COVID vaccines and pregnancy: informed decision-making for women

For women who are pregnant, lactating or trying to become pregnant, deciding whether to take the COVID vaccine when eligible can be a tough decision. UAB experts offer guidance.

Editor's Note: The information published in this story is accurate at the time of publication. Always refer to for UAB's current guidelines and recommendations relating to COVID-19.

The decision to get vaccinated before, during or after pregnancy can be difficult for many, explained Warner Huh, M.D., chair of the University of Alabama at Birmingham Department of Obstetrics and Gynecology, but its key that women know and have access to options.

During peak child-bearing years, women are already weighing many decisions: When should my partner and I try to get pregnant? Is my pregnancy going according to plan? Is my baby growing and safe? Should I breastfeed my baby?

The COVID-19 pandemic has added a new dimension of worry and decisions for these women, especially with the development and administration of the long-awaited COVID vaccines from providers like Pfizer and Moderna.

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The decision to get vaccinated before, during or after pregnancy can be difficult for many, explains Warner Huh, M.D., chair of the University of Alabama at Birmingham Department of Obstetrics and Gynecology.  

“This is the ultimate form of what we called ‘shared decision-making’ between a woman, her partner and her provider,” Huh explained. “The real challenge is that there is a lot we do and a lot we do not yet know about the COVID-19 vaccines and their efficacy and safety on pregnancy. However, overall, we know and are confident that vaccines are a critical form of disease prevention, and it is our job to help a woman make an informed decision regarding a prevention strategy that is best for her and her fetus.”


Huh stresses that, while pregnant women were not included in clinical trials for the vaccines, there are consistent and profound recommendations from professional health organizations such as the Centers for Disease Control and Prevention, Society for Maternal Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society for Reproductive Medicine stating that eligible pregnant and lactating women should be offered the vaccine, which speaks tremendous volumes about the opinions of providers on how the vaccines can help prevent serious illness from the COVID-19 virus in these women. 

“We have learned a lot about the impact on COVID during pregnancy in this past year, and we know that, when compared to their non-COVID counterparts, the risk of being hospitalized in an intensive care unit, on a ventilator or having serious adverse outcomes from the virus is higher for pregnant women than their non-pregnant counterparts. We are worried about the fetus as well,” Huh said. “When you look at the risk/benefit ratio between getting the vaccine or not, most providers are recommending getting the vaccine, because we do think the benefits for mother and baby outweigh the risks.”


Jessica Grayson, M.D., assistant professor in the UAB Department of Otolaryngology, received her first Pfizer vaccine dose at 21 weeks gestation. She explains her decision making process for getting the COVID vaccine while pregnant.

It’s OK to not get the vaccine

Huh further explains that, for the pregnant woman unsure of what to do, it is OK to not get the vaccine if a woman feels that there is a safe way to mitigate her risk of getting COVID, which would include proper masking, social distancing, hand washing and more.

“If you think after talking to your provider that that’s the best strategy for you, that’s OK – we want our patients to be comfortable with that strategy. But we also want them to know that, if asked, many providers who deliver obstetrical care will recommend the vaccine,” Huh said.

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Jodie Dionne-Odom, M.D., MPH, assistant professor of infectious diseases in UAB’s School of Medicine and associate director of Global Health in the UAB Center for Women’s Reproductive Health, adds further context about vaccinations in pregnancy that are already considered standard.

“Routinely recommended vaccinations in pregnancy can have benefits for women and their infants, since maternal antibodies can provide protection to their newborn that can last for months. Studies are underway to assess short- and long-term benefits, as well as potential risks, of COVID-19 vaccination in pregnancy,” Dionne-Odom said.

While women in this population may get conflicting advice from friends, family, and external sources like media and social media, both Huh and Dionne-Odom stress talking with a trusted health care provider about the options.

“Decision-making in pregnancy involves weighing the potential risks and benefits of vaccination against the potential risks of infection itself,” Dionne-Odom said. “Women who are pregnant, or may become so, are encouraged to discuss these concerns with a trusted health care provider.