Advice and information for women who are pregnant or breastfeeding
The COVID-19 vaccine is recommended for pregnant and breastfeeding women. Vaccination during pregnancy will also protect the baby after birth.
Pregnant women and their risk for severe COVID-19 disease course
The risk of serious illness among pregnant women who become infected with coronavirus is low. However, international studies show that pregnant women are somewhat more likely to have a severe COVID-19 disease course than non-pregnant women, and that the risk is highest in the later stages of pregnancy. This may be because pregnant women have a greater strain on their heart and lungs as the foetus grows, and are therefore more prone to a severe disease course if they first become ill.
It is recommended that pregnant women follow advice for at-risk groups.
What do we know about COVID-19 and the risk for pregnant women?
- Pregnant women have a slightly higher risk of admission to hospital due to COVID-19 than women who are not pregnant, although the risk for both groups is very low. This applies to all virus variants, although most cases of a severe disease course so far have been with the delta variant.
- The most common symptoms among pregnant women are coughing and difficulty breathing. It appears that fever and moderate general symptoms are less common than in non-pregnant women.
- Pregnant women with COVID-19 who develop symptoms have a slightly greater risk of needing treatment in hospital, intensive care units and with a respirator.
- The risk groups for severe course of COVID-19 are the same as for others: underlying conditions such as diabetes, cardiovascular disease and / or obesity. See Risk groups and their relatives
- The proportion of pregnant women with a migrant or minority background is higher than other pregnant women.
- Some studies suggest that the risk of premature birth is somewhat higher if the mother has COVID-19. However, this does not apply to spontaneous births, and may be related to how pregnant COVID-19 patients have been treated in different countries.
- COVID-19 has not been shown to increase the risk of miscarriage during pregnancy.
In the studies, the incidence and risk of a severe disease course among pregnant women with COVID-19 is partly compared with the risk among pregnant women without COVID-19, partly with the risk among non-pregnant women in the same age group, and partly only observed and described.
- Engjom HM, Ramakrishnan R, Vousden N, et al Severity of maternal SARS-CoV-2 infection and perinatal outcomes of women admitted to hospital during the omicron variant dominant period using UK Obstetric Surveillance System data: prospective, national cohort study BMJ Medicine 2022;1:e000190. doi: 10.1136/bmjmed-2022-000190
- Vousden N, Ramakrishnan R, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort. Acta Obstet Gynecol Scand. 2022 Feb 25. doi: 10.1111/aogs.14329. Epub ahead of print. PMID: 35213734.
Vaccination of pregnant women
Most pregnant women who become infected with the coronavirus get only a mild disease course. Nevertheless, Norwegian and international data show that pregnant women have an increased risk of a severe disease course compared with non-pregnant women of the same age. The risk of a severe disease course increases throughout pregnancy and is greatest in the 2nd and 3rd trimesters. If the pregnant woman also has other risk factors, such as multiple births or underlying illness, the risk increases further. This also applies in the first trimester.
The NIPH therefore recommends that all pregnant women should accept the offer of a COVID-19 vaccine during pregnancy. The vaccine is recommended in the 2nd and 3rd trimester, due to increasing risk in this part of the pregnancy. Vaccination in the 1st trimester can be considered if the pregnant woman has additional conditions that increase the risk further. This also applies to those who have not previously been vaccinated, as Comirnaty Omicron XXB.1.5 is also approved for basic vaccination and basic vaccination now consists of one dose. Pregnant women therefore follow the same advice as non-pregnant women in the risk group.
No other side effects have been observed in pregnant women after vaccination compared to non-pregnant women of the same age.
This means that they can experience pain in the arm, lethargy, body aches and fever. The side effects are short-lived and pass in one to two days.
What do we know about COVID-19 vaccination of pregnant women?
Vaccination during pregnancy requires special considerations, because the woman and the foetus are in a vulnerable phase in life. Previously, there has been a somewhat restrictive attitude to all vaccination during pregnancy, but in recent decades there is more knowledge that it is both important, has a good effect, and is safe for both mother and foetus. Globally, there is an immunisation programme for pregnant women against influenza (WHO recommendation from 2005), against tetanus in low- and middle-income countries (WHO recommendation from 2006) and against pertussis (WHO recommendation from 2015). In addition, several other vaccines, both inactivated and some live, attenuated vaccines, are recommended for pregnant women if they are exposed to infection.
