Primary sources

Primary scientific reports of clinical data on the safety and effectiveness of SARS-CoV-2 vaccines in pregnancy, and in women of childbearing age. In reverse order. Regularly updated. Click here for ripe-tomato.org’s Covid-19 navigation page. Thank you Susan Bewley and Keelin O’Donoghue for getting this started. Click here for “Vaccine in pregnancy news reports“.  We are not providing running totals by vaccine or control group but Viki Male @VikiLovesFACS is doing so here. .

Update 28 November – source 80 added

Source 80 – 24,759 vaccinated women giving birth in UK

Between January and August 2021, 355,299 women gave birth in UK, of whom 24,759 had received at least one dose of COVID-19 vaccine prior to delivery (click here or source). Citation: UK Health Security Agency. COVID-19 vaccine surveillance report – week 47 Published 25 November 2021. Available here https://www.gov.uk/government/publications/covid-19-vaccine-weekly-surveillance-reports Accessed 28 November 2021.

Update 24 November – source 79 added

Source 79 – 92 vaccinated cases from USA

Cord blood IgG in 92, two and six month-old infants, whose mothers were vaccinated in pregnancy, and in 12, six month-old infants after maternal natural infection with SARS-CoV-2 (click here or source). From author affiliations the two large academic medical centers in Boston, were Massachusetts General, and Brigham and Women’s Hospitals, so there may be overlap with studies 15, 25, 68 & 77. Citation: Lydia L. Shook, Caroline G. Atyeo, Lael M. Yonker, Alessio Fasano, Kathryn J. Gray, Galit Alter, Andrea G. Edlow. Durability of anti-Spike antibodies in the infant after maternal COVID-19 vaccination. medRxiv 2021.11.17.21266415; doi: https://doi.org/10.1101/2021.11.17.21266415

Update 18 November – source 78 added

Source 78 – case report from Brazil

A 33-year-old physician, got the 1st dose of the CoronaVac® vaccine on February 23, 2021, at 34 weeks of gestation, and 2nd does on March 15, 2021, when she was at 37 weeks of gestation (click here or source). From author affiliations she was probably cared for in Tubarão. Citation: Menegali BT, Schuelter-Trevisol F, Barbosa AN, Izidoro TM, Feurschuette OHM, Marcon CEM, Trevisol DJ. Vertical transmission of maternal COVID-19 antibodies after CoronaVac vaccine: A case report. Rev Soc Bras Med Trop. 2021 Nov 12;54:e0385. doi: 10.1590/0037-8682-0385-2021. PMID: 34787263.

Update 17 November – sources 76 and 77 added

Source 77 – 158 fully vaccinated pregnant women

This MedRxic preprint reports women vaccinated in all trimesters, and with one of the three main vaccines, Ad26.COV2.S, mRNA-1273 or BNT162b2 (click here or source). Citation: Caroline G. Atyeo, Lydia L. Shook, Sara Brigida, Rose M. De Guzman, Stepan Demidkin, Cordelia Muir, Babatunde Akinwunmi, Arantxa Medina Baez, Erin McSweeney, Madeleine Burns, Ruhi Nayak, Maya K. Kumar, Chinmay D. Patel, Allison Fialkowski, Dana Cvrk, Ilona T. Goldfarb, Lael M. Yonker, Alessio Fasano, Michal A. Elovitz, Kathryn J. Gray, Galit Alter, Andrea G. Edlow. Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms. medRxiv 2021.11.12.21266273; doi: https://doi.org/10.1101/2021.11.12.21266273

Source 76 – 1,273 vaccinated women & their menstrual cycles

This preprint reports a volunteer cohort of women, mostly from UK, who kept a record of their menstrual cycles (click here or source). There were no “strong signals to support the idea that COVID-19 vaccination is linked to menstrual changes”. Citation: Victoria Male. Effect of COVID-19 vaccination on menstrual periods in a retrospectively recruited cohort. medRxiv 2021.11.15.21266317; doi: https://doi.org/10.1101/2021.11.15.21266317

Update 8 November – source 75 added

Source 75 – 125 vaccinated women from Israel

An update of source 39 (click here or source). See also study 857 (click here).Citation: Romina Plitman Mayo, Tal Raz, Bar Ben David, Gila Meir, Haim Barr, Leonardo J. Solmesky, Rony Chen, Ana Idelson, Lucilla Zorzetti, Rinat Gabbay-Benziv, Yuval Jaffe Moshkovich, Tal Biron-Shental, Gil Shechter-Maor, Hen Yitzhak Sela, Itamar Glick, Hedi Benyamini Raischer, Raed Salim, Yariv Yogev, Ofer Beharier, Debra Goldman-Wohl, Ariel Many, Michal Kovo, Simcha Yagel, Michal Neeman. Waning of the Humoral Response to SARS-CoV-2 in Pregnancy is Variant-Dependent. medRxiv 2021.11.03.21265478; doi: https://doi.org/10.1101/2021.11.03.21265478

Update 4 November – sources 73 (HT Asma Khalil) and 74 added.

Source 74 – Six months follow-up of the C4591001 trial

In this report six women (total 12)became pregnant in each group (click here or source). This is three more than reported (total 9) in source 5; presumably further data became available. Citation: S.J. Thomas, E.D. Moreira, Jr., N. Kitchin, J. Absalon, A. Gurtman, S. Lockhart, J.L. Perez, G. Pérez Marc, F.P. Polack, C. Zerbini, R. Bailey, K.A. Swanson, X. Xu, S. Roychoudhury, K. Koury, S. Bouguermouh, W.V. Kalina, D. Cooper, R.W. Frenck, Jr., L.L. Hammitt, Ö. Türeci, H. Nell, A. Schaefer, S. Ünal, Q. Yang, P. Liberator, D.B. Tresnan, S. Mather, P.R. Dormitzer, U. Şahin, W.C. Gruber, and K.U. Jansen, for the C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med 2021;385:1761-73. DOI: 10.1056/NEJMoa2110345

Source 73 – case report from Brazil

A 35-years-old pregnant woman received the first dose of the ChAdOx1 nCov-19 vaccine in late April 2021 (day 0) at 23 weeks gestation. She died from intracerebral haemorrhage 17 days later, with the cause presumed to be VIITT. From author affiliations she was likely treated in the Department of Obstetrics, Universidade Federal do Estado do Rio de Janeiro, and the Neurosurgical Department, Hospital Sao Lucas, Rio de Janeiro(click here or source). The location and timing suggest this is the same case as the post vaccine maternal death in news report 712 (click here). Citation: Mendes-de-Almeida DP, Martins-Gonçalves R, Morato-Santos R, De Carvalho GAC, Martins SA, Palhinha L, Sandim V, Avvad-Portari E, Bozza FA, Monteiro RQ, Bozza PT, Kurtz P. Intracerebral hemorrhage associated with vaccine-induced thrombotic thrombocytopenia following ChAdOx1 nCOVID-19 vaccine in a pregnant woman. Haematologica. 2021 Nov 1;106(11):3025-3028. doi: 10.3324/haematol.2021.279407. PMID: 34261297.

