Using COVID-19 vaccines in women of child bearing potential

Sue Dickinson, Director of Pharmacy, Regional Drug & Therapeutics Centre (Newcastle)Published Last updated See all updates

Summary information concerning COVID-19 vaccination in women of child-bearing age or who are pregnant

Pregnancy testing prior to vaccination

UK Health Security Agency (UKHSA – formerly known as PHE) Immunisation Against Infectious Disease (the Green Book) advises that routine questioning about last menstrual period and/or pregnancy testing is not required before offering the vaccine. Women who are planning pregnancy or in the immediate postpartum can be vaccinated with a suitable product for their age and clinical risk group.

Fertility and pre-conception Covid-19 vaccine advice

The British Fertility Society and Association of Reproductive and Clinical Scientists have produced a document addressing questions asked about COVID-19 vaccines and fertility. This states that there is absolutely no evidence, and no theoretical reason that any of the vaccines can affect the fertility of women or men.

UK Health Security Agency (UKHSA) state that there is no need to avoid getting pregnant after COVID-19 vaccination. They go on to advise that there is no evidence that COVID-19 vaccines have any effect on fertility or the chances of becoming pregnant after vaccination.

Vaccination during pregnancy

Risk

The Green book advises that there is no known risk associated with giving inactivated, recombinant viral or bacterial vaccines or toxoids during pregnancy. Since inactivated vaccines cannot replicate, they cannot cause infection in either the mother or the foetus.

Although AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating so will not cause infection in the mother or the foetus.

UKTIS provide advice on the use of ‘non-live’ vaccines’ in pregnancy.

A recent UKHSA study has reported a similar very low risk of still birth, prematurity and low birth weight in vaccinated and unvaccinated women.

Recommendations

The Green book states that women who are pregnant should be offered vaccination at the same time as non-pregnant women based on their age and clinical risk group.

Vaccine selection

Pfizer BioNTech and Moderna vaccines are the preferred vaccines to offer to pregnant women based on extensive post-marketing experience of their use in the USA with no safety signals so far.

For those under 18 years, Pfizer BioNTech is preferred.

Clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the limited evidence of safety data for the vaccine in pregnancy.

Inadvertent vaccination

The Green book advises that women who are inadvertently vaccinated in early pregnancy should complete vaccination at the recommended interval.

If a woman finds she is pregnant after she has started a course of vaccine, she may complete vaccination during pregnancy using the same vaccine product (unless contraindicated). UKHSA advice states that second doses should not be delayed.

Where the first dose was from the AstraZeneca (AZ) vaccine, women should also consider the information in the COVID-19 vaccination and blood clotting leaflet.

Termination of pregnancy following inadvertent immunisation should not be recommended.

Surveillance of inadvertent administration in early pregnancy

You should report cases of inadvertent administration of COVID-19 vaccines in early pregnancy to UK Health Security Agency (UKHSA).

This is being conducted for the UK by the UK Health Security Agency (UKHSA) Immunisation Department and information collected will be used to better inform pregnant women who are immunised, their families and health professionals who are responsible for their care.

Further information

The following resources are readily available for further information:

  • UKTIS have produced a monograph on the use of non-live vaccines in pregnancy which provides further information.
  • The RCOG have developed a range of information resources for healthcare professionals and pregnant women about COVID-19 vaccination.
  • Up to date leaflets and posters on vaccination in pregnancy to share with women who are pregnant, planning a pregnancy or breastfeeding are available from the UK Health Security Agency.
  • The Royal College of Midwives also has a number of useful resources for maternity staff to support pregnant women to get the vaccine.

Change history

  1. Wording updated to reflect Green book advice covering preferred vaccine in under 18 years and completion of vaccination at recommended interval in cases of inadvertent administration
  1. Updated information from the Green Book added. Information and link to UKHSA study added
  1. New link to recent PHE information relating to fertility. Reference to JCVI statement removed.
  2. Added link to leaflets and posters now available from the UKHSA. Link to PHE removed.
  3. Information on timing of second dose added from UKHSA guidance with link to COVID-19 vaccination and blood clotting leaflet
  1. PHE and Royal College of Midwives resources now linked
  1. Updated to reference new RCOG information resources
  1. Linked to updated RCOG information
  2. Link to UKTIS website added
  3. Amended to include revised recommendations from JCVI and Green book
  1. Hyperlinks amended
  1. Updated to include link to RCOG Questions and Answers document
  2. Updated to include detailed British Fertility Society statement about impact on fertility.
  3. Updated page reference and wording from Green book
  4. RCOG press statement removed as superseded by British Fertility Society statement
  1. Updated to include RCOG statement about impact on fertility
  1. Published