Fertility, Pregnancy and Breastfeeding Event | Questions and Answers

Fertility Related Questions and Answers:

Q: I’ve read several things about women having disruptions on their periods after taking the Pfizer or Moderna vaccines (more than one period in a month, heavier bleeding, etc). So I have two questions relating to that: 1) I had to go through a surgery last week due to a miscarriage. My vaccination is scheduled for next Wednesday. Should I delay it? 2) I’ll try to get pregnant again in the next months. Considering that the vaccine can affect my periods, does that mean it affects my ovulation as well? Will it affect my chances of getting pregnant?

A: I have not read any formal reports indicating menstrual issues so this may be coincidence rather than causal. There is no reason it should effect your ability to ovulate

Q: I had my first COVID jab a few weeks ago. I am currently trying to conceive. If I become pregnant before my next vaccine is due (8 weeks time) I would want to avoid the second jab in my first trimester. This may mean I have a 5 month gap between the two vaccines. Is this OK? Will it be just as effective with this gap between the two doses?

A: We don’t know the efficacy of the vaccine beyond 12-14 weeks as the data doesn’t report beyond this. The JCVI state you do not have to start again but to have the vaccine as soon after your 11 weeks time as possible. There will be some improvement in vaccine effectiveness, but we can’t tell you how much.

Q: Does the vaccine effect male fertility for people trying to conceive?

A: There is no known impact or effect on male fertility.

Q: I have already had my first and second AstraZ vaccines but did have concerns because I'm trying to conceive. what is the reason for AZ not being offered to pregnant women? I'm under 40 too so guess ideally I wouldn't have had AZ in the first place.

A: It is because of the very small increased risk of clot formation with the AZ vaccine – pregnancy itself increases the risk of clots too – hence the AZ vaccine is avoided in pregnant women. The increased risk of clots only persists for about a month after vaccination though.

Q: We have spoken a little about there being no evidence to suggest vaccines can impact fertility. Can you tell us about the research that has happened and what we do know.  Numbers of woman impacted? Are there links to miscarriage?

A: There have been no human studies looking at this although I suspect more data will be available in time.  Animal studies have been undertaken which have not shown the vaccine has any detrimental effects on fertility.  Experts don’t think there is any plausible mechanism by which the vaccine (which is not a live vaccine) could impact on fertility. 100000 pregnant women have been vaccinated with the Pfizer / Moderna vaccines in the USA and no increase in miscarriage rates have been noted in this population.

Q: Is there any research about partners having different vaccines and fertility?

A: No evidence but as above nothing to suggest the vaccines should impact on fertility.

Pregnancy Related Questions and Answers:

Q: Should I get the vaccination in the first trimester?

A: Depends on if you are in an at-risk group? If you are, with the delta variant active I would say yes. If you aren’t then wait until 12w or go for it - either would be ok. It is your choice.

Q: Is it just in the third trimester that the risk with COVID gets higher? Is it because you are much bigger and therefore more likely to be breathless or because you could go into early Labour/have a premature baby?

A: It is the respiratory issues and clotting issues created by active COVID that cause third trimester pregnancies to have an increased risk. Third trimester is 27-28 weeks and beyond.

Q: Can you give information around miscarriage concerns for early pregnancy and taking vaccines?

A: There is no known impact or effect of the vaccination.

Q: Is the position of the JCVI/NHS that they recommend pregnant women do have the vaccine in the same way that they recommend the whooping cough/flu vaccine? Is the position that it is actually recommended with the same confidence as the other vaccines recommended for pregnant women?

A: Yes it is. They have been careful to make sure they advocate choice - if you speak to JCVI they are very keen for all to have but it is not compulsory.

Q: This presentation is extremely pro-vaccine and I wondered if there would be any acknowledgement of the unknown risks -  that current guidance is recommending choice rather than actively recommending the vaccination like the NHS does for flu or whooping cough. If it was as safe as it's being made out today, why isn't the NHS actively recommending it?