Update 1 November – sources 70 to 72 added

Source 72 – IVF before and after vaccination

36 pre vaccination and 36 post vaccination cycles (click here or source). From Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. Citation: Orvieto R, Noach-Hirsh M, Segev-Zahav A, Haas J, Nahum R, Aizer A. Does mRNA SARS-CoV-2 vaccine influence patients’ performance during IVF-ET cycle? Reprod Biol Endocrinol. 2021 May 13;19(1):69. doi: 10.1186/s12958-021-00757-6. PMID: 33985514; PMCID: PMC8116639.

Source 71 – Embryo transfer after vaccination

No difference in implantation rates in 35 post vaccine transfers, 20 post covid transfers and 88 non-immune transfers (click here or source). From author affiliation treated in Naperville, Illinois. Citation:Morris, Randy S. SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. F&S Reports, Volume 2, Issue 3, 253 – 255

Source 70 – Menstrual disorders post vaccine

The UK Yellow card reporting scheme (click here). For 20 October Moderna update (click here), for Astra Zeneca (click here) and Pfizer click (here). Citation: Medicines & Healthcare products Regulatory Agency. Coronavirus vaccine – weekly summary of Yellow Card reporting Updated 28 October 2021 https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting#annex-1-vaccine-analysis-print Acccessed 1 November 2021

Update 31 October – source 69 added

Source 69 – 12,030 vaccinated pregnant women from Israel

They included 4,588 pregnant women who had had two doses, and 7,442 who had had three doses, of the Pfizer BNT162b2 mRNA COVID-19 vaccine under the care of Clalit Health Services (click here or source). Citation: Noam Barda, Noa Dagan, Cyrille Cohen, Miguel A Hernán, Marc Lipsitch, Isaac S Kohane, Ben Y Reis, Ran D Balicer. Effectiveness of a third dose of the for preventing severe outcomes in Israel: an observational study. Lancet October 29, 2021 https://doi.org/10.1016/S0140-6736(21)02249-2

Update 23 October – sources 66 to 68 added

Source 68 – 84 pregnant, & 31 lactating, vaccinated women

Recruited between December 17, 2020 and February 23 2021, at Massachusetts General or Brigham & Women’s Hospital, Boston, Massachussetts, and enrolled in a COVID-19 pregnancy vaccination biorepository (click here or source). Citation: Atyeo C, DeRiso EA, Davis C, Bordt EA, DeGuzman RM, Shook LL, Yonker LM, Fasano A, Akinwunmi B, Lauffenburger DA, Elovitz MA, Gray KJ, Edlow AG, Alter G. COVID-19 mRNA vaccines drive differential Fc-functional profiles in pregnant, lactating, and non-pregnant women. bioRxiv [Preprint]. 2021 Apr 5:2021.04.04.438404. doi: 10.1101/2021.04.04.438404. PMID: 33851165; PMCID: PMC8043455.

Source 67 – Case control study from Norway

Vaccination rates among women registered between February 15 and August 15, 2021, as having had a miscarriage <14 weeks (case patients) and those with a confirmed ongoing pregnancy in the first trimester (controls) (click here or source). Citation: Magnus MC, Gjessing HK, Eide HN, Wilcox AJ, Fell DB, Håberg SE. Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage. N Engl J Med. 2021 Oct 20. doi: 10.1056/NEJMc2114466. Epub ahead of print. PMID: 34670062.

Source 66 – 121 pregnancies in four vaccine trials

The pregnancies occurred in NCT04324606 and NCT04400838 in the UK, NCT04536051 in Brazil, and
NCT04444674 in South Africa (click here or source). Likely overlap with other trial reports. Citation: Kushalinii Hillson, Sue Costa Clemens, Shabir A Madhi, Merryn Voysey, Andrew J Pollard, Angela M Minassian, the Oxford COVID Vaccine Trial Group. Fertility rates and birth outcomes after ChAdOx1 nCoV-19 (AZD1222) vaccination. Lancet. Published online October 21, 2021 https://doi.org/10.1016/S0140-6736(21)02282-0

Update 18 October – source 65 added

Source 65 – 3 vaccinated pregnant women from Germany

From Jena University Hospital, which has not previously reported cases (click here or source). Participants had prime vaccination with AZD1222 and boost vaccination after 12 weeks with either BNT162b2 or mRNA-1273. Citation: Gloeckner S, Hornung F, Heimann Y, Schleussner E, Deinhardt-Emmer S, Loeffler B, Zoellkau J, Newborns passive humoral SARS-CoV-2 immunity following heterologous vaccination of the mother during pregnancy, American Journal of Obstetrics and Gynecology (2021), doi:
https://doi.org/10.1016/j.ajog.2021.10.006.

Update 14 October – source 64 added. Source 32 updated.

Source 64 – 1,332 vaccinated pregnancies in USA

Among all active pregnancies in the Ochsner Health System between June 15 and August 20, 2021, 1,332 were vaccinated, and 8,760 incompletely or unvaccinated (click here or source). One vaccinated and 58 unvaccinated women had severe or critical covid. aOR 0.10 (0.01–0.49). Citation: Morgan, John A. MD; Biggio, Joseph R. Jr MD, MS; Martin, Jane K. MD; Mussarat, Naiha MD; Chawla, Harsheen K. BSc; Puri, Priya BSc; Williams, Frank B. MD Maternal Outcomes After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Vaccinated Compared With Unvaccinated Pregnant Patients, Obstetrics & Gynecology: October 13, 2021 – Volume – Issue – 10.1097/AOG.0000000000004621 doi: 10.1097/AOG.0000000000004621

