Covid vaccines for pregnancy and babies: Sorting fact from chaos
The events of the past week around Covid-19 vaccines have created a whirlwind of confusion—especially for those trying to make the best decisions for themselves and their families. So this is for the parents, expectant families, and clinical care teams trying to do the right thing through all the noise. If that’s not you, I hope you’ll forward this to someone navigating early parenthood or practicing on the frontlines of medical care.
Have more questions? I’ll be hanging out in the YLE chat live at 12pm PST today for paid subscribers. Come say hi!
Let’s start with where things stand today: Pregnant women and children are still eligible for the Covid-19 vaccine.
It’s effective. It’s safer than the disease. It helps during pregnancy and the first few months of life. Once a baby is 6 months old, the primary Covid-19 vaccine series remains important to build long-term immunity.
But… didn’t I just see headlines saying pregnant people and kids aren’t eligible anymore?
Yes. And this is very confusing. Let’s back up.
Until recently, everyone over 6 months old was eligible for an annual Covid-19 vaccine every year. That included pregnant women who could get vaccinated during each pregnancy. And many did: last fall, 14% of pregnant women received the shot (~200,000 people).
Then, the FDA Commissioner announced that vaccines would only be available to those over age 65 and those under 65 with a high-risk condition. This included pregnancy.
Then, Health Secretary RFK Jr.—a longtime opponent of vaccination—announced that pregnant women and kids would no longer be eligible. This wasn’t based on any new data. And the decision wasn’t made with input from pediatricians, obstetricians, vaccinologists, or public health experts.
THEN, after what appears to have been urgent conversations with CDC scientists, the CDC did not go through with removing pregnant women and kids from eligibility. Instead, they updated the guidance to say that vaccination should be based on shared clinical decision-making—meaning you can get the vaccine in consultation with your physician.
This ping-pong decision-making bypassed the usual scientific process of vaccine policy. In other words, this is abnormal.
But, today, you can still get the vaccine. Here is the official vaccine schedule from CDC.
This could change again. Later this month, the CDC’s scheduled vaccine policy meeting will take place to discuss fall plans, and since they have already pushed back, I doubt that it will change again. RFK Jr. could veto it all at any point, too.
Why does vaccination during pregnancy matter? And why should babies get vaccinated again?
1. To protect you.
Pregnancy puts extra stress on the body: lung function changes, blood clot risk rises, immune function shifts. Covid-19 infection adds another layer. Compared to nonpregnant people of the same age and health status, pregnant people with Covid-19 are more likely to require ICU care, need a ventilator, or die. They’re also at higher risk for complications like preeclampsia, blood clots, and cesarean delivery.
2. To protect your fetus before birth.
Covid-19 infection during pregnancy increases the risk of preterm birth and, during previous Covid waves, stillbirths. (During the Delta wave, a study showed a 4-fold increase in stillbirths.) It can also damage the placenta, impairing antibody transfer. While risks have gone down (largely thanks to background immunity), they’re not zero.
3. To protect your newborn after birth.
The human body is extraordinary. During pregnancy, you can pass protective antibodies to your baby through the placenta starting at about the 17th week of pregnancy and peaking ~4 weeks before delivery. Once born, the baby is well protected in the short term. If this transfer doesn’t happen, newborns are left largely unprotected.
Antibodies will also occur in breast milk, but it’s difficult to tell how much of a role they play in protection.
Babies are at high risk.
Even healthy babies are vulnerable to Covid-19 infection. Data from this past winter shows:
Infants had the highest ER visit rates for Covid-19 compared to any age group.
Hospitalization rates for infants were higher than for all people ages 6 months to 64 years.
Most (58%) of infants hospitalized for Covid-19 had no underlying health conditions. Among those who did, prematurity was the most common.
This is largely preventable by getting the vaccination during pregnancy.
What the evidence says about safety and effectiveness
The original Covid-19 vaccine trials did not include pregnant women—this is common in early drug and vaccine research, though it’s increasingly being challenged. However, some trial participants became pregnant after enrollment, and no complications were reported. Also, vaccine companies conducted studies on pregnant rats, which showed no adverse effects.
Based on this data, the American College of Obstetricians and Gynecologists (ACOG) and other medical organizations strongly recommend vaccination during pregnancy, and they continue to do so.
Since then, multiple “real-world” studies (i.e., not tightly controlled clinical trials) across different populations have confirmed: the vaccine is safe and effective for pregnant women. We’ve seen this over and over again:
A 2024 meta-analysis of 1.8 million pregnant vaccinees found no increased risk of bad outcomes for the pregnant person, fetus, or infant, and found that vaccination with any COVID-19 vaccine reduced the risk of hospitalization by 94%.
A 2021 study in the New England Journal of Medicine following 35,000 vaccinated pregnant individuals found no increase in adverse pregnancy or neonatal outcomes.