A: The NHS does always say it is a choice based on risks and benefits for all vaccines. The discussion on COVID vaccine is higher profile because of the pandemic.

Q: How is an mRNA vaccine providing immunity and how can it potentially affect the baby?

A: In summary, mRNA goes into arm and the immune system gets interested in this mRNA. Immunity to protein spike creates an immune protein T cell antibody) that circulates around the body as a security guard. If it meets this protein spike in the future it attaches to the virus and stops it infecting

Q: I got the AZ vaccine pre-pregnancy. Should I have that 1 again for my 2nd jab or request the Pfizer? Is it safe to swap?

A: I would suggest second dose is AZ as would give you best protection. There is a study called ‘Com Cov’ looking at this but it is in the over 50s so may not extrapolate to you.

Q: Earlier in the webinar, you talked about how the Pzifer and Moderna jabs use mRNA technology and stay in your arm etc and don't reach the baby.  AZ uses an animal adenovirus - are you able to give you thoughts on how this type of vaccine could/couldn't affect the baby?  Is there a difference?

A: The AZ vaccine uses a modified adenovirus, it is not a live virus. It starts off slightly differently to Pfizer and Moderna but they all end up doing the same thing. They all cause the cells to make spike proteins which trigger the immune response. Then the original cells will be destroyed by the immune system within 48 hours.

Q: I’ve looked at the booking slots and if I have my first jab now, my second one will fall pretty much on my due date. Do you know if they will consider administering second jabs sooner in this instance?

A: That would seem sensible. If you had the dose at your GP vaccine centre speak to them and see if they have a slot 2 weeks earlier. If through the national booking system I don’t think this will be possible - worth asking though.

Q: I had my first Pfizer vaccine on 5th February due to being a health professional, this was before I was pregnant. I found out I was pregnant just before my 2nd vaccine and at that point it wasn’t being broadly recommended in pregnancy as it is now. I decided, following discussion with my GP, that I’d wait until after 12 weeks of pregnancy, which I am now. Will I now need 2 more vaccines as I had my first vaccine 17 weeks ago?

A: No - the recommendation is that you will not need a repeat course, just the 2nd vaccine as soon as possible.

Q: If I get the first jab at 22 weeks should I try to get the next before 28 weeks if possible?

A: No, the earliest you can get the vaccine will be 8 weeks after your first dose. So you this would mean having the second dose at 30 weeks.

Q: I had made the decision to wait till after the baby is born. How soon can I have the first jab after giving birth?

A: You can have the vaccine as soon as you want to after the birth. You may choose to wait until you have had time to recover from the birth itself, in which case you may want to remind any potential visitors to be extra cautious.

Q: For pregnant women in late 30's with less exposure from outside, is it recommended as well to get vaccinated? I mostly see health authorities highlighting it for frontline workers.

A: Absolutely, yes.

Q: I’m 24 weeks pregnant and about to have my first vaccine. I’m likely to be approaching my due date when I’m offered my 2nd vaccine. Is there a cut-off point when I can’t have it as I’m too close to due date?

A: No - speak to your vaccine centre and ask if it is possible to bring forward the 2nd vaccine.

Q: Is it better to get the vaccine before getting pregnant, or while pregnant after the first 12 weeks? If you have had anaphylaxis to a vaccine in the past (not covid) should you still have the vaccine?

A: If you have had anaphylaxis to the vaccine we would have previously offered AZ vaccine. There is a constituent part of the Pfizer and Moderna vaccine called a PEG which is what people are often allergic too. You may need to speak to your GP re the reaction you had and they can ask immune specialists at Southmead for advice on which vaccine and where you should have it. This system works well but cannot be used on the day so pick up the phone and speak to your GP practice about this.

Q: If you get a fever after having the vaccine is that anything to worry about?

A: when you have your vaccine they will explain to you the difference between a reaction fever and a fever that might be due to something else. Please talk to the team when you have your vaccine.

Q: I appreciate that our research is not quite as extensive yet as in the US, I had maybe naively assumed much of the trials of this drug on pregnant women had been completed?