Update 26 September – sources 61 to 63 added

Source 63 – 24 postnatal women from Portugal

A convenience sample of 14 lactating and 10 non-lactating women vaccinated with BNT162b2 Pfizer (click here or source). The article implies that the 10 non-lactating women were recently delivered, although this is not explicitly stated. From author affiliations the participants were cared for in unnamed Lisbon hospitals. Citation: Charepe, N., Gonçalves, J., Juliano, A.M. et al. COVID-19 mRNA vaccine and antibody response in lactating women: a prospective cohort study. BMC Pregnancy Childbirth 21, 632 (2021). https://doi.org/10.1186/s12884-021-04051-6

Source 62 – 913 women vaccinated in pregnancy from Israel

Vaccinated with Pfizer-BioNTech COVID-19 (BNT162b2 mRNA), and delivered between January and June 2021 at Soroka University Medical Center (click here or source). Citation: Wainstock T, Yoles I, Sergienko R, Sheiner E. Prenatal maternal COVID-19 vaccination and pregnancy outcomes. Vaccine. 2021 Sep 7;39(41):6037–40. doi: 10.1016/j.vaccine.2021.09.012. Epub ahead of print. PMID: 34531079; PMCID: PMC8421099. [Case control]

Source 61 – 64 vaccinated (& 11 Covid cases) from Israel

Given BNT162B2 mRNA vaccine during pregnancy in, from author affiliations, Sheba Medical Center, Tel-Hashomer, between February and March 2021 (click here or source). Citation: Nir O, Schwartz A, Toussia-Cohen S, Leibovitch L, Strauss T, Asraf K, Doolman R, Sharabi MS, Cohen C, Lustig Y, Regev-Yochay G, Yinon Y. Maternal-Neonatal Transfer of SARS CoV-2 IgG Antibodies among Parturient Women Treated with BNT162b2 mRNA Vaccine during Pregnancy. Am J Obstet Gynecol MFM. 2021 Sep 18:100492. doi: 10.1016/j.ajogmf.2021.100492. Epub ahead of print. PMID: 34547533; PMCID: PMC8451978.

Update 10 September – sources 59 and 60 added. Source 19 updated.

Source 60 – case control study of vaccination rates among miscarrying and ongoing pregnancies in USA

From eight Vaccine Safety Datalink Sites (Kaiser Permanente: Washington, Northwest, Northern California, Southern California, and Colorado; Denver Health; HealthPartners; and Marshfield Clinic, Wisconsin) over seven 4-week surveillance periods from December 15, 2020, through June 28, 2021 (click here or source). Citation: Kharbanda EO, Haapala J, DeSilva M, et al. Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy. JAMA. Published online September 08, 2021. doi:10.1001/jama.2021.15494

Source 59 – 259 vaccinated pregnant women from Israel

This MedRxiv preprint reports vaccinated women admitted for delivery during February to April 2021 at Hadassah Medical Center, Jerusalem (click here or source). It may overlap with source 19. Citation: Amihai Rottenstreich, Gila Zarbiv, Esther Oiknine-Djian, Olesya Vorontsov, Roy Zigron, Geffen Kleinstern, Dana G. Wolf, Shay Porat. Early versus late third trimester maternal SARS-CoV-2 BNT162b2 mRNA immunization maximizes transplacental antibody transfer and neonatal neutralizing antibody levels. medRxiv 2021.08.30.21262875; doi: https://doi.org/10.1101/2021.08.30.21262875

Update 9 September – source 58 updated

Update 8 September – source 67 added

Source 67 – 10,861 vaccinated pregnant women, & controls, from Israel

Data from Clalit Health Services, Tel Aviv (click here or source). Vaccinated between 20 December 2020 and 3 June 2021. Likely overlap with sources 24 and 65. The authors cite source 24, but their ref 16, to “an updated analysis of the same data over a longer period” is a letter reporting subgroups of source 24. Presumably an error. Citation: Dagan, N., Barda, N., Biron-Shental, T. et al. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy. Nat Med (2021). https://doi.org/10.1038/s41591-021-01490-8

Update 2 September – source 66 added

Source 66 – case report from USA

The patient received the first injection of the Moderna mRNA1273 vaccine at 7 weeks gestation, and 13 days later developed acute-onset bruising and petechiae, and immune thrombocytopaenia (click here or study). Following steroid therapy she recovered. Apart from the gestational age, no pregnancy information was reported. From author affiliations she was probably cared for at the Cleveland Clinic, Ohio. Citation: Bennett C, Chambers LM, Son J, Goje O. Newly diagnosed immune thrombocytopenia in a pregnant patient after coronavirus disease 2019 vaccination. J Obstet Gynaecol Res. 2021 Aug 22. doi: 10.1111/jog.14978. Epub ahead of print. PMID: 34420249.

Update 27 August – source 65 added

Source 65 – 6,082 vaccinated pregnant women from Israel

Cared for by Clalit Health and vaccinated with the BNT162b2 vaccine between December 20, 2020 and May 24, 2021 (click here or source). Likely overlap with patients reported in source 24. Citation: Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, Hernán MA, Lipsitch M, Kohane I, Netzer D, Reis BY, Balicer RD. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. N Engl J Med. 2021 Aug 25. doi: 10.1056/NEJMoa2110475. Epub ahead of print. PMID: 34432976..

Update 22 August – source 64 added

Source 64 – 39,985 vaccinated pregnant women in Canada

Update of source 53 (click here or source). Citation: COVID-19 Vaccination During Pregnancy in Ontario, Report #2: Covering December 14, 2020 to June 30, 2021 https://www.bornontario.ca/en/whats-happening/resources/Documents/BORN-COVID-19-Vaccination-During-Pregnancy-in-Ontario-Report-2—FINAL.pdf Accessed 22 August.

Update 19 August – source 63 added

Source 63 – 424 vaccinated pregnant women from USA

They all received an mRNA vaccine at New York University Langone Health prior to April 22, 2021 (click here or source). This centre has not reported vaccination data before, but the cases likely overlap with sources 26, 58 and 62. Citation: Megan E. Trostle MD , Meghana A. Limaye MD , Ms. Valeryia Avtushka, Jennifer L. Lighter MD , Christina A. Penfield MD MPH , Ashley S. Roman MD MPH , COVID-19 vaccination in pregnancy: early experience from a single institution, American Journal of Obstetrics & Gynecology MFM (2021), doi: https://doi.org/10.1016/j.ajogmf.2021.100464

Update 18 August – source 62 added

Source 62 – 17,525 pregnant, lactating or planning pregnancy people vaccinated.

