pregnant you should delay the second dose until after the pregnancy is over
  • if you are pregnant you should not be vaccinated – you can be vaccinated after your pregnancy is over
  • if you think you may be pregnant you should delay vaccination until you are sure you are not

 

Evidence so far reviewed by the UK Medicines and Healthcare products Regulatory Agency (MHRA) has raised no concerns for safety in pregnancy. Because of the new formulation of the first Pfizer/BioNTech vaccine the MHRA wanted to see more data before finalising the advice in pregnancy. It is standard practice when waiting for such data on any medicine to avoid its use in those who may become pregnant or who are breastfeeding.

 

On December 30th, the Joint Committee on Vaccination and Immunisation (JCVI) published its latest advice for the priority groups to receive the Pfizer/BioNTech and the second Oxford University/AstraZeneca vaccines. This includes updated advice for pregnant and breastfeeding women who meet other criteria for priority vaccination.

The JCVI confirms that although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy. On the other hand the JCVI does not advise routine pregnancy testing before receipt of a COVID-19 vaccine. Furthermore they have indicated that those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

The JCVI advises that if a pregnant woman meets the definition of being clinically extremely vulnerable (see below), then she should discuss the options of COVID-19 vaccination with her doctor. This is because her underlying condition may put her at very high risk of experiencing serious complications of COVID-19. Additionally, pregnant women who are frontline health or social care workers, including carers in a residential home, can also discuss the option of vaccination. This is because the risk of exposure to COVID-19 may be higher, even if they have a lower risk of experiencing complications if they are otherwise well.

It is important to appreciate that there is still a lack of safety data for these specific vaccinations for pregnant or breastfeeding women. Whilst there is no known risk associated with giving other non-live vaccines to pregnant women the Pfizer/BioNTech is a very different type of vaccine. There may also be a difference in the administration in extremely early pregnancy at a time that the baby is being formed and before a pregnancy has become properly established.

In Summary - We do not know that the vaccine is safe in pregnancy or if it can be safely given if you are trying to conceive. However, on balance, if you are a front-line worker or at significant risk of developing COVID-19 and you would like to be vaccinated, it would be reasonable for you to do so. It has to be your choice and we are unable to advise you further. We will continue with fertility treatment as planned if you wish, although a precautionary approach would still be to wait 2 months after the second dose.

Clinically extremely vulnerable women:

The most relevant groups of pregnant women are as follows, however they are unlikely to be attending for fertility treatment at the present time:

  • Solid organ transplant recipients
  • Those with severe respiratory conditions including cystic fibrosis and severe asthma
  • Those who have homozygous sickle cell disease
  • Those receiving immunosuppression therapies sufficient to significantly increase risk of infection
  • Those receiving dialysis or with chronic kidney disease (stage 5)
  • Those with significant congenital or acquired heart disease