On October 21, the Centers for Disease Control and Prevention (CDC) expanded their recommendations on who, as of right now, can get a COVID-19 booster shot. The guidance splits up people at the most basic level, splits up people in to two groups: Those who who initially received a two-dose mRNA vaccine (Moderna or Pfizer-BioNTech) and those who received the single-dose Johnson & Johnson/Janssen (J&J) vaccine. From there, the guidance breaks down like this, per the CDC:
People who received a two-dose mRNA vaccine may receive a booster shot if they are:
- Age 65 or older
- Age 18 or older, and live in a long-term care setting
- Age 18 or older and have an underlying medical condition
- Age 18 or older and work/live in a high-risk setting
People who received a single-dose J&J vaccine may receive a booster shot if they are:
- Age 18 or older, and received their J&J vaccine two or more months ago
Even with these recommendations, there is still some confusion regarding certain populations—and how they fall into these categories. Namely, pregnant people are wondering: Can (and should) they get a COVID-19 booster, too?
Fortunately, the answer is pretty clear: Pregnancy is technically considered an underlying medical condition when it comes to COVID-19, according to the CDC. The reasoning: "Pregnant and recently pregnant people (for at least 42 days following the end of pregnancy) are more likely to get severely ill from COVID-19, compared with non-pregnant people," the CDC says.
And the CDC isn't the only reputable health agency that gives pregnant people the OK to get a booster shot. Both the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM)—the two major agencies that oversee medical providers who care for pregnant people in the US—urge pregnant people to get a booster shot if it's been at least six months since they completed the COVID-19 vaccination series.
"ACOG recommends that pregnant and recently pregnant people up to 6 weeks postpartum, including pregnant and recently pregnant health care workers, receive a booster dose of COVID-19 vaccine following the completion of their initial COVID-19 vaccine or vaccine series," according to the agency's page on COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care. The agency goes on to specify that their recommendations fall in line with the CDC's recommendations: For those who initially received a J&J vaccine to get a booster dose at least two months after their initial dose, and for those who received an mRNA vaccine to get a booster dose six months following completion of their initial series.
Echoing ACOG, the SMFM also recommends that pregnant people, including health care workers, get a Pfizer booster dose at least six months after their primary Pfizer series, at any stage during pregnancy or postpartum. (Note: This statement was issued before the FDA authorized booster shots for the Moderna and J&J vaccines, and has not yet been updated.) In their statement, the SMFM also added that pregnancy is "independently associated with a three-fold increased risk for ICU admission, a 2.4-fold increased risk for needing ECMO [a machine that allows a severely ill patient's heart and lungs to rest], and a 1.7-fold increased risk of death due to COVID-19, compared with symptomatic non-pregnant patients."
It's not just the agencies either. All of the health care providers we spoke to for this story, both ob-gyns and infectious disease experts, recommend pregnant or recently postpartum people get their COVID-19 vaccine and a booster dose.
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"I tell my patients that the COVID-19 vaccine, whether it's the first series or booster, is completely safe and recommended during pregnancy," Melissa Simon, MD, an ob/gyn at Northwestern Medicine, tells Health. Kjersti Aagaard, MD, PhD, a professor in the Department of Obstetrics and Gynecology at Baylor College of Medicine and Texas Children's Hospital, also tells Health that her practice is "recommending the booster in pregnancy, just like we do for any high-risk group."
Dr. Aagaard notes that expectant moms should consider the benefits, not only for themselves, but for their babies, as well. "One of the things we do as pregnant moms is prepare babies to live in the outside world—and that has COVID in it," she says. "Getting vaccinated is important but the duration of those antibodies is a little unknown and we know, in general, that the mRNA vaccines have wavering antibodies. That's the reason we're giving boosters."
According to infectious disease expert Amesh A. Adalja, MD, a senior at the Johns Hopkins Center for Health Security, pregnant people should think of themselves as "higher risk than the average person for complications from COVID." He, too, advises them to get the booster.
Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies in Orlando, Florida, urges pregnant people to consider all the risks, benefits, and alternatives in any medical situation—and that includes the decision to get a booster shot. In her opinion, that decision-making process offers up an answer that clearly points to getting the vaccine as well. "We're not seeing a whole lot of risks from the vaccine, but we do see a lot from getting COVID-19 and dying," Dr. Greves tells Health. "It just makes sense to get a booster during pregnancy given that there is data to support that immunity goes down after six months"—which, again, is the entire reason behind booster doses to begin with.
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That waning immunity is why Michael Cackovic, MD, a maternal-fetal medicine physician at the Ohio State University Wexner Medical Center, also recommends COVID-19 booster doses for pregnant people. "The bottom line is that, physiologically, your antibody response will wane," he tells Health. "Since most people got their vaccine in March and April of last year, we're not beyond that point that shows there is typically waning immunity. This it the time to get it." That's especially true, he says, due to the Delta variant, which is still present in the US.
The bottom line: If you are pregnant, you can rest assured that the overwhelming advice from health agencies and physicians alike is to get the COVID-19 booster (or, to urgently get an initial COVID-19 vaccine if you haven't done so already).
If you have any lingering nerves—maybe you experiences some rough side effects after your first series, or you've heard others have had side effects from their booster—remember that it's OK to (and even recommended) to take it easy. Dr. Aagaard recommends having Tylenol handy (it's considered safe during pregnancy) in case you develop a fever, and to drink plenty of fluids. "If you didn't feel well with that second dose in your first series, I would absolutely recommend taking it easy after your booster and maybe taking that day off if you can, just to be safe," Dr. Simon says. But, she points out, "A lot of people who get their booster don't have a reaction, even if they had a reaction during their initial series."
And, as always, talk to your ob-gyn about your decision, along with any hesitations. They should be able to answer any specific concerns you have and offer up personalized advice.
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