Recruited to the University of Washington COVID-19 Vaccine in Pregnancy and Lactation Registry using chain-referral and snowball sampling (click here or source). 10, 790 got Pfizer-BioNTech BNT162b2 and 6,592 Moderna mRNA-1273. The authors admit likely overlap with Source 26. Citation: Kachikis A, Englund JA, Singleton M, Covelli I, Drake AL, Eckert LO. Short-term Reactions Among Pregnant and Lactating Individuals in the First Wave of the COVID-19 Vaccine Rollout. JAMA Netw Open. 2021;4(8):e2121310. doi:10.1001/jamanetworkopen.2021.21310

Update 16 August – source 61 added

Source 61 – nine pregnancies in Pfizer-BioNTech’s April FDA vaccine extension application

Among 2,260 participants aged 12-15 years, in the ongoing Study C4591001 randomised trial, nine pregnancies (3 BNT162b2, 6 placebo) were reported in Pfizer’s FDA application to extend emergency authorisation to this age group (click here or source). See p32. Citation: Pfizer-BioNTech COVID-19 Vaccine EUA Amendment Review Memorandum. April 9, 2021. https://www.fda.gov/media/148542/download. Accessed 16 August 2021

Update 14 August – sources 59 and 60 added

Source 60 – Two vaccinated women in Italy

Two healthcare workers had BNT162b2 mRNA vaccination during pregnancy at Fondazione IRCCS Policlinico San Matteo, Pavia (click here or source). Listed also as Study 788 here. Citation: Cassaniti I, Percivalle E, Zelini P, Nanhorngue KN, Parolo A, Bernardi V, Jorizzo G, Santer P, Perotti F, Spinillo A, Lilleri D, Baldanti F. Both SARS-CoV-2 infection and vaccination in pregnancy elicited neutralizing antibodies in pregnant women and newborns. Clin Microbiol Infect. 2021 Aug 6:S1198-743X(21)00442-0. doi: 10.1016/j.cmi.2021.08.004. Epub ahead of print. PMID: 34371204; PMCID: PMC8349424.

Source 59 – 50 vaccinated lactating women from USA

This MedXRiv preprint reports of 50 vaccinated lactating women selected from the COVID-19 Vaccine in Pregnancy and Lactation (COVIPAL) cohort study from December 2020 to June 2021 (click here or source). Two already had Covid. of the rest 27 women had the BNT162b2 vaccine and 21 mRNA-1237. The cohort comprises volunteers planning to deliver at University of California San Francisco Medical Center. Citation: Golan Y, Prahl M, Cassidy AG, Gay C, Wu AHB, Jigmeddagva U, Lin CY, Gonzalez VJ, Basilio E, Warrier L, Buarpung S, Li L, Asiodu IV, Ahituv N, Flaherman VJ, Gaw SL. COVID-19 mRNA Vaccination in Lactation: Assessment of adverse effects and transfer of anti-SARS-CoV2 antibodies from mother to child. medRxiv [Preprint]. 2021 Aug 3:2021.03.09.21253241. doi: 10.1101/2021.03.09.21253241. PMID: 34373861; PMCID: PMC8351783.

Update 13 August – sources 57 & 58 (HT Viki Male) added

Source 58 – 2,456 vaccinated pregnant people from the US

This ResearchSquare preprint reports 2,456 pregnant persons who received an mRNA COVID-19 vaccine preconception or prior to 20 weeks’ gestation, and enrolled in the v-safe COVID-19 Vaccine Pregnancy Registry 2020-21 (click here or source). This is a follow-up of women enrolled in the v-safe registry, and previously reported in source 26. Citation: Lauren Head Zauche, Bailey Wallace, Ashley N. Smoots, Christine K. Olson, Titilope Oduyebo, Shin Y. Kim, Emily E. Peterson, Jun Ju, Jennifer Beauregard, Allen J. Wilcox, Charles E. Rose, Dana Meaney-Delman, Sascha R. Ellington. Receipt of mRNA COVID-19 vaccines preconception and during pregnancy and risk of self-reported spontaneous abortions, CDC v-safe COVID-19 Vaccine Pregnancy Registry 2020-21. ResearchSquare preprint. https://doi.org/10.21203/rs.3.rs-798175/v1 Update 9 Sept. Peer reviewed citation: Zauche LH et al. Receipt of mRNA Covid-19 Vaccines and Risk of Spontaneous Abortion (letter). New Engl J Med. September 8, 2021 DOI: 10.1056/NEJMc2113891

Source 57 – 141 women vaccinated in pregnancy in UK

Of 1,328 pregnant women who gave birth at St George’s University Hospital, London, between 1 March and 4 July 2021, 141 had received at least one dose of vaccine (click here or source). There were no adverse effects. Citation: Blakeway H, Prasad S, Kalafat E, Heath PT, Ladhani SN, Le Doare K, Magee LA, O’brien P, Rezvani A, Dadelszen Pv, Khalil A, COVID-19 Vaccination During Pregnancy: Coverage and Safety, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.08.007.

Update 12 August – source 56 added

Source 56 – no pregnancies in the UK series of VITT

Among 230 (170 definite, 50 probable) cases of vaccine-induced immune thrombocytopenia and thrombosis (VITT) following the Astra Zeneca, ChAdOx1 nCoV-19 vaccine, 119 were female, but none were reported to be pregnant (click here or source). Citation: Sue Pavord, Marie Scully, Beverley J. Hunt, William Lester, Catherine Bagot, Brian Craven, Alex Rampotas, Gareth Ambler, Mike Makris. Clinical Features of Vaccine-Induced Immune Thrombocytopenia and Thrombosis. New Engl J Med. August 11, 2021 DOI: 10.1056/NEJMoa2109908

Update 8 August – source 55 added

Source 55- Case report of Pfizer-BioNTech vaccine from US

A 33-year-old doctor had the BNT162b2 SARS-CoV-2 vaccine at 29 & 32 weeks’ gestation, and delivered a healthy male infant with antibodies (click here or source). From author affiliations cared for at Jefferson Obstetrics and Gynecology, Charlottesville, Virginia. Citation: Mehaffey JH, Arnold M, Huffstetler E, Mehaffey RL, Quillian H, Mehaffey JH. Successful vertical transmission of SARS-CoV-2 antibodies after maternal vaccination. Birth. 2021 Aug 6. doi: 10.1111/birt.12582. Epub ahead of print. PMID: 34355820.