A: 12 weeks seems like a sensible decision. The system is requesting that all pregnant women who are vaccinated report this - this is to allow us to continue to monitor the effectiveness of the vaccination and pick up any untoward events. These are not expected as large > 90000 review of US patients has already been published shows this vaccine to be safe to give in and around pregnancy.

Q: What evidence is there on the impact the vaccine will have on the development of the baby?

A: There is no reason the vaccine should effect your baby as it develops. The mRNA goes into your arm. The immunity travels round the body as does the immunity from flu and whooping cough vaccine. The US data supports it is safe for both mother and growing baby.

Q: What do we know about the impact on the growing baby? Are there any developmental concerns? especially seeing as children are not yet eligible for vaccine. I am due in 5/6 weeks and was planning to wait until after the birth to get my vaccine.

A: There are some anecdotal descriptions with no evidence attached but absolutely no actual evidence from the US reports.

Q: I am 16 weeks and hoping to find out what - if anything - is known about the impact on the baby of the vaccines. I've done a lot of reading but this seems to be missing information - due to the short timelines since vaccine rollout began, I assume. Is there any emerging research on what impact there is on the baby, or will this be covered in the discussion tonight?

A: The honest answer is we don’t know. 100000 pregnancies have been looked at in the US using the Pfizer vaccine with absolutely no issues reported around development. Pre term birth can be a consequence of active COVID usually due to maternal well being issues and oxygenation requirements. So in my view risks ae outweighed by protection the vaccine gives.

Q: I would like to know more about the known effects on the development of the baby once born. Will the vaccine cross the placenta? Are there tests/checks on baby's development? Is this vaccine similar to ones already safely used in pregnancy?

A: The vaccine is different to other vaccines as mRNA vector is a new way of vaccinating. The immunity crosses the placenta the vaccine stays in the arm. Hope that reassures.

Q: Have any babies actually been born to vaccinated women yet?

A: Yes in the US study.

Q: I'm worried about longer term effects on the baby of having the vaccination in pregnancy (eg after a year or two). Of course there is no evidence about this. What can you tell me to make me think it won't cause problems?

A: I can't think of any reason this could happen. You are right, we don’t know but theoretically as medical professionals we can't think of a way this could harm. This is a good as it gets currently. Doctors who are pregnant are getting their vaccinations which may say something?

Q: Does it matter which trimester the vaccine is had in? 

A: You can have the vaccine during any trimester. Some people may choose to wait until after their first trimester depending on their own risk to COVID-19. It is good to get vaccinated before the 3rd trimester due to pregnant women in their 3rd trimester being more at risk of becoming seriously ill from COVID-19.  

Q: Is it ok to have the COVID-19 vaccine at the same time as the whooping cough vaccine or should there be a gap between them? 

A: A 2 week gap in usually advised between vaccines. 

Q: Is there any preference for pregnant women on having either the Pfizer and moderna vaccine? 

A: The Joint Committee on Vaccination and Immunisation said no specific safety concerns related to pregnancy have been identified, but that real world evidence from the US has shown around 90 000 pregnant women have been vaccinated—mainly with the Pfizer and Moderna vaccines—without any safety concerns being raised.  

Q: Is the reason that the AZ vaccine is no longer recommended for pregnant women purely about the blood clotting risk and the lack of data? 

A:  Yes pregnant women are already at a higher risk of clotting, so would not give them something that increases that risk further, even though the risk is very low. And yes, there is more data on Pfizer and Moderna available through the US trials.  

Q: I have had the first vaccination (AstraZeneca) and am due the second vaccine (12 weeks) now. Since then however I have successfully conceived and am 10 weeks pregnant. Is it best to ask for a different vaccine such as Pfizer for which there is more evidence?  

A: Anyone who has already had a first dose of the AZ vaccine without suffering this specific form of extremely rare blood clot should have their second dose of AZ. 

Q: Should we do an anti body test? I have already had both AZ vaccine. What if I still don’t have anti bodies? 

