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Medications and More during pregnancy and breastfeeding

​​COVID-19 Vaccines, mRNA (Moderna and Pfizer-BioNTech)​

Selected References: 

  • American Academy of Pediatrics. 2021. Breastfeeding during the COVID-19 pandemic. Available at URL: https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Breastfeeding-During-COVID-19.aspx  
  • Academy of Breastfeeding Medicine. 2020. ABM Statement: Considerations for COVID-19 vaccination in lactation. Available at URL: https://abm.memberclicks.net/abm-statement-considerations-for-covid-19-vaccination-in-lactation 
  • American College of Obstetricians and Gynecologists. 2023. COVID-19 vaccination considerations for obstetric-gynecologic care. Available at URL: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care 
  • American Society for Reproductive Medicine. 2022. Patient management and clinical recommendations during the coronavirus (COVID-19) pandemic. Available at URL: https://www.asrm.org/news-and-publications/covid-19/statements/patient-management-and-clinical-recommendations-during-the-coronavirus-covid-19-pandemic  
  • Avraham S, et al. 2022. COVID-19 vaccination and fertility treatment outcomes. Fertility and Sterility 117(6):1291-1299.  
  • Baird JK, et al. 2021. SARS-CoV-2 Antibodies Detected in Mother’s Milk Post-Vaccination. J Hum Lact. 37(3):492-498.  Beharier O, et al. 2021. Efficient maternal to neonatal transfer of SARS-CoV-2 and BNT162b2 antibodies. J Clin Invest 131(13):e150319
  • Bertrand K, et al. 2021. Maternal and child outcomes reported by breastfeeding women following mRNA COVID-19 vaccination. Breastfeeding Medicine 16(9).  
  • Bookstein Peretz S, et al. 2021. Short-term outcome of pregnant women vaccinated by BNT162b2 mRNA COVID-19 vaccine. Ultrasound in Obstetrics & Gynecology 58(3):450-456.  
  • Carlsen EØ, et al. 2022. Association of COVID-19 vaccination during pregnancy with incidence of SARS-CoV-2 infection in infants. JAMA Intern Med. DOI: https://doi.org/10.1001/jamainternmed.2022.2442  
  • Ciapponi A, et al. 2023. Safety of COVID-19 vaccines during pregnancy: A systematic review and meta-analysis. Vaccine. 41(25): 3688–700.  
  • Ciapponi A, et al. 2024. Safety and Effectiveness of COVID-19 Vaccines During Pregnancy: A Living Systematic Review and Meta-analysis. Drug safety. 47(10): 991–1010.  
  • Dong Y, et al. 2024. Comprehensive evaluation of inactivated SARS-CoV-2 vaccination on sperm parameters and sex hormones. Frontiers in immunology. 15: 1321406.  
  • Edele Santos D, et al. 2023. Effects of COVID-19 or vaccines for SARS-COV-2 on sperm parameters: A systematic review and meta-analysis. Journal of reproductive immunology, 160, 104140.  
  • Edelman A, et al. 2022. Association between menstrual cycle length and Coronavirus Disease 2019 (COVID-19) vaccination: a U.S. cohort. Obstet Gynecol Apr, 1;139(4):481-489. 
  • Esteve-Palau E, et al. 2021. Quantification of specific antibodies against SARS-CoV-2 in breast milk of lactating women vaccinated with an mRNA vaccine. JAMA Netw Open. 4(8):e2120575.  
  • Favre G, et al. 2025. Neurodevelopmental outcomes of infants after in utero exposure to SARS-CoV-2 or mRNA-COVID-19 vaccine compared with unexposed infants: a COVI-PREG prospective cohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 31(2). 266–73.  
  • Fell DB, et al. 2022. Association of COVID-19 vaccination in pregnancy with adverse peripartum outcomes. JAMA 327(15):1478–87.  
  • Gonzalez D, et al. 2021. Sperm parameters before and after COVID-19 mRNA vaccination. JAMA 326(3):273–274. 