The mRNA vaccines are non-live vaccines and cannot replicate so neither the mother nor the foetus can be infected by the vaccine. Large studies of the mRNA vaccines indicate no direct or indirect harmful effects with respect to pregnancy, foetal development, childbirth or postnatal development.
There is limited knowledge from the manufacturers, as pregnant women were not included in the initial phase III studies that led to the marketing authorisation. However, there is increasing experience from countries that offer vaccination to pregnant women, especially with the mRNA vaccines. Data from vaccinated pregnant women in the USA and Israel have not shown any signs of adverse side effects1,2. There is also no increased risk of miscarriage, congenital deformities or premature birth among pregnant women who have been vaccinated against coronavirus.
Studies also show that pregnant women have the same vaccine response as non-pregnant women3, and that antibodies are transmitted to the child by vaccination in the third trimester4. In this way, vaccination of pregnant women will help to protect the child against COVID-19 after birth. It has been shown that COVID-19 vaccination of women during pregnancy results in lower admission of newborns with COVID-195.
More and more countries are recommending pregnant women to take vaccines. From 18 August 2021, the NIPH also recommends that pregnant women in Norway should also be vaccinated.
The risk of a severe COVID-19 disease course increases if the pregnant woman has underlying conditions such as diabetes, cardiovascular disease and / or obesity6. Nordic studies support this, and have shown an increased risk for women with obesity or who had an immigrant background7.
- Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med.
- Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2
- Magnus MC, Örtqvist AK, Dahlqwist E,et.al. Association of SARS-CoV-2 Vaccination During Pregnancy With Pregnancy Outcomes. 2022 Apr 19;327(15):1469-1477. doi: 10.1001/jama.2022.3271. PMID: 35323851; PMCID: PMC8949721.
- Magnus MC, Gjessing HK, Eide HN, et al. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. N Engl J Med. 2021 Nov 18;385(21):2008-2010. doi: 10.1056/NEJMc2114466. Epub 2021 Oct 20. PMID: 34670062; PMCID: PMC8552533. Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. 202
- Gray KJ, Bordt EA, Atyeo C, et al. COVID-19 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol.
- Rottenstreich A, Zarbiv G, Oiknine-Djian E, Zigron R, Wolf DG, Porat S. Efficient maternofetal transplacental transfer of anti- SARS-CoV-2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Clin Infect Dis.
- Halasa NB, Olson SM, Staat MA, et al. Effectiveness of Maternal Vaccination with mRNA COVID-19 Vaccine During Pregnancy Against COVID-19–Associated Hospitalization in Infants Aged <6 Months — 17 States, July 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:264–270. DOI: http://dx.doi.org/10.15585/mmwr.mm7107e3external icon
- Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. 2020;370:m3320.
There is no evidence that coronavirus vaccines affect women's fertility. Menstrual irregularities after vaccination have been reported, but not during pregnancy.
Pregnant women in their second and third trimester, and pregnant women in their first trimester who have risk factors, are recommended to take the seasonal influenza vaccine. This advice applies regardless of the coronavirus vaccine.
To prevent infection in pregnant women, the same advice applies as for the general population: good hand hygiene and limited physical contact with others than your closest contacts (you decide who your closest contacts are, but they are usually the ones you live with). Primary vaccinated people are considered to be well protected against a severe disease course. Unvaccinated people can discuss the possibility of working from home with their employer.
If any of the closest contacts have symptoms of a respiratory tract infection, the pregnant woman should limit contact with them if possible, and otherwise have good hand hygiene and follow other basic infection control advice.
Healthcare professionals who are pregnant
The recommended personal protective equipment should be used by all healthcare professionals during contact with a patient with suspected, probable or confirmed COVID-19 disease, regardless of the healthcare professional's vaccination status.