Update 2 August – source 54 added

Source 54 – Case of Cononavac in pregnancy from Turkey

A pregnant woman was vaccinated with Coronavac (Sinovac Life Science Co, Ltd, Beijing, China) at 28 and 32 weeks, and gave birth normally (click here or source). She was cared for at Memorial Bahçelievler Hospital, İstanbul. The authors claim this is the first case of antibody detection in cord blood after this vaccine. Citation: Soysal A, Bilazer C, Gönüllü E, Barın E, Çivilibal M. Cord blood antibody following maternal SARS-CoV-2 inactive vaccine (CoronaVac) administration during the pregnancy. Hum Vaccin Immunother. 2021 Jul 30:1-3. doi: 10.1080/21645515.2021.1947099. Epub ahead of print. PMID: 34325615.

Update 15 July – source 53 added. HT @DanielaDrandic

Source 53 – 30,892 vaccinated pregnant women in Canada

From Ontario (click here or source). “Cumulative incidence rates of pregnancy and birth outcomes among vaccinated individuals do not suggest any pattern of increased risk in these preliminary data.” Citation: COVID-19 Vaccination During Pregnancy in Ontario, Report #1: December 14, 2020 to May 31, 2021. https://www.bornontario.ca/en/whats-happening/resources/Documents/COVID-19-Vaccination-During-Pregnancy-in-Ontario-Report-1—FINAL.pdf Accessed 15 July.

Update 14 July – source 52 added

Source 52 – 3,698 vaccinated pregnant women in Scotland

3,698 pregnant women had been vaccinated in Scotland up to 31 May 2021 (click here or source). No outcome data but the following statement appears (p 31). “To date (13 July 2021), Public Health Scotland has not been notified of any serious pregnancy related adverse events following COVID-19 vaccination in pregnancy.” Citation: Public Health Scotland. COVID-19 Statistical Report As at 12 July 2021. Publication date: 14 July 2021. https://publichealthscotland.scot/media/8433/21-07-14-covid19-publication_report.pdf Accessed 14 July 2021

Update 13 July – source 51 added

Source 51 – 15,060 vaccinated pregnant women in Israel

In this cohort study pregnant women who received the Pfizer-BioNTech BNT162b2 mRNA vaccine had an adjusted hazard ratio for incident SARS-CoV-2 infection of 0.22 (95% CI, 0.11-0.43) compared with matched unvaccinated controls (click here or source). There were no severe adverse vaccine reactions. Data from Maccabi Healthcare Services, one of four heath funds in Israel, so no overlap with source 24 from a different fund. Possible overlap with sources 19, 39 and 49. Citation: Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. Published online July 12, 2021. doi:10.1001/jama.2021.11035 Important

Update 9 July – source 50 added

Source 50 – 3 pregnant women in Turkish CoronaVac trial

Two were in the intervention group and one in the control, in this phase 3 trial of the CoronaVac, inactivated whole-virion SARS-CoV-2 vaccine, (Sinovac Life Sciences, Beijing, China) (click here or source). Citation: Mine Durusu Tanriover, Hamdi Levent Doğanay, Murat Akova, et al., and the CoronaVac Study Group. Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey. Lancet. July 8, 2021. https://doi.org/10.1016/S0140-6736(21)01429-X

Update 7 July – sources 48 and 49 added

Source 49 – 539 vaccinated pregnant women and controls from Israel

539 pregnant women who had 2-doses of BNT162b2 vaccine between January-February 2021, and an age-matched unvaccinated control group (click here or source). The vaccinated women were recruited via social media. Citation: Bookstein Peretz S, Regev N, Novick L, Nachshol M, Goffer E, Ben-David A, Asraf K, Doolman R, Sapir E, Regev Yochay G, Yinon Y. Short-term outcome of pregnant women vaccinated by BNT162b2 mRNA COVID-19 vaccine. Ultrasound Obstet Gynecol. 2021 Jul 1. doi: 10.1002/uog.23729. Epub ahead of print. PMID: 34198360.

Source 48 – 16 vaccinated pregnant women from Poland

150 women had been vaccinated in pregnancy with BNT162b2 mRNA vaccine, and clinical details and cord serology are reported on 16 of them (click here or source). The pregnant women were all also medical doctors, and they gave birth at the Provincial Specialist Hospital in Olsztyn. Citation: Zdanowski W, Waśniewski T. Evaluation of SARS-CoV-2 Spike Protein Antibody Titers in Cord Blood after COVID-19 Vaccination during Pregnancy in Polish Healthcare Workers: Preliminary Results. Vaccines (Basel). 2021 Jun 19;9(6):675. doi: 10.3390/vaccines9060675. PMID: 34205434; PMCID: PMC8234119.

Update 1 July – source 47 added

Source 47 – one pregnant woman in Novavax trial

She was in the placebo group (click here or source) Citation: Heath PT, Galiza EP, Baxter DN, Boffito M, Browne D, Burns F, Chadwick DR, Clark R, Cosgrove C, Galloway J, Goodman AL, Heer A, Higham A, Iyengar S, Jamal A, Jeanes C, Kalra PA, Kyriakidou C, McAuley DF, Meyrick A, Minassian AM, Minton J, Moore P, Munsoor I, Nicholls H, Osanlou O, Packham J, Pretswell CH, San Francisco Ramos A, Saralaya D, Sheridan RP, Smith R, Soiza RL, Swift PA, Thomson EC, Turner J, Viljoen ME, Albert G, Cho I, Dubovsky F, Glenn G, Rivers J, Robertson A, Smith K, Toback S; 2019nCoV-302 Study Group. Safety and Efficacy of NVX-CoV2373 Covid-19 Vaccine. N Engl J Med. 2021 Jun 30. doi: 10.1056/NEJMoa2107659. Epub ahead of print. PMID: 34192426.

Update 26 June – source 46 added

Source 46 – 22,197 women vaccinated in pregnancy in USA

They amount to 16.3% of 135,968 pregnant women identified via CDC’s Vaccine Safety Datalink between December 14, 2020 and May 8, 2021 (click here or source). No pregnancy outcome data reported. Citation: Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, Kenigsberg TA, Lamias MJ, Irving SA, Kauffman TL, Vesco KK, Daley MF, DeSilva M, Donahue J, Getahun D, Glenn S, Hambidge SJ, Jackson L, Lipkind HS, Nelson J, Zerbo O, Oduyebo T, Singleton JA, Patel SA. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy – Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021. MMWR Morb Mortal Wkly Rep. 2021 Jun 18;70(24):895-899. doi: 10.15585/mmwr.mm7024e2. PMID: 34138834.