A 2022 study found that infants whose mothers were vaccinated during pregnancy had a 61% lower risk of hospitalization for Covid-19.
Real-world data from the CDC’s V-safe and VAERS systems show no safety signals among vaccinated pregnant individuals.
Real-world data show that infants born to mothers vaccinated during pregnancy had a 47% reduced risk of getting COVID-19 for every 10-fold rise in spike antibodies, including the period where Omicron was predominant, and had a 56% lower chance of getting COVID-19 in the first 6 months.
After birth: Why vaccination still matters at 6 months
The risk of severe Covid-19 outcomes significantly decreases after 6 months, largely because the baby’s immune system becomes stronger and stronger.
However, if the pregnant mom gets vaccinated, the baby only gets antibodies, and these wane over time. Infant protection lasts only 4-6 months, as vaccination during pregnancy only transfers antibodies across the placenta, not memory cells.
This is why the primary series for children is important, starting at 6 months old, so their immune system can remember Covid-19 for a long time.
Other questions you’ve asked
Will insurance cover Covid-19 vaccines now? Maybe. Because the CDC now recommends shared decision-making (rather than a broad eligibility statement), some insurers may not cover it. Check with your provider ahead of time—unfortunately, coverage is inconsistent right now.
When is the best time to get vaccinated? To pass antibodies to your baby, aim to get vaccinated between 23–34 weeks, and at least 4 weeks before delivery. But timing also depends on surges—if Covid-19 is circulating and it’s been a while since your last dose, earlier vaccination may be best for your own protection. Covid-19 is at very low levels right now, but we expect a summer wave in the next month or two.
Do pregnant women get too many vaccines during pregnancy? Currently, four vaccines are recommended during pregnancy: Covid-19, flu, RSV, and Tdap. This can feel like a lot, but each has been thoroughly tested for safety and effectiveness, and the benefits are much greater than the risks. If you’re unsure, talk to your doctor about timing or prioritization. (Researchers are actively working on combination vaccines to simplify this in the future.)
Should my child get the covid-19 vaccine every year? It depends. Covid-19 risk is low in young kids, but not zero. My own kids got the vaccine a few times after their primary series—for short-term protection during school, family gatherings, and high-risk periods. I haven’t gotten them every year—they’re hard to find.
What about the hover text on the CDC website? Some of you noticed that when you hovered a mouse over the CDC schedule these past few days, a pop-up said pregnant people shouldn’t get a vaccine. This was a mistake, and the CDC fixed it yesterday.
What about the wording “there is no guidance/not applicable” on the CDC website for pregnancy? This is confusing. But CDC has never had a specific recommendation for pregnant individuals. Pregnant people have always been lumped into people under 65 years old and high-risk.
Bottom line
Pregnancy is hard enough without politics getting in the way of protection. If you’re unsure or feel stuck, talk to your OB-GYN, midwife, or pediatrician. But know this:
You still have the option to get vaccinated for Covid-19. And it could make a big difference—for you and your baby.
Love, YLE
P.S. If you have more questions, I’ll be in the YLE chat live at 12pm PST today for paid subscribers. Hope to see you there!
Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE is a public health newsletter that reaches over 380,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
This is great to keep talking about. To be silent about the persistent Covid threat to pregnant women and young children is to casually endorse the misinformation against vaccination, really. I've been actively writing about this on my site for the past month, whether popular or not!
Vignette: I had the great pleasure of seeing a 32 year old pregnant woman yesterday, due in August, who ASKED ME for a Tdap shot, and how to game out the Covid shot she wants to get soon based upon community rates, anticipated Covid wave in mid-July, maximizing placental transfer of antibodies, etc.
It was like the good old days, and so rewarding, really.
Next patient said "no" to all vaccines recommended.
That's the primary care circus.
It's a big tent.
Great post, as always. I'm a former FDAer and want to provide a little context and advice to help navigate this with vaccine skeptics. You note that the vaccine is "safer than the disease." That is a low bar, and well below what FDA requires for vaccine approval. It's important to remember that vaccine safety has to be considered for use in otherwise healthy people, not the small subset of people who are infected or contract the disease targeted by the vaccine. When they were approved, the safety of COVID vaccines was thoroughly demonstrated, but like any effective vaccine (or drug), they're not completely without risk. FDA makes decisions based on benefit/risk assessment, and the approved vaccines clearly met that standard. There is, however, presumably some residual uncertainty as to whether the modifications made to keep up with variants have the same original efficacy ands safety profile. It's a reasonable assumption but has not been evaluated with the same rigor that these were in the original versions. All that said, I agree that the decision to vaccinate, or boost, should be well-informed (as you have done here) and made by individuals in discussion with their healthcare providers, and not subject to the whims of politics!