There are no other recommendations for pregnant healthcare workers than for other healthcare workers in risk groups due to y
For healthcare professionals who are pregnant and who have pregnancy complications or chronic diseases with an increased risk of severe COVID-19 progression (see section on pregnant women and risk factors above), work adjustment or remote working should be assessed based on individual risk. This applies regardless of vaccination status.
All pregnancy check-ups should follow normal guidelines for healthcare.
Unvaccinated pregnant women with chronic diseases or pregnancy complications should discuss with their doctor whether or not there is reason to exercise extra care and if workplace adjustment is necessary. In the event of an increased risk of transmission in society and in work where it is not possible to follow advice on the recommended distance to others, transfer to other tasks should be considered.
- Risk groups and their relatives
- Pregnancy and COVID-19 - Norwegian Medical Association (in Norwegian)
It is recommended that pregnant women contact the health service if they have a positive COVID-19 test. Since the professional communities have prepared advice on follow-up during pregnancy, it is recommended that the pregnant woman takes a confirmatory test with PCR in a positive self-test. If you are pregnant and have a negative self-test, but have symptoms from the upper respiratory tract, you should also contact your regular doctor to assess whether or not you should be tested for other respiratory viruses.
Birth and maternity
There is uncertainty about whether coronavirus can be transmitted from mother to child before or during birth. Babies born to mothers with COVID-19 that have been infected after birth have had mild or no symptoms. However, in rare cases, viruses have been detected in samples from the child's blood or there have been changes in the placenta where there has also been a severe disease course in the foetus or newborn.
Severe fetal/neonatal events were reported more frequently with the delta variant of the virus (8). Viruses have been detected in umbilical cord blood, which indicates that there is a possibility the child has been affected by the virus in the womb. The virus is mainly spread by droplet and contact transmission. Mothers who are sick may infect their child after birth and shall follow the infection control advice given by the healthcare personnel.
Women who give birth and who had confirmed COVID-19 just before birth can be together with their newborn after the birth, unless the mother is seriously ill or the child is very premature or sick.
After returning home from the hospital, it is important to remember that new mothers may be vulnerable and need support from those around them, even during the corona pandemic. Anyone who visits newborns should be healthy and without symptoms.
Coronavirus has not been detected in breast milk from women with COVID-19 infection, where this has been studied. Women with COVID-19 infection can therefore breastfeed normally. This is also the advice of the World Health Organization (WHO).
A large summary of documentation on the effect on breastfeeding after COVID-19 vaccination has been made. There is nothing to suggest that breastfeeding after vaccination is harmful to the child. Antibodies (both IgA and IgG) against COVID-19 have been detected in breast milk 1-2 weeks after vaccination among breastfeeding mothers(9)
What do we know about COVID-19 vaccination of breastfeeding women?
For most vaccines, there is little documentation about transfer to breast milk. There are still few studies on breastfeeding mothers who have been vaccinated with COVID-19 vaccines.
Breastfeeding mothers have a good immune response to the vaccine (1). When the mother is vaccinated, the child will have antibodies transferred from the mother through the breast milk (2-4).
Two studies did not find mRNA from the vaccines in breast milk (5, 6), while a non-peer reviewed study that used an even more sensitive method found very limited amounts of mRNA in breast milk (4). However, it is very unlikely that even small amounts of vaccine in breast milk could have any effect, as the vaccine does not contain live virus and any small residues will break down in the digestive system.
The WHO recommends no restrictions in connection with breastfeeding. Women who are vaccinated should continue to breastfeed.
- Collier A-rY, McMahan K, Yu J, Tostanoski LH, Aguayo R, Ansel J, et al. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. 2021;325(23):2370-80.
- Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol.
- Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers. Vaccines (Basel). 2021;9(6).
- Low JM, Gu Y, Ng MSF, Amin Z, Lee LY, Ng YPM, et al. BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA. medRxiv. 2021:2021.04.27.21256151.
- Mattar CN, Koh W, Seow Y, Hoon S, Venkatesh A, Dashraath P, et al. Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination. medRxiv. 2021:2021.05.23.21257686.
- Golan Y, Prahl M, Cassidy A, Lin CY, Ahituv N, Flaherman VJ, et al. Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk. JAMA Pediatr. 2021.