COVID-19 vaccination in pregnant and breastfeeding women and those planning pregnancy

Pregnant women have a higher risk of severe illness from COVID-19.

RANZCOG

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Updated
12 January 2024

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the risk posed to the community, healthcare workers, and all patients, due to the COVID-19 pandemic. RANZCOG also recognises our responsibility to respond to this situation as a large organisation, and also as a medical college, and health leader.

The College respects the role of government, health departments and health administrators in coordinating a national response in Australia and New Zealand. The purpose of this communiqué is to provide updated advice on the issue of vaccination for pregnant and breastfeeding women, and those planning pregnancy in Australia, in line with updated advice from The Australian Technical Advisory Group on Immunisation (ATAGI) and the Ministry of Health and Immunisation Advisory Centre in New Zealand.

RANZCOG advice aligns with that issued by ATAGI.

Key points

Pregnant women have a higher risk of severe illness from COVID-19. Their babies also have a higher risk of being born prematurely. 

COVID-19 vaccination significantly reduces the risk of becoming infected with COVID-19. Vaccination also reduces your risk of transmitting the virus to others, including to infants.

COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (for pregnant women) or through breastmilk (for breastfeeding women).

Pregnant women in Australia are a priority group for COVID-19 vaccination and should be routinely offered the Pfizer vaccine (Comirnaty) or Moderna (Spikevax) at any stage of pregnancy. 

Pregnant women in Aotearoa New Zealand are a priority group for COVID-19 vaccination and should be routinely offered the Pfizer vaccine (Comirnaty) as this is the only vaccine currently approved for pregnant women in Aotearoa New Zealand.

Pfizer (Comirnaty) and Moderna (Spikevax) are mRNA vaccines. Global evidence has shown that the Pfizer and Moderna vaccines are safe for pregnant women. 

Novavax COVID-19 vaccine can also be used in pregnancy.  While there are no immunogenicity or safety data, there are no theoretical safety concerns relating to its use in pregnancy, since the Novavax COVID-19 vaccine, like other COVID-19 vaccines, is not a live vaccine.

There is no evidence of increased risk of miscarriage or teratogenic risk with mRNA or viral vector vaccines.

Women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination. 

All healthcare workers, including midwives and doctors, are encouraged to be vaccinated, to protect themselves, pregnant women, and their babies.

What are the current recommendations for the COVID-19 vaccine in pregnant women? 

Pregnant women are a priority group for COVID-19 vaccination and should be routinely offered Pfizer mRNA vaccine (Cominarty) [or Moderna (Spikevax) in Australia] at any stage of pregnancy. 

Pregnant women with COVID-19 have a higher risk of severe illness compared to non-pregnant women with COVID-19 of the same age. This includes an increased risk of:

hospitalisation

admission to an intensive care unit

invasive ventilation

COVID-19 during pregnancy also increases the risk of complications for the baby including a higher risk of stillbirth and of being born prematurely.

Vaccination is the best way to reduce these risks.

Pregnant women should get vaccinated and continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. Vaccination significantly reduces the risk of becoming infected with COVID-19. Vaccination also reduces your risk of transmitting the virus to others, including your baby. Everyone should continue with hand hygiene, masks where social distancing cannot be maintained, testing when symptoms are present and isolation, when appropriate.

Please note: Eligibility for vaccination is determined by the Australian Government and the New Zealand Ministry of Health, and local jurisdictions, and is not within the authority of RANZCOG. 

When is the best time to have a COVID-19 vaccine if I am pregnant?

It is recommended to have a COVID-19 vaccine as soon as you are offered one.

Pfizer (Cominarty) [and Moderna (Spikevax) in Australia] are mRNA vaccines and can be given at any stage of pregnancy. Two doses of Pfizer or Moderna vaccine, 3–6 weeks apart, provides good protection against COVID-19.

Booster doses are recommended for pregnant women aged 18 years and over in Australia, and 16 years and over in Aotearoa New Zealand, using an approved booster vaccine. RANZCOG recommends that pregnant people discuss this with their maternity care provider or GP.

There are no minimum intervals between COVID-19 vaccination and other routine vaccinations, which means COVID-19 vaccines can be given at the same time as others; this includes the influenza vaccine. All medical advice should be patient-centred and take into account each individual’s personal considerations and preferences. 

Other treatments in pregnancy

Pregnant women should continue to receive pertussis and influenza vaccination during pregnancy.
 
The administration of Anti-D should continue as per usual indications and timing is not affected by vaccination.

Country-specific advice

Aotearoa New Zealand advice:

Three (3) COVID-19 vaccines are currently available in New Zealand: Pfizer (Comirnaty); AstraZeneca (Vaxzevria) and Novavax (Nuvaxovid).

Pregnant women in Aotearoa New Zealand are a priority group for COVID-19 vaccination and should be routinely offered the Pfizer vaccine (Comirnaty) as the only vaccine currently approved for pregnant women in New Zealand.

Information on vaccinations and eligibility is on COVID-19 vaccines | Ministry of Health NZ.  Vaccinations can be booked by visiting www.BookMyVaccine.nz or calling the COVID Vaccination Healthline on 0800 28 29 26.

