The COVID-19 vaccine is the best way to protect against the known risks [bmj.com] of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth. More than half of women who test positive for COVID-19 in pregnancy have no symptoms at all but for some pregnant women, COVID-19 can be life-threatening, particularly if they have underlying health condition [medrxiv.org]. In the later stages of pregnancy, women have been found to be at increased risk of becoming seriously unwell with COVID-19. One in every five [england.nhs.uk] of the most critically ill COVID-19 patients are pregnant women who have not received their first vaccine.

For pregnant women with symptoms of COVID-19, it is more than twice as likely that their baby will be born early, exposing the baby to the risks and potentially long term complications of prematurity. A recent study also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia or need an emergency caesarean. The risk of stillbirth was also twice as high. Infection with COVID-19 is also associated with an increased risk of early miscarriage [pubmed.ncbi.nlm.nih.gov].

The benefits of vaccination include:

• reduction in severe disease for the pregnant woman
• reduction in the risk of stillbirth and prematurity for the baby
• potential reduction in transmission [medrxiv.org] to vulnerable household members

The JCVI advises [gov.uk] that it is preferable for all pregnant women in the UK to be offered a choice of either the Pfizer-BioNTech or Moderna mRNA vaccines. This is because these vaccines have the most real world data, since the majority of pregnant women in the UK and USA have received these vaccines, with no safety concerns reported.

Women who have already had one dose of AstraZeneca (before they became pregnant or earlier on in pregnancy), can have their second dose with AstraZeneca or with an mRNA vaccine. Further details are available in the Green Book of Immunisation [assets.publishing.service.gov.uk].

It is highly recommended [rcog.org.uk] that pregnant women receive their COVID-19 booster vaccine (third dose), 3 months after their 2nd dose in order to provide them and their baby with the best protection against the virus. High-risk pregnant woman with underlying medical conditions causing immunosuppression will be eligible to have a fourth vaccine dose after the initial COVID-19 booster (third dose).

The Booster dose “tops up” the protection received by the initial two doses of the vaccine and has been found [gov.uk] to provide an additional level of protection against the most recent Omicron variant which is currently circulating at high levels.

Date available in both the UK [gov.uk] and USA [bmj.com] 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 13 studies in five countries, involving more than 100,000 people vaccinated in pregnancy, shows having the vaccine does not increase the risk of miscarriage, preterm birth or stillbirth. Nor does it increase the risk of a small-for-gestational age baby, or the risk of congenital anomalies. One of these studies was from St George’s, University of London and is available to read here.

Furthermore, the Medicines and Healthcare products Regulatory Agency’s (MHRA) Yellow Card scheme – 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 – has been analysing reports of miscarriage and stillbirth in pregnant women who have received the COVID-19 vaccines. The MHRA says there is no evidence [gov.uk] to suggest any of the COVID-19 vaccines used in the UK, or any reactions to these vaccines, increase the risk of miscarriage or stillbirth.

The COVID-19 vaccines do not include any harmful ingredients [gov.uk] known to be harmful to pregnant women or their babies. 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.

None of the COVID-19 vaccines being administered in the UK are ‘live’ vaccines so they cannot infect pregnant women or their babies with the virus and are considered safe to receive in pregnancy. Studies have shown that protective antibodies developed from vaccination can transfer from mother to baby across the placenta, and after birth through breast milk, potentially helping with the baby’s immunity to COVID-19.

The data available in the UK [gov.uk] and USA [bmj.com] 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 13 studies in five countries, involving more than 100,000 people vaccinated in pregnancy, shows having the vaccine does not increase the risk of miscarriage, preterm birth or stillbirth. Nor does it increase the risk of a small-for-gestational age baby, or the risk of congenital anomalies. One of these studies was from St George’s, University of London and is available to read here.

From the current data available there is no evidence that having the vaccine during pregnancy will impact child development. Whilst there is no long term data on this topic, experts do not expect vaccination to negatively impact child development as there is no theoretical mechanism for how this would happen. The RCOG provide more information here.

However, the babies of women infected with COVID-19 have been shown [bmj.com] to be at increased risk of adverse outcomes in light of the higher rates of stillbirth and preterm birth associated with the COVID-19 infection. Vaccination against the COVID-19 infection offers protection [bmj.com] against these risks.

Whilst the vaccine is highly recommended for pregnant women, it is possible to request a short-term exemption from vaccination, which expires 16 weeks following delivery. This will allow the person to become fully vaccinated after giving birth. Pregnant women can either use their MAT B1 certificate as evidence of exemption or they can apply for a medical exemption by ringing 119 and requesting an NHS COVID Pass medical exemption application form.
Details on exemptions to the COVID-19 vaccine [gov.uk]

No. The British Fertility Society and Royal College of Obstetrics and Gynaecology state that there is absolutely no evidence and no theoretical reason that any of the vaccines can affect the fertility of men or women.

There have been some myths circulating about the possibility that immunity to the spike protein could lead to fertility problems. However studies [ncbi.nlm.nih.gov] have proved this to be false.

Animal studies of the Pfizer and Moderna vaccines showed that there was no effect on the fertility of rats. Furthermore, although clinical vaccine trial participants were asked to avoid becoming pregnant, a number of accidental pregnancies still occurred. There was no significant difference [nature.com] in the rate of accidental pregnancies in the vaccinated groups compared to the control groups which indicates that vaccines do not prevent pregnancy in humans. This clinical trial data as well as the real world data that we currently have has shown that there is no evidence that the COVID-19 vaccine affects fertility at all.

