Lactation and the COVID-19 Vaccine
by Anne Eglash MD, IBCLC, FABM
There is a great deal of excitement and apprehension regarding the vaccine for COVID-19, as our lives are dominated in so many ways by this pandemic.
The US Advisory Committee on Immunization Practices (ACIP), directed by Dr. Robert Redfield, makes recommendations to the US Centers for Disease Control (CDC) on recommendations regarding the vaccine, including prioritization and circumstances of use. ACIP meeting recordings and slides can be viewed on YouTube.
Healthcare personnel are among the first group of individuals to receive the COVID-19 vaccine.
The CDC’s Interim considerations for COVID-19 Vaccination of Healthcare Personnel acknowledge that many healthcare providers are pregnant and/or lactating individuals. Nevertheless, they recommend waiting until data from phase III clinical trials and conditions of FDA Emergency Use Authorization are reviewed, before making a decision on vaccination for pregnant and/or lactating people.
What are others saying?
The Society for Maternal-Fetal Medicine published a December 1st 2020 statement advocating for the ethical inclusion of pregnant and lactating women in ongoing and future trials, and encouraging pregnant and lactating women to be engaged in shared decision making with their healthcare providers regarding immunization with the COVID-19 vaccine. They state that there is no biologic plausibility for the exclusion of lactating women from the vaccine trials. In addition, the theoretical risk of fetal harm from mRNA vaccines during pregnancy is low.
Pfizer, the first drug company to have its vaccine accepted in the UK, stated in their filed document that for women of childbearing age, pregnancy should be excluded before vaccination and that women of childbearing age should be advised to avoid pregnancy for at least 2 months after their second dose. In addition, it is unknown whether the COVID-19 mRNA Vaccine BNT162b2 is excreted in human milk, and a risk to the newborns/infants cannot be excluded. In addition, COVID-19 mRNA Vaccine BNT162b2 should not be used during breastfeeding. Pfizer also states that it is unknown whether COVID-19 mRNA Vaccine BNT162b2 has an impact on fertility.
- People who demonstrate COVID-19 antibodies are recommended to not have the vaccine.
- People with known SARS-CoV-2 infection should not receive the vaccine within 90 days of illness.
- People who are not sure if they had SARS-CoV-2 infection should have their antibodies checked before receiving the COVID-19 vaccine.
- More than 10% of people who receive Pfizer’s vaccine will experience headache, body aches, fatigue, chills, and swelling at the injection site.
- The COVID-19 vaccine would be the first mRNA vaccine approved for use in the USA.
See the Answer
People who have had COVID-19 illness are still recommended to receive the vaccine. However, because the vaccine will be a limited resource in the next few months, they suggest that those who tested positive wait 90 days before receiving the vaccine, since they are unlikely to contract COVID-19 again within 90 days of illness. However, it is not necessary to wait the 90 days after infection. The CDC does not advise testing for COVID-19 antibodies before giving the COVID-19 vaccine.
Although Pfizer, in its UK document, advises not using their mRNA vaccine for pregnant or lactating individuals, we are awaiting the advice from ACIP to guide us, in the USA, on what to do about pregnant and/or lactating individuals who are healthcare workers. The good news is that there are dozens more vaccines in development, including those that are inactivated or weakened viruses, protein-based vaccines, and viral vector vaccines. Several of these vaccine technologies have been proven to be safe in children, pregnant, and lactating individuals.