Update 25 June – source 45 added

Source 45 – Post vaccination thromboses in the small pelvic veins; case report

A 50-year-old woman with a pulmonary embolus, and presumed vaccine-induced immune thrombotic thrombocytopenia, had multiple thromboses in the smaller veins of the pelvis (click here or source plus more pictures in the appendices here). She was not pregnant, and recovered. Citation: Guetl K, Gary T, Raggam RB, Schmid J, Wölfler A, Brodmann M. SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia treated with immunoglobulin and argatroban. Lancet. 2021 Jun 11;397(10293):e19. doi: 10.1016/S0140-6736(21)01238-1. Epub ahead of print. PMID: 34126043; PMCID: PMC8195494.

Update 14 June – sources 43 and 44 added

Source 44 – 38 vaccinated pregnant health-care workers

Twenty got Pfizer-BioNTech, and 18 Moderna (click here or source). Pregnancy-related events (gestational hypertension (1), threatened labor (1), miscarriage (1), premature delivery (1) from the Pfizer-BioNTech group and none from the Moderna group. Self-reported via SurveyMonkey. Citation: Kalyan Kadali RA, Janagama R, Peruru SR, Racherla S, Tirumala R, Madathala RR, Gajula V, Adverse effects of COVID-19 mRNA vaccines among pregnant women: A cross-sectional study on healthcare workers with detailed self-reported symptoms, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.06.007.

Source 43 – Case report from Italy

A 42-year-old pregnant healthcare worker received the Comirnaty (Pfizer/BioNTech) mRNA vaccination at 31 and 34 weeks (click here or source). Cord blood antibodies were present. The hospital is not named but the authors came from Firenze, Italy. Citation: Riviello C, Pontello V. Maternal and neonatal SARS-CoV-2 antibodies assessment after mRNA maternal vaccination in the third trimester of pregnancy. Int J Gynaecol Obstet. 2021 Jun 11. doi: 10.1002/ijgo.13783. Epub ahead of print. PMID: 34115887.

Update 8 June – sources 40 to 42 added

Source 42 – 14 lactating women from Portugal

All vaccinated with Pfizer BNT162b2 mRNA (click here or source). From Centro Hospitalar Universitário Lisboa Central. Citation: Juliana Gonçalves, A. Margarida Juliano, Nádia Charepe, Marta Alenquer, Diogo Athayde, Filipe Ferreira, Margarida Archer, Maria João Amorim, Fátima Serrano, Helena Soares. Non-neutralizing secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon BNT162b2 vaccination. medRxiv 2021.05.03.21256416; doi: https://doi.org/10.1101/2021.05.03.21256416

Source 41 – 6 lactating women from USA

Five vaccinated with BNT162b2 (Pfizer) and one with mRNA-1273 (Moderna) (click here or source). From University of California, San Francisco. Citation: Yarden Golan, Mary Prahl, Arianna Cassidy, Christine Y. Lin, Nadav Ahituv, Valerie J. Flaherman, Stephanie L. Gaw. COVID-19 mRNA vaccine is not detected in human milk. medRxiv 2021.03.05.21252998; doi: https://doi.org/10.1101/2021.03.05.21252998

Source 40 – 122 vaccinated women from USA

Eighty five had Pfizer-BioNTech, & 37 Moderna (click here or source). From Weill Cornell Medicine, New York. Citation: Malavika Prabhu, Elisabeth A. Murphy, Ashley C. Sukhu, Jim Yee, Sunidhi Singh, Dorothy Eng, Zhen Zhao, Laura E. Riley, Yawei J. Yang. Antibody response to SARS-CoV-2 mRNA vaccines in pregnant women and their neonates. bioRxiv 2021.04.05.438524; doi: https://doi.org/10.1101/2021.04.05.438524

Update 7 June – source 39 added

Source 39 – 86 vaccinated pregnant women from Israel

From eight Israeli hospitals (click here or source). Compared with 65 pregnant women who had had Covid – see study 714. Citation: Beharier O, Plitman Mayo R, Raz T, Nahum Sacks K, Schreiber L, Suissa-Cohen Y, Chen R, Gomez-Tolub R, Hadar E, Gabbay-Benziv R, Jaffe Moshkovich Y, Biron-Shental T, Shechter-Maor G, Farladansky-Gershnabel S, Yitzhak Sela H, Benyamini-Raischer H, Sela ND, Goldman-Wohl D, Shulman Z, Many A, Barr H, Yagel S, Neeman M, Kovo M. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest. 2021 May 20:150319. doi: 10.1172/JCI150319. Epub ahead of print. PMID: 34014840.

Update 6 June – source 38 added

Source 38 – 47 vaccinated women undergoing IVF in Israel

Forty seven women underwent IVF and ICSI, both before and after BNT162b2 COVID-19 vaccination (click here or source). There were no major differences between the pre- and post-vaccination cycles. They were cared for at the Hadassah Hebrew-University Medical Center in Jerusalem. Citation: Myriam Safrai, Amihai Rottenstreich, Shmuel Herzberg, Tal Imbar, Benjamin Reubinoff, Assaf Ben-Meir. Stopping the misinformation: BNT162b2 COVID-19 vaccine has no negative effect on women’s fertility. medRxiv 2021.05.30.21258079; doi: https://doi.org/10.1101/2021.05.30.21258079

Update 3 June – sources 36 and 37 added

Source 37 – four pregnant & four breast-feeding women vaccinated

These authors report a convenience sample (overweight on health workers) of women who responded to an online survey in January 2021 (click here or source). 87/656 (13%) of non-pregnant, 4/216 (1.9%) of pregnant, and 4/122 (3.3%) of breast-feeding respondents had been vaccinated. Citation: Desmond Sutton, Mary D’Alton, Yijia Zhang, Ka Kahe, Ana Cepin, Dena Goffman, Anna Staniczenko, Hope Yates, Anna Burgansky, Jaclyn Coletta, Zev Williams, Cynthia Gyamfi-Bannerman, COVID-19 Vaccine Acceptance Among Pregnant, Breastfeeding and Non-pregnant Reproductive Aged Women, American Journal of Obstetrics & Gynecology MFM (2021), doi: https://doi.org/10.1016/j.ajogmf.2021.100403

Source 36 – interim report of S African Ad26.COV2.S vaccine study

This interim report (click here or source) of adverse thromboembolic events in the ongoing Sisonke study of the Ad26.COV2.S (Janssen) vaccine (NCT04838795) includes a a 38-year-old woman who had given birth to twins nine months before vaccination and presented with features of transient ischemic attack 8 days post vaccination. Citation: Simbarashe Takuva,Azwidhwi Takalani, Nigel Garrett, Ameena Goga, Jonny Peter, Vernon Louw, Jessica Opie, Barry Jacobson, Ian Sanne, Linda Gail‑Bekker, Glenda Gray. Thromboembolic Events in the South African Ad26.COV2.S Vaccine Study. NEJM. June 2, 2021 DOI: 10.1056/NEJMc2107920