It is worth noting that the COVID-19 infection itself has been shown [sciencedirect.com] to negatively impact male fertility with a fall in sperm count and function.

Yes, the vaccine can be given to those undergoing fertility investigations and/or treatment.

The British Fertility Society recommend considering the timing of having the COVID-19 vaccine during fertility treatment, taking into account that some people may have side effects in the first few days after vaccination that they do not want to have during treatment. It is also recommended that it may be sensible to have a few days gap between the vaccination and some treatment procedures (such as egg collection in IVF) so that any symptoms, such as fever, are attributed correctly to the vaccine or treatment procedure. Your medical team will be able to advise you about the best timing for your situation. More information about COVID-19 and fertility:

• britishfertilitysociety.org.uk
• hfea.gov.uk

If you have the vaccine at this time, you will help protect yourself and your baby from the effects of COVID-19 infection in pregnancy.

There has been some anecdotal data that the vaccine has affected the menstrual cycle for women. Emerging evidence [journals.lww.com] suggests that the COVID-19 vaccination does impact menstrual cycle length, but that the effect is minor and temporary. There was not found to be any impact on menstruation length itself and no evidence that vaccines permanently change menstrual cycles. The authors of the latest research do suggest that further studies are required to explore other possible changes in menstrual cycles, such as heaviness of bleeds, menstrual symptoms and unscheduled bleeding.

Many people experience a temporary change in their periods during their life for a number of different reasons and it is possible that these could coincide with the vaccination. If, however, the changes persist or there is any new bleeding after the menopause, it is important to seek medical advice as per advice from the RCOG.

It is also worth noting that infection [ncbi.nlm.nih.gov] with the COVID-19 virus itself can also cause temporary changes to periods.

Common side effects of the vaccine are mild and short-lasting symptoms such as pain around injection site, mild flu-like symptoms or fever. These usually resolve within a few days. Reports of serious side effects, such as allergic reaction or clotting problems have been very rare.

A very rare side effect of the mRNA vaccine is myocarditis (inflammation of the heart muscle) which is usually mild and short-lived. For the Astrazeneca vaccine, idiosyncratic thrombocytopenia (which can cause serious blood clots) is also an extremely rare side effect which happens on first exposure to the vaccine. There is no increased risk of this condition in people who are at higher risk of having blood clots. This is less relevant in pregnancy as pregnant women (and all adults under 40) are now being offered the mRNA vaccines as first line, although there have been no cases of pregnant women with this side effect.

It is worth noting that these extremely rare side effects of the vaccine are significantly more likely in people who have been infected [medrxiv.org] with COVID-19 itself, rather than from receiving the vaccines.
More information on the side effects of the COVID-19 vaccination [assests.publishing.service.gov.uk].

No. All the standard safety procedures have been followed during clinical trials on vaccines for COVID-19 and the rigorous regulatory processes have been fully completed as for any other vaccine or medicine.

Before any vaccine can be given to the population it must go through rigorous testing. Like all medicines, vaccines undergo extensive clinical trials, where they are administered and monitored in groups of volunteers. In the UK, the results of the trials are then assessed by the Medicines and Healthcare products Regulatory Agency (MHRA) [gov.uk].

No medicine can ever be completely risk-free or 100% effective. However, strong licencing processes and safety tests ensure that the health benefits of medicines being given through the NHS greatly outweigh any risks.

There are a number of reasons why the COVID-19 vaccine was able to be developed at pace without compromising safety:

• Governments and funding bodies joined forces to remove the financial obstacles which often cause delays in vaccine / medicines development.
• Large-scale manufacturing of the vaccines occurred in parallel with the clinical trials, to scale-up production quickly.
• Thousands of keen volunteers were recruited quickly [gov.uk] to trials so recruiting enough volunteers was not an issue and did not cause any delay.
• Advances in vaccine technology have been built on the back of many years of existing research.

More information on vaccine development [vk.ovg.ox.ac.uk].

One dose of COVID-19 vaccination was found to provide good protection against the original infection, but with the Delta variant of the virus, two doses were found to be needed to give a good level of immunity. Second doses are given 8 weeks after the first dose. A booster (third dose) is recommended to provide the best protection against the most recent (Omicron) variant [gov.uk], 12 weeks after the second dose. At present, fourth doses are only being offered to high risk patients with an underlying condition leading to immunosuppression.
More information on the vaccine dosing schedule.

Yes. It is recommended [gov.uk] that you have the vaccine even if you’ve had a previous COVID-19 infection, provided you wait 28 days since the infection. In children under the age of 16 years, the advice [gov.uk] is a delay of 12 weeks after becoming infected with COVID-19.

A recent study [jamanetwork.com] has shown that being vaccinated adds an additional layer of protection to the previous natural infection. Additional studies that support this can be found here [pubmed.ncbi.nlm.gov] and here [cdc.gov]. There is also some research [wwwnc.cdc.gov] which demonstrates that not all people recovering from the COVID-19 virus develop the necessary antibodies to prevent reinfection. Therefore, the advice remains to have the vaccine, even if you have had the COVID-19 infection in the past, particularly as it is known that immunity wanes over time.

No. Vaccines trigger an immune response in a safer and more reliable way than when infected with COVID-19. Natural infection is unpredictable and is associated with significant illness, long term disease [bmj.com] and death [bmj.com]. Even if your own infection is mild, you can spread it to others who may be seriously affected.

The approved vaccines have been found to be safe and effective at protecting from serious illness and death, and the risks of the COVID-19 vaccine side effects are extremely low (much lower than the risks associated with having the infection itself).