  • Gray KJ, et al. 2021. COVID-19 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol Mar 24:S0002-9378(21)00187-3.   
  • Golan Y, et al. 2021. Evaluation of messenger RNA from COVID-19 BTN162b2 and mRNA-1273 vaccines in human milk. JAMA Pediatr 175(10):1069-71.   
  • Goldshtein I, et al. 2022. Association of BNT162b2 COVID-19 vaccination during pregnancy with neonatal and early infant outcomes. JAMA Pediatr 176(5):470-77.  
  • Halasa NB, et al. 2022. Effectiveness of maternal vaccination with mRNA COVID-19 vaccine during pregnancy against COVID-19–associated hospitalization in infants aged <6 months — 17 states, July 2021–January 2022. MMWR Morb Mortal Wkly Rep. 71:264–70. 
  • Hamouda NI, et al. 2024. Persistence of COVID-19 Human Milk Antibodies After Maternal COVID-19 Vaccination: Systematic Review and Meta-Regression Analysis. Cureus. 16(5): e59500.  
  • Hanna N, et al. 2023. Biodistribution of mRNA COVID-19 vaccines in human breast milk. EBioMedicine. 96: 104800.  
  • Hariton E, et al. 2023. The effect of the coronavirus disease 2019 vaccine and infection on menstrual cycle length: an analysis of 12 months of continuous menstrual cycle data from 5,314 participants. Fertility and sterility. 120(2): 387–88.  
  • Jorgensen SCJ, et al. & Canadian Immunization Research Network (CIRN) Provincial Collaborative Network (PCN) Investigators. 2024. Association between maternal mRNA covid-19 vaccination in early pregnancy and major congenital anomalies in offspring: population based cohort study with sibling matched analysis. BMJ medicine. 3(1): e000743.  
  • Jorgensen SCJ, et al. 2023. Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy. JAMA pediatrics. 177(12): 1314–23.  
  • Kharbanda EO, et al. 2021. Spontaneous abortion following COVID-19 vaccination during pregnancy. JAMA 326(16):1629-31.  
  • Kharbanda EO, et al. 2023. COVID-19 Booster Vaccination in Early Pregnancy and Surveillance for Spontaneous Abortion. JAMA network open. 6(5): e2314350. 
  • Kharbanda EO, et al. 2024. COVID-19 Vaccination in the First Trimester and Major Structural Birth Defects Among Live Births. JAMA pediatrics. 178(8): 823–29. 
  • Kigel A, et al. 2023. Maternal Immunization During the Second Trimester with BNT162b2 mRNA Vaccine Induces a Robust IgA Response in Human Milk: A Prospective Cohort Study. The American journal of clinical nutrition. 118(3): 572–78.  
  • Kim K, et al. 2025. Maternal Exposures to COVID-19 Vaccine and Adverse Birth Outcomes: National Population Study in Korea. Journal of Korean medical science. 40(17): e63.  
  • Lipkind HS, et al. 2022. Receipt of COVID-19 vaccine during pregnancy and preterm or small-for-gestational-age at birth — Eight integrated health care organizations, United States, December 15, 2020–July 22, 2021. MMWR Morb Mortal Wkly Rep 71:26–30. 
  • Lipschuetz M, et al. 2023. Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization. Nat Med. 10.1038/s41591-023-02270-2.  
  • Low JM, et al. 2021. Codominant IgG and IgA expression with minimal vaccine mRNA in milk of BNT162b2 vaccines. npj Vaccines 202;6:105. 
  • Magnus MC, et al. 2022. Association of SARS-CoV-2 vaccination during pregnancy with pregnancy outcomes. JAMA 327(15):1469-1477.  
  • McLaurin-Jiang S, et al. 2021. Maternal and child symptoms following COVID-19 vaccination among breastfeeding mothers. Breastfeeding Medicine 16(9).  
  • Morgan JA, et al. 2022. Maternal outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in vaccinated compared with unvaccinated pregnant patients. Obstet Gynecol 139:107-109.  
  • Morris RS. 2021. SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. F&S Reports 2(3):253-255.  
