COVID-19 vaccine: fertility and pregnancy

By RCM Director for Professional Midwifery Mary Ross-Davie on 16 November 2021 Midwifery Maternity Services Covid-19

We know that midwives and maternity support workers (MSWs) across the UK have been working really hard to get the clear and consistent message out to the women that we recommend that all pregnant women take up the COVID-19 vaccine. 

To support members to have these conversations with women, we have recently updated our joint decision aid with RCOG and have also created a dialogue sheet so members can use sound bites on what to say and the evidence available – we also created a factsheet directed at women that members can distribute in their units. But still pregnant women continue to be one of the lowest vaccinated groups in the UK. While levels of hesitancy seem to be improving, we need to continue to share good evidence and information. So, what is the very latest?

Over the last few weeks and months, new research evidence has been published that will further support your messaging and provide women with more facts when making their decision. I’ve broken it down in two key parts:

  1. We now have more information about the worse impact of COVID-19 in pregnancy compared to the non-pregnant population and how protective the vaccine is in pregnancy against severe disease

If women contract COVID-19 in pregnancy, they are more likely to become severely unwell than non-pregnant women of the same age. Unvaccinated women are much more likely to become severely unwell with COVID-19 than unvaccinated women.

A recent study found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

The benefits of vaccination include:

  • reduction in severe disease for the pregnant woman
  • reduction in the risk of stillbirth and prematurity for the baby
  • potentially reducing transmission to vulnerable household members.

UKOSS recently produced a helpful infographic that highlights the risks of COVID-19 in pregnancy and how protective the vaccine has been in the UK.

  1. We now have more information about the safety of the vaccine in pregnancy and pre-pregnancy

The UK Teratology information on the safety of non-live vaccines, including COVID-19, is regularly updated and provides reassuring data from all of the ongoing real life and research studies, see Use of non-live vaccines in pregnancy.

Earlier this year, a study from St Georges in London was published in the American Journal of Obstetrics and Gynaecology. It found that pregnancy outcomes were not adversely affected when women received the vaccine in pregnancy.

And just last month, the Lancet published research that identified there was no evidence of an association between vaccination and reduced fertility, miscarriage or stillbirth in a study including close to one thousand participants.  

We understand the current pressures facing maternity staff right now and because of this, it is not easy to go trawling for facts and figures during or after a long shift. We will continue to package this information for members so that we keep getting the message out. Our key message and the one we encourage members to share remains: the COVID-19 vaccine in pregnancy reduces the risk of becoming severely unwell, of preterm birth and stillbirth associated with becoming very unwell and has not been found to increase miscarriage, prematurity, any abnormalities or stillbirth.