Last Updated:
January 13, 2025

Comirnaty_COVID-19 disease and COVID-19 vaccination in pregnancy and breastfeeding

This factsheet provides key information for health professionals relating to COVID-19 disease and COVID-19 vaccination in pregnancy and when breastfeeding.

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Overview

References

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References

1.             Meyerowitz EA, Scott J, RichtermanA, et al. Clinical course and management of COVID-19 in the era of widespreadpopulation immunity. Nat Rev Microbiol. 2024;22(2):75-88.

2.             BranchDW. Physiologic adaptations of pregnancy. Am J Reprod Immunol.1992;28(3-4):120-2.

3.             RobinsonDP, Klein SL. Pregnancy and pregnancy-associated hormones alter immuneresponses and disease pathogenesis. Horm Behav. 2012;62(3):263-71.

4.             AlloteyJ, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, andmaternal and perinatal outcomes of coronavirus disease 2019 in pregnancy:living systematic review and meta-analysis. BMJ. 2020;370:m3320.

5.             VousdenN, Bunch K, Morris E, et al. The incidence, characteristics and outcomes ofpregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2infection in the UK from March to September 2020: A national cohort study usingthe UK Obstetric Surveillance System (UKOSS). PLoS One. 2021;16(5):e0251123.

6.             DengJ, Ma Y, Liu Q, et al. Association of infection with different SARS-CoV-2variants during pregnancy with maternal and perinatal outcomes: a systematicreview and meta-analysis. Int J Environ Res Public Health. 2022;19(23).

7.             CarlsonJ, Simeone RM, Ellington S, et al. Pre-delta, delta, and omicron periods of thecoronavirus disease 2019 (COVID-19) pandemic and health outcomes duringdelivery hospitalization. Obstet Gynecol. 2024;143(1):131-8.

8.             VillarJ, Soto Conti CP, Gunier RB, et al. Pregnancy outcomes and vaccineeffectiveness during the period of omicron as the variant of concern,INTERCOVID-2022: a multinational, observational study. Lancet.2023;401(10375):447-57.

9.             GuntherJ, Ziert Y, Andresen K, et al. Variability in COVID-19 symptom presentationduring pregnancy and its impact on maternal and infant outcomes across thepandemic. Int J Infect Dis. 2024;146:107157.

10.           VillarJ, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortalityamong pregnant women with and without COVID-19 infection: The INTERCOVIDmultinational cohort study. JAMA Pediatr. 2021;175(8):817-26.

11.           laCour Freiesleben N, Egerup P, Hviid KVR, et al. SARS-CoV-2 in first trimesterpregnancy: a cohort study. Hum Reprod. 2021;36(1):40-7.

12.           El-AtawiK, Abdul Wahab MG, Elsayed Y, Saleh M. Perinatal outcomes of newborns ofCOVID-19-infected pregnant women: an updated systematic review andmeta-analysis. Cureus. 2024;16(2):e54306.

13.           VousdenN, Ramakrishnan R, Bunch K, et al. Management and implications of severeCOVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance Systemnational cohort. Acta Obstet Gynecol Scand. 2022;101(4):461-70.

14.           MullinsE, Hudak ML, Banerjee J, et al. Pregnancy and neonatal outcomes of COVID-19:coreporting of common outcomes from PAN-COVID and AAP-SONPM registries.Ultrasound Obstet Gynecol. 2021;57(4):573-81.

15.           LiguoroI, Pilotto C, Bonanni M, et al. SARS-COV-2 infection in children and newborns:a systematic review. Eur J Pediatr. 2020;179(7):1029-46.

16.           AljohaniMA, Albalawi FM, Albalawi BM, et al. Consequences of SARS-CoV-2 infection inpregnant women and their infants: a systematic review. Cureus.2022;14(12):e32787.

17.           WalkerKF, O'Donoghue K, Grace N, et al. Maternal transmission of SARS-COV-2 to theneonate, and possible routes for such transmission: a systematic review andcritical analysis. BJOG. 2020;127(11):1324-36.

18.           KnezevicI, Liu MA, Peden K, et al. Development of mRNA vaccines: scientific andregulatory issues. Vaccines (Basel). 2021;9(2).

19.           PrasadS, Kalafat E, Blakeway H, et al. Systematic review and meta-analysis of theeffectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. NatCommun. 2022;13(1):2414.

20.           CiapponiA, Berrueta M, Argento FJ, et al. Safety and effectiveness of COVID-19 vaccinesduring pregnancy: a living systematic review and meta-analysis. Drug Saf.2024;47(10):991-1010.

21.           UtaM, Craina M, Marc F, Enatescu I. Assessing the impact of COVID-19 vaccinationon preterm birth: a systematic review with meta-analysis. Vaccines (Basel).2024;12(1).

22.           JaswaEG, Cedars MI, Lindquist KJ, et al. In utero exposure to maternal COVID-19vaccination and offspring neurodevelopment at 12 and 18 months. JAMA Pediatr.2024;178(3):258-65.

23.           AusVaxSafety.Pfizer COVID-19 vaccine safety data - pregnant participants  2023 [updated 23 Jan 2023; cited 2024 Nov27]. Available from: https://ausvaxsafety.org.au/vaccine-safety-data/covid-19-vaccines

24.           Fernandez-GarciaS, Del Campo-Albendea L, Sambamoorthi D, et al. Effectiveness and safety ofCOVID-19 vaccines on maternal and perinatal outcomes: a systematic review andmeta-analysis. BMJ Glob Health. 2024;9(4).

25.           KugelmanN, Nahshon C, Shaked-Mishan P, et al. Third trimester messenger RNA COVID-19booster vaccination upsurge maternal and neonatal SARS-CoV-2 immunoglobulin Gantibody levels at birth. Eur J Obstet Gynecol Reprod Biol. 2022;274:148-54.

26.           JorgensenSCJ, Hernandez A, Fell DB, et al. Maternal mRNA covid-19 vaccination duringpregnancy and delta or omicron infection or hospital admission in infants: testnegative design study. BMJ. 2023;380:e074035.

27.           RottenstreichA, Vorontsov O, Alfi O, et al. Maternal and neonatal severe acute respiratorysyndrome coronavirus-2 omicron variant neutralization after antenatalmessenger-RNA vaccination. Clin Infect Dis. 2022;75(11):2023-6.

28.           PerlSH, Uzan-Yulzari A, Klainer H, et al. SARS-CoV-2-specific antibodies in breastmilk after COVID-19 vaccination of breastfeeding women. JAMA.2021;325(19):2013-4.

29.           RickAM, Lentscher A, Xu L, et al. Impact of maternal SARS-CoV-2 booster vaccinationon blood and breastmilk antibodies. PLoS One. 2023;18(6):e0287103.

30.           ShimabukuroTT, Kim SY, Myers TR, et al. Preliminary findings of mRNA COVID-19 vaccinesafety in pregnant persons. N Engl J Med. 2021;384(24):2273-82.

31.           Medsafe.Overview of vaccine reports  2022[updated 30 Nov 2022; cited 2024 Nov 27]. Available from: https://www.medsafe.govt.nz/COVID-19/vaccine-report-overview.asp

32.           ShimabukuroTT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19vaccines in the US-December 14, 2020-January 18, 2021. JAMA.2021;325(11):1101-2.

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