Who May Be Affected

Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor table showing uptake by groups (age, gender, race, ethnicity, political affiliation).

Fertility, Pregnancy, and Lactation

• CDC recommends COVID-19 vaccination for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
• ACOG and many other organizations have issued the statement: “As the leading organizations representing experts in maternal care and public health professionals that advocate and educate about vaccination, we strongly urge all pregnant individuals—along with recently pregnant, planning to become pregnant, lactating and other eligible individuals—to be vaccinated against COVID-19.”
  • Risk of severe COVID-19 infection is higher for pregnant and recently pregnant people:
    • Pregnant and recently pregnant people are more likely to experience ICU admission, invasive ventilation, and death compared with non-pregnant people.
    • COVID-19 infection is associated with pregnancy complications (e.g. pre-eclampsia, coagulopathy, sepsis) and adverse pregnancy outcomes (e.g. preterm birth, stillbirth).
  • COVID-19 infections are increasing among pregnant people:
    • The Delta variant is highly contagious, but the current vaccination rate among pregnant people is low.
    • Clinicians caring for pregnant people have seen an increase in the number of pregnant people with COVID-19 cases in July and August 2021.
  • Studies show COVID-19 vaccines are safe:
    • Analysis from the v-safe pregnancy registry did not find an increased risk for miscarriage among people who recently received an mRNA COVID-19 vaccine before 20 weeks of pregnancy. Previous findings from 3 safety monitoring systems did not find any safety concerns for pregnant people who were vaccinated late in pregnancy, or their babies. Baseline miscarriage rates are 11-16%. The risk of miscarriage in women vaccinated prior to 20 weeks gestation was 13% — within this range.
    • No safety concerns have been observed in animal developmental and reproductive toxicity studies of COVID-19 vaccines.
    • No adverse pregnancy-related outcomes were observed in clinical trials using the same vaccine platform as the J&J/Janssen COVID-19 vaccine.
    • Vaccination during pregnancy builds antibodies that might protect the baby.
  • Summaries of COVID-19 vaccine recommendations, studies, and data:
    • CDC:
      • While Pregnant or Breastfeeding
      • For People Who Would Like to Have a Baby
    • ACOG Key Information and Recommendations
    • SMFM COVID-19 Vaccines If You Are Pregnant or Breastfeeding (pdf)
    • Mother-to-Baby COVID-19 Vaccine Fact Sheet
    • AAP COVID-19 Vaccine Recommendations
• Mother-to-Baby: Confidential, no-cost, English and Spanish. Experts are available to answer questions by phone or chat Monday–Friday 8am–5pm (local time). To reach MotherToBaby, call 1-866-626-6847, chat live or email.

Applying Principles of Diversity, Equity, and Inclusion (DEI)

• The healthcare workforce reflects the diversity of the country as a whole. In terms of vaccine uptake, consider:
  • Certain healthcare personnel are at higher risk for COVID-19 infection, potentially with less support for vaccination:
    • Kaiser Family Foundation (KFF):
      • COVID-19 Vaccine Monitor table showing uptake by groups (age, gender, race, ethnicity, political affiliation)
      • Concerns and barriers by stakeholder group
    • Lower wage workers within healthcare delivery systems may have higher rates of COVID-19 infection due to their inability to work remotely, the need take public transportation to work, and exposures in households, high-risk communities, and the workplace.
    • Post-vaccine side effects may require HCP to call out from work.
    • Consider ways to support workers who will face challenges covering shifts, hourly wages, and childcare. KFF provides a brief on concerns over access among people of color (April 21, 2021).
    • Stanford Polarization and Social Change Lab:
      • PNAS: Elite Party Cues Increase Vaccination Intentions among Republicans (pdf)
      • 5 Experimental Tests of the Effects of Short Messages on Compliance with COVID-19 Public Health Guidelines (pdf)
• IDSA provides the following DEI principles, which may be used to guide development of policies for vaccination as a CoE:
  • Cultivate a welcoming environment where differences are embraced, valued, and respected.
  • Ensure that processes, policies, and practices foster fairness, belonging, equity, and reflect the views and values of the organization.
  • Guarantee transparency to promote fair treatment and access to opportunities for all members within all levels of the organization.

Last updated August 30, 2021