Advice on a 2023 booster dose is as follows:

The Pfizer BA.4/5 COVID-19 bivalent vaccine is recommended for pregnant people at any stage of pregnancy or during breastfeeding, as long as it has been at least 6 months since their last COVID-19 vaccine or positive COVID-19 test. The Pfizer BA.4/5 COVID-19 bivalent vaccine is considered likely to be more effective against Omicron subvariants than earlier vaccines.

The additional COVID-19 booster is available for anyone aged 30 and over, and pregnant people aged 16 to 29 years, and people at higher risk of severe illness from COVID-19, as long as it’s been at least six months since their last COVID-19 booster or positive COVID-19 test.

Pregnant women are encouraged to have an informed decision-making discussion with an authorised prescriber on their health needs, and the risks and benefits of an additional dose.

Further information is available at:

Aotearoa New Zealand Government Ministry of Health — provides up-to-date information on eligibility for booster doses in New Zealand

Australian advice:

Four (4) COVID-19 vaccines are approved in Australia: Pfizer (Comirnaty original and Comirnaty bivalent Original/Omicron BA.1 vaccine); Moderna (Spikevax original and Spikevax bivalent Original/Omicron BA.1 vaccine); AstraZeneca (Vaxzevria) and Novavax (Nuvaxovid).

Pregnant women in Australia are a priority group for COVID-19 vaccination and should be routinely offered the Pfizer vaccine (Comirnaty) or Moderna (Spikevax) at any stage of pregnancy.

Everyone in Australia aged 5 years and over is eligible for a free COVID-19 vaccination.

To arrange an appointment, use the Australian Government Vaccine Clinic Finder

A 2023 booster dose:

is recommended among adults aged 18–64 years who have medical comorbidities that increase their risk of severe COVID-19, or disability with significant or complex health needs. A 2023 booster dose should be given 6 months or more after the person’s last COVID-19 vaccine dose (regardless of the number of prior doses received) or confirmed infection. An mRNA bivalent booster is preferred.

can be considered among adults aged 18–64 years within in the general population if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was 6 months ago or longer, and regardless of the number of prior doses received, based on an individual risk benefit assessment with their immunisation provider.

is recommended for all adults aged 65 years and over.

At this stage, pregnancy is not considered a specific indication for a booster dose. All currently available COVID-19 vaccines are anticipated to provide benefit as a booster dose; however, bivalent mRNA booster vaccines (Pfizer Original/Omicron BA.4/5; Pfizer Original/Omicron BA.1; Moderna Original/Omicron BA.1) are preferred over other vaccines. Further information is available here.

What are the recommendations for women planning pregnancy?

Women who are trying to become pregnant can receive either COVID-19 vaccines (Pfizer, Moderna, AstraZeneca or Novavax), as approved within their country. They do not need to delay vaccination or avoid becoming pregnant after vaccination.

What are the recommendations for breastfeeding women? 

Vaccination is recommended for breastfeeding women. They do not need to stop breastfeeding before or after vaccination.

Either Pfizer, Moderna or AstraZeneca vaccines are considered safe for breastfeeding women.

There are substantial data on the safe use of the Pfizer and Moderna vaccines in breastfeeding women. The mRNA in Pfizer or Moderna is rapidly broken down in the body and does not appear to pass into breastmilk. The viral vector in AstraZeneca cannot cause infection.

There is currently no immunogenicity or safety data for these groups with the Novavax vaccine. 

Further information

Further information can be found here:

MyAus COVID-19 app

RANZCOG recognises the importance of ensuring multicultural communities throughout Australia have the information they need about the COVID-19 vaccination program, and would recommend members encourage their patients use:

The MyAus app has been developed to help the broader community get all the knowledge they need, in the language they require. MyAus COVID-19 app supports access to information in a user-friendly format, including via short animations. The app is available for iPhones and Android devices.

Further research

The circumstances of the COVID-19 pandemic are unprecedented and knowledge is continually evolving. RANZCOG emphasises the importance of inclusion of pregnant and breastfeeding women in clinical trials of COVID-19 vaccines to develop evidence-based advice regarding safety and efficacy.

RANZCOG will continue to monitor available data and issue updated advice as evidence emerges.

Disclaimer

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is the lead body for women’s health in Australia and New Zealand and carries the responsibility for advice, dissemination of information and support of our members, our patients and the community during the Covid-19 pandemic.

The College respects the role of government, health departments and health administrators in coordinating a national response. Our public statements are made following consultation with officials, and medical experts, and with the understanding that the impacts of the pandemic are evolving, multifactorial and that action in one area will have intended, and unintended, effects on other areas.

RANZCOG will continue to provide information and advice that is the best available, to our knowledge. Given the recency of COVID-19 and the paucity of data, particularly in pregnancy, the accuracy of any advice may be rapidly superseded. We will endeavour to regularly update our communication as new information becomes available. Furthermore, RANZCOG will not comment on areas beyond our remit.

RANZCOG commentary on COVID-19 should be considered advisory, and not proscriptive, and all health workers, and the general public, should heed the advice of government and health authorities.

CATEGORIES
COVID-19 Women’s health

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