Update 29 May – source 35 added

Source 35 – two pregnant and five breast-feeding women

The authors for this MedRxiv preprint report 15 women (two pregnant, five breast feeding) who received at least one dose of the BNT162B2 vaccine (click here or source). None of them showed any cross reactivity to human syncytin-1. Nor was any mRNA detected in breast milk. Citation: Citra NZ Mattar, Winston Koh, Yiqi Seow, Shawn Hoon, Aparna Venkatesh, Pradip Dashraath, Li Min Lim, Judith Ong, Rachel Lee, Nuryanti Johana, Julie SL Yeo, David Chong, Lay-Kok Tan, Jerry Chan, Mahesh Choolani, Paul Anantharajah Tambyah. Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination. medRxiv 2021.05.23.21257686; doi: https://doi.org/10.1101/2021.05.23.21257686

Update 27 May – source 34 added

Source 34 – Ten pregnant women in Chinese vaccine (WIV04 and HB02) trial

In this interim analysis of a randomised trial (40,382 participants), conducted in six centres in the Middle East, of two SARS-Cov-2 vaccines (WIV04 and HB02) 5 pregnant women received the first dose of the WIV04 vaccine, 2 the HBO2 vaccine, and 3 placebo (click here or source). No pregnancy outcomes are reported. The vaccines were developed by the Wuhan Institute of Biological Products Co, Ltd, and the Beijing Institute of Biological Products Co, Ltd, both of which belong to the China National Biotec Group Company Limited. The trial centres were Sheikh Khalifa Medical City in Abu Dhabi and the Al Qarain Health Center in Sharjah, both in the United Arab Emirates (UAE); the Salmanyia Medical Complex in Bahrain; Vacsera Medical Center and Katameya Medical Center in Egypt; and Prince Hamza Hospital in Jordan. Citation: Al Kaabi N, Zhang Y, Xia S, et al. Effect of 2 Inactivated SARS-CoV-2 Vaccines on Symptomatic COVID-19 Infection in Adults: A Randomized Clinical Trial. JAMA. Published online May 26, 2021. doi:10.1001/jama.2021.8565

Update 26 May – source 33 added

Source 33 – no pregnancies among three cases of Astra Zeneca VITT

There were no pregnant women among three cases (two women of childbearing age) of ischemic stroke associated with vaccine-induced immune thrombotic thrombocytopaenia (VITT) after the Astra Zeneca ChAdOx1 nCoV-19 vaccine (click here or source). See also Source 27. These case are probably not included in Source 27. Citation: Al-Mayhani T, Saber S, Stubbs MJ, et alIschaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopaeniaJournal of Neurology, Neurosurgery & Psychiatry Published Online First: 25 May 2021. doi: 10.1136/jnnp-2021-326984

Update 24 May – source 32 added

Source 32 – Birth outcomes for 140 women vaccinated in pregnancy

MedRxiv preprint. Cases collected by the Mayo clinic (click here or source). Citation: Regan N. Theiler, Myra Wick, Ramila Mehta, Amy Weaver, Abinash Virk, Melanie Swift. Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy. medRxiv 2021.05.17.21257337; doi: https://doi.org/10.1101/2021.05.17.21257337. 14 October update. Peer reviewed publication (click here or source). Citation: Theiler RN, Wick M, Mehta R, Weaver AL, Virk A, Swift M. Pregnancy and birth outcomes after SARS-CoV-2 vaccination in pregnancy [published online ahead of print, 2021 Aug 20]. Am J Obstet Gynecol MFM. 2021;3(6):100467. doi:10.1016/j.ajogmf.2021.100467

Update 15 May – sources 30 and 31 added

Source 31 – USA. 84 vaccinated pregnant women and controls

From author affiliations identified through Feinberg School of Medicine, and the Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois (click here or source). Citation: Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Pregnancy: Measures of Immunity and Placental Histopathology. Obstet Gynecol. 2021 May 11. doi: 10.1097/AOG.0000000000004457. Epub ahead of print. PMID: 33975329.

Source 30 – USA. 30 pregnant and 16 lactating vaccinated women

Identified through the Beth Israel Deaconess Medical Center, Boston, Massachusetts (click here or source). Citation: Collier AY, McMahan K, Yu J, Tostanoski LH, Aguayo R, Ansel J, Chandrashekar A, Patel S, Apraku Bondzie E, Sellers D, Barrett J, Sanborn O, Wan H, Chang A, Anioke T, Nkolola J, Bradshaw C, Jacob-Dolan C, Feldman J, Gebre M, Borducchi EN, Liu J, Schmidt AG, Suscovich T, Linde C, Alter G, Hacker MR, Barouch DH. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. 2021 May 13. doi: 10.1001/jama.2021.7563. Epub ahead of print. PMID: 33983379.

Update 6 May – source 29 added

Source 29 – five pregnancies in Novavax vaccine trial in South Africa

Two women became pregnant after their first dose in the vaccine arm and three in the control, in this trial of the Novavax NVX-CoV2373 vaccine (click here or source). Citation: Shinde V, Bhikha S, Hoosain Z, Archary M, Bhorat Q, Fairlie L, Lalloo U, Masilela MSL, Moodley D, Hanley S, Fouche L, Louw C, Tameris M, Singh N, Goga A, Dheda K, Grobbelaar C, Kruger G, Carrim-Ganey N, Baillie V, de Oliveira T, Lombard Koen A, Lombaard JJ, Mngqibisa R, Bhorat AE, Benadé G, Lalloo N, Pitsi A, Vollgraaff PL, Luabeya A, Esmail A, Petrick FG, Oommen-Jose A, Foulkes S, Ahmed K, Thombrayil A, Fries L, Cloney-Clark S, Zhu M, Bennett C, Albert G, Faust E, Plested JS, Robertson A, Neal S, Cho I, Glenn GM, Dubovsky F, Madhi SA; 2019nCoV-501 Study Group. Efficacy of NVX-CoV2373 Covid-19 Vaccine against the B.1.351 Variant. N Engl J Med. 2021 May 5. doi: 10.1056/NEJMoa2103055. Epub ahead of print. PMID: 33951374.

