The COVID-19 pandemic has highlighted the difficulties that pregnant women face regarding the decision to use medicines, including vaccines.

With recent NHS England figures showing that one in every six of the most critically ill COVID-19 patients is an unvaccinated pregnant woman, the low uptake of COVID-19 vaccinations during pregnancy is extremely concerning.

In winter 2020 when the vaccine first became available, pregnant women were not routinely offered vaccination due to a lack of safety information. Data then began to accumulate showing that pregnant women with COVID-19 infection, particularly those in the third trimester, were at increased risk of adverse pregnancy outcomes (stillbirth and preterm delivery). Guidance was therefore updated to highlight the increased risks from COVID-19 infection and to outline the extensive reassuring evidence of safety of other non-live vaccines such as influenza and whooping cough in pregnancy.  Using this information, official guidance was altered to encourage pregnant women to get the COVID-19 vaccination.

However, anecdotal reports from women and healthcare providers suggest that many pregnant women declined vaccination due to a lack of specific pregnancy safety information, confusion and mistrust due to repeated changes in guidance, and the perception that there may be unknown long-term effects on their baby.

Eighteen months into the pandemic, pregnant women can be offered further reassurance of COVID-19 vaccine safety as much more information has been collected. Data collected by regulatory authorities via their adverse reporting systems have not raised any concerns in 160,000 pregnant women in the US, and 100,000 in the UK, who have received at least one dose of a COVID-19 vaccine. In the peer-reviewed literature, there are 9,000 reported cases from women recruited into research studies, most of whom were vaccinated in the third trimester. No increased risks of adverse birth outcomes have been noted.

Public health messaging relating to medicine use in pregnancy can be confusing, leading to the magnitude of risk being overestimated, while the maternal benefits of treatment are often overlooked. UKTIS has updated the BUMPS patient information leaflet to outline the risks of COVID-19 infection, versus the risks and benefits of the COVID-19 vaccines to help women decide whether to have the vaccination.  If you are a healthcare provider, please encourage women to read the leaflet to help informed decision-making. The patient information leaflet is available here -  bumps - best use of medicine in pregnancy (medicinesinpregnancy.org).

We also have more information about the COVID-19 vaccination for healthcare providers in our UKTIS use of non-live vaccines in pregnancy review.

Pregnant women can help with data collection by creating a myBUMPS record (here) to report all their medicine use in pregnancy.