A: AZ is affective at protecting you against COVID-19. The decision to stop offering AZ to pregnant women was not due to it being an ineffective vaccine. Just keep going with the 2 lateral flow tests a week as all vaccinated people are advised, as no vaccine is 100% affective.   

Q: If I wait until I have the baby to have the vaccine (December) will vaccines still be readily available in the same way/volumes they are now? Or will vaccine sites be a lot less? 

A: Vaccines will still be available but likely to be at less sites.  

Q: I'm 35 weeks pregnant and trying to decide if it's worth getting my first jab now or waiting until I give birth. What concerns me is any impact to child development as I imagine there will be very little data relating to this at the moment (assuming babies born to those who have been vaccinated are not yet at a stage of walking / talking etc). Are there any studies looking at this at the moment, which is publishing any preliminary results at periodic intervals? 

A: The Joint Committee on Vaccination and Immunisation said no specific safety concerns related to pregnancy have been identified, but that real world evidence from the US has shown around 90 000 pregnant women have been vaccinated—mainly with the Pfizer and Moderna vaccines—without any safety concerns being raised. 

Q: Is there a minimum space needed between COVID-19 vaccine 1 and 2? I'm due to have whooping cough next Friday and I'll be 29 weeks, I have been told to wait a week between COVID and whooping cough jab. It’ll be tight to fit in the 2 jabs before I give birth? 

A: The space between each COVID-19 vaccination should be 8 to12 weeks.  

Q: Does being vaccinated mean you don't transmit COVID? I wasn't aware this had been concluded from the research. 

A:  No vaccine is 100% effective but the vaccines are very good at stopping people becoming seriously unwell from COVID and significantly reduce the likely hood of you catching and transmitting COVID.

There are a number to research papers especially with older Adults on effectiveness. For example https://www.bmj.com/content/373/bmj.n1088 

Q: What are the additional medical risks to pregnant women/unborn babies over the general public with catching COVID?

A: Pregnant women are not at greater risk of catching Covid 19 but it does depend on your individual circumstances what your risk is.

Take a look at the 'Information sheet and decision aid' from tool from the RCOG: https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf

Q: Having read a lot about the vaccine, there was a lot of talk about thalidomide and how that was considered safe and making comparisons. Is this scaremongering? What’s the science behind the difference? 

A: Thalidomide was very different as it was an oral medicine and not a vaccination. Many non-live vaccinations, such as the COVID-19 one, are given to pregnant women with no issues.  

Q: My daughter has contracted COVID-19 already when she was 22 weeks pregnant, was really ill but not hospitalised. She is now 28 weeks and suffers post COVID fatigue, and has booked for her first COVID vaccination - what effect will this have for her if she already has antibodies?

A:  There is little evidence to answer this question. COVID vaccination cannot give you COVID as it is not live. It cannot worsen Post viral fatigue either. It will boost her immunity to the virus and the delta variant, so I would say difficult to quantify risk but low – can't say for certain that there is no risk. No risk to baby though.  

Q: I was wondering if there has been any stats/health worries in babies who have been born to see if the vaccine has affected their development, with so little time there isn't likely to much data on this yet. 

A: “It will take time to follow infants of people who were vaccinated in pregnancy in order to answer this question. However, based on what is known about these and other vaccines, getting a COVID-19 vaccine is not expected to cause long-term problems for the baby”  (mothertobaby.org, USA).

Q: Is the baby able to handle the antibodies of the vaccine, on top of the other vaccinations that are taken?  All the research so far has been on the pregnant mothers safety, is there any research on the baby’s safety? 

A: Babies benefit from any anti bodies to infections that are  passed on by the mother. Some of these antibodies will come from the mother’s natural immunity that she has built up to infections. Other antibodies will come from vaccines. This is how the whooping cough vaccine works. By giving it to the mother in pregnancy the antibodies are passed on to the baby to prevent them from getting whooping cough. “COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. The COVID-19 vaccines that we are using in the UK are not ‘live’ vaccines and so cannot cause COVID-19 infection in you or your baby” (RCOG,RCM 2021).