  • Nicolaidou V, et al. 2023. Detection of SARS-CoV-2-Specific Antibodies in Human Breast Milk and Their Neutralizing Capacity after COVID-19 Vaccination: A Systematic Review. International journal of molecular sciences. 24(3): 2957.  
  • Norman M, et al. 2024. Neonatal Outcomes After COVID-19 Vaccination in Pregnancy. JAMA, 331(5), 396–407.  
  • Otero S, et al. 2022. Maternal antibody response and transplacental transfer following SARS-CoV-2 infection or vaccination in pregnancy. Pre-print online March 20, 2022. DOI: https://doi.org/10.1101/2022.03.17.22272574.  
  • Perez SE, et al. 2022. Human milk SARS-CoV-2 antibodies up to 6 months after vaccination. Pediatrics 148(2): e2021054260. 
  • Perl SH, et al. 2021. SARS-CoV-2–specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women. JAMA 325(19):2013-14.   
  • Piekos SN, et al. 2023. Effect of COVID-19 vaccination and booster on maternal-fetal outcomes: a retrospective cohort study. The Lancet. Digital health. 5(9): e594–e606.  
  • Rosenberg-Friedman M, et al. 2021. BNT162b2 mRNA vaccine elicited antibody response in blood and milk of breastfeeding women. Nat Commun. 12(1):6222. 
  • Rottenstreich M, et al. 2023. Covid-19 third vaccination during pregnancy: maternal and neonatal outcomes-a retrospective study. Archives of gynecology and obstetrics. 308(4): 1197–1205.  
  • Rowe SL, et al. 2025. COVID-19 Vaccination During Pregnancy and Major Structural Birth Defects. Pediatrics. 155(4): e2024069778. https://doi.org/10.1101/2021.05.30.21258079.  
  • Safrai M, et al. 2022. The BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters. Reproductive BioMedicine 44(4):685-88.  
  • Sajadi MM, et al. 2023. Maternal transfer of IgA and IgG SARS-CoV-2 specific antibodies transplacentally and via breast milk feeding. PloS one. 18(4): e0284020.  
  • Santimano AJ, et al. 2024. Efficacy and Clinical Outcomes of mRNA COVID-19 Vaccine in Pregnancy: A Systematic Review and Meta-Analysis. Intervirology. 67(1): 40–54. 
  • Shimabukuro TT, et al. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med 384:2273-82.  
  • Shook LL, et al. 2022. Durability of anti-spike antibodies in infants after maternal COVID-19 vaccination or natural infection. JAMA 327(11):1087-89.  
  • Suseeladevi AK, et al. 2024. COVID-19 vaccination and birth outcomes of 186,990 women vaccinated before pregnancy: an England-wide cohort study. The Lancet regional health. Europe, 45: 101025.  
  • Takeshita T, et al. 2025. Does COVID-19 infection or COVID-19 mRNA vaccination induce antiphospholipid antibodies in women with recurrent pregnancy loss?. Journal of reproductive immunology. 168:104442.  
  • Tavares Veras Florentino P, et al. 2023. Safety of BNT162b2 and CoronaVac during pregnancy on birth outcomes and neonatal mortality: a cohort study from Brazil. International journal of epidemiology. 52(6): 1708–15.  
  • Temocin F, et al. 2024. Investigation of Anti-SARS-CoV-2-specific IgG Levels in Breast Milk after Vaccination or COVID-19 Infection. American journal of perinatology. 41: e3085–90.  
  • Vesco KK, et al. 2024. Obstetric Complications and Birth Outcomes After Antenatal Coronavirus Disease 2019 (COVID-19) Vaccination. Obstetrics and gynecology. 143(6): 794–802.  
  • Ware J, et al. 2023. Sustained and Boosted Antibody Responses in Breast Milk After Maternal SARS-CoV-2 Vaccination. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 18(8: 612–20.  
  • Zambrano LD, et al. 2020. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1641–47. 
  • Zauche LH, et al. 2021. Receipt of mRNA COVID-19 vaccines and risk of spontaneous abortion. N Engl J Med 385:1533-153. 

 

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