Q: What are the long term (potential) side effects of having the vaccine and the consequent antibodies being in the baby? What are the unknowns? I'm finding it hard to make an informed decision as the other side of the story isn't being told. Or is it just that there isn't one? Why aren't we given vaccines to everything if it is always safe to have them? 

A: The vaccine is not passed on the baby only the antibodies that the mother produces from having the vaccine. There are many vaccines that are given to prevent us from getting diseases that can be very harmful to us. Eg malaria, typhoid, measles, mumps and rubella. Vaccines go through rigorous testing and trials before they are passed as being safe to be given by MHRA(Medicines and Healthcare products Regulatory Agency).

Q: I have a planned c-section. How soon after a c-section is it safe to have the vaccine. I'm in my 30s if that is relevant. 

A: I don’t know of any reason for waiting any specific time after a caesarean before having the Covid 19 vaccine but it may be advisable to wait a week or two for the body to recover in case of any reaction to the vaccine at a time when you are recovering from the birth and an operation.

Breastfeeding Related Questions and Answers:

Q: Are there any studies with breastfeeding mums?

A: Yes, there are a few studies. Please look at the UNICEF BFI website for Covid-19 research and breastfeeding and the breastfeeding network website also has a list of published research which was last updated in May.

Q: I am breastfeeding, and my concern is the longevity of the research. What’s to say that in 3/4 year’s time the children of breastfeeding mothers who had the vaccine won’t get some sort of disease or condition?

A: We don’t know the answer to this yet, there is not really a way that the vaccine can get into breastmilk. The antibodies the mother produces will get into the breastmilk and that will potentially provide protection to the baby rather than harm.

Q: If you have the vaccine early on in the breastfeeding journey could it affect milk supply if you have the flu like symptoms which are common after having vaccine?

A: The vaccine can give side effects so it would be sensible to make sure you have family supporting you in the 24/48hrs after the vaccine in case you feel unwell. Your breastmilk supply should be maintained as long as baby continues to breastfeed responsively.

Q: How long does it take for the antibodies to come into the breastmilk?

A: In the study from Israel there were anti-SARS-Cov-2 specific IgA anti-bodies in mothers expressed breastmilk 2 weeks after the first dose of Pfizer vaccine.

Q: Is there any information about passing on antibodies to breastfed babies after having vaccine or it having a negative effect on breastfed babies when they are younger/older?

A: Breastmilk contains antibodies for all the immunities a mother has built up, the presence of antibodies is one of the things that makes breastmilk so protective for babies. Antibodies are a positive.

Q: Where can I find the USA trial data reliably written up in more detail?

A: The RCOG website and UNICEF BFI websites have lots of links to research.

Q: I’m part of a breastfeeding support group. A large number reported that their baby showed signs of falling unwell after the vaccine. Signs were similar to flu symptoms and a change in their poo turning green. The information I can find says the vaccine doesn’t pass through the breast milk but antibodies do. Why would antibodies cause these symptoms?  

A: It is always a worry for parents when their baby is unwell. The vaccine is very unlikely to enter breastmilk and the cells that the vaccine change will be localised to the injection site. These cells are destroyed by the mother’s body as her immune system makes the antibodies and so these cells are also very unlikely to enter breastmilk. Yes, antibodies that the mother produces to any infection will be in her breastmilk and this is one of the wonders of breastmilk. Antibodies don’t make us ill, they destroy the infection. Babies are quite susceptible to viruses that cause “colds”. So, it is quite likely that these babies may have caught a “cold” around the same time their mothers had the vaccine. Green poos can occur in a baby temporarily for lots of reasons and sometimes can occur as a result of a “cold” as well.  Please do speak to your health visitor, Midwife or GP if you are ever concerned about your baby. 

https://www.unicef.org/laos/reports/covid-19-vaccines-and-breastfeeding-based-who-sage-interim-recommendations