Update 5 May – source 28 added

Source 28 – 10 vaccinated & lactating women from Singapore

This MedRxiv preprint reports ten women who had received the Biontech BNT162b2 vaccine while lactating (click here or source). Citation: Jia Ming Low, Yue Gu, Melissa Shu Feng Ng, Zubair Amin, Le Ye Lee, Yvonne Peng Mei Ng, Bhuvaneshwari D/O Shunmuganathan, Yuxi Niu, Rashi Gupta, Paul Anantharajah Tambyah, Paul A MacAry, Liang Wei Wang, Youjia Zhong BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA medRxiv 2021.04.27.21256151; doi: https://doi.org/10.1101/2021.04.27.21256151

Update 2 May – source 27 added

Source 27 – no pregnancies among 21 women with thrombotic thrombocytopenia after Oxford/AZ or Janssen/J&J vaccines

Of 11 cases (including nine women age 22-49) of thrombotic thrombocytopenia after the Oxford/Astra Zeneca ChAdOx1 nCov-19 vaccine, none were currently or recently pregnant (click here or source). Citation: Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021 Apr 9. doi: 10.1056/NEJMoa2104840. Epub ahead of print. PMID: 33835769. Of 12 cases (all women under age 60) following the Janssen/Johnson & Johnson Ad26.COV2.S vaccine, none were currently or recently pregnant (click here or source). Citation: See I, Su JR, Lale A, et al. US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021. JAMA. Published online April 30, 2021. doi:10.1001/jama.2021.7517

Update 22 April – source 26 added

Source 26 – 35,691 vaccinated pregnant people from USA

The first peer reviewed publication with pregnancy outcome data from the v-safe and VAERS vaccine surveillance systems (click here or source). Citation: Tom T. Shimabukuro, Shin Y. Kim, Tanya R. Myers, Pedro L. Moro, Titilope Oduyebo, Lakshmi Panagiotakopoulos, Paige L. Marquez, Christine K. Olson, Ruiling Liu, Karen T. Chang, Sascha R. Ellington, Veronica K. Burkel, Ashley N. Smoots, Caitlin J. Green, Charles Licata, Bicheng C. Zhang, Meghna limchandani, Adamma Mba-Jonas, Stacey W. Martin, Julianne M. Gee, Dana M. Meaney-Delman, for the CDC v-safe COVID-19 Pregnancy Registry Team. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. New Engl J Med April 21, 2021 DOI: 10.1056/NEJMoa2104983 Important

Update 18 April – source 25 added

Source 25 – 131 reproductive-age vaccine recipients from USA

Further immunological studies from the same 84 pregnant, 31 lactating, and 16 non-pregnant women who received either the Pfizer/BioNTech or Moderna mRNA vaccines reported in source 15 (click here or source). Citation: Atyeo C, DeRiso EA, Davis C, Bordt EA, DeGuzman RM, Shook LL, Yonker LM, Fasano A, Akinwunmi B, Lauffenburger DA, Elovitz MA, Gray KJ, Edlow AG, Alter G. COVID-19 mRNA vaccines drive differential Fc-functional profiles in pregnant, lactating, and non-pregnant women. bioRxiv [Preprint]. 2021 Apr 5:2021.04.04.438404. doi: 10.1101/2021.04.04.438404. PMID: 33851165; PMCID: PMC8043455.

Update 16 April – source 24 added

Source 24 – 1,508 vaccinated pregnant women from Israel

There were 1,508 vaccinated pregnant women in this real world study of 596,618 people who received the BNT162b2 mRNA vaccine between December 20, 2020, and to February 1, 2021, and an equal number of matched unvaccinated controls (click here or study). Data from Clalit Health Services, insurer of about half the Israeli population. Citation: Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz MA, Hernán MA, Lipsitch M, Reis B, Balicer RD. BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N Engl J Med. 2021 Apr 15;384(15):1412-1423. doi: 10.1056/NEJMoa2101765. Epub 2021 Feb 24. PMID: 33626250; PMCID: PMC7944975.

Update 15 April – sources 22 and 23 added

Source 23 – Follicular function in nine vaccinated women from Israel

The authors of this MedRxiv preprint report follicular function in nine women vaccinated with the BNT162b2 mRNA vaccine (click here or source). They were cared for at Hadassah-Hebrew University Medical Center, in Jerusalem. Citation: Yaakov Bentov, Ofer Beharier, Arbel Moav-Zafrir, Maor Kabessa, Miri Godin, Caryn S. Greenfield, Mali Ketzinel-Gilad, Efrat Esh Broder, Hananel E. G. Holzer, Dana Wolf, Esther Oiknine-Djian, Iyad Barghouti, Debra Goldman-Wohl, Simcha Yagel, Asnat Walfisch, Anat Hersko Klement Ovarian follicular function is not altered by SARS-Cov-2 infection or BNT162b2 mRNA Covid-19 vaccination. medRxiv 2021.04.09.21255195; doi: https://doi.org/10.1101/2021.04.09.21255195

Source 22 – Twenty two vaccinated & breast-feeding women from USA

The authors of this MedRxiv preprint report SARS-CoV-2 IgA and IgG levels in the milk of 22 lactating women who had received the SARS-CoV-2 mRNA vaccine (Pfizer/BioNtech or Moderna) (click here or source). They were cared for at Shands Hospital, in Florida. Citation: Vivian Valcarce, Lauren S. Stafford, Josef Neu, Nicole Cacho, Leslie Parker, Martina Mueller, David J Burchfield, Nan Li, Joseph Larkin III Detection of SARS-CoV-2 specific IgA in the human milk of COVID-19 vaccinated, lactating health care workers medRxiv 2021.04.02.21254642; doi: https://doi.org/10.1101/2021.04.02.21254642

Update 14 April – source 15 updated

Update 13 April – source 22 added

Source 22 – 84 vaccinated breast feeding women from Israel

Women who had received 2 doses of the Pfizer-BioNTech vaccine and were breastfeeding (click here or source). There were no serious adverse events, and antibodies were detected in breast milk. Citation: Perl SH, Uzan-Yulzari A, Klainer H, et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. Published online April 12, 2021. doi:10.1001/jama.2021.5782

Update 7 April – source 7 update.

Update 6 April– source 21 added

Source 21 – 69,337 women in v-safe were pregnant. 3,953 in v-safe vaccine register

As of March 29th, 69,337 v-safe participants indicated they were pregnant at the time they received COVID-19 vaccination. 3,953 women have also been enrolled in the v-safe COVID-19 Vaccine Pregnancy Registry. Click here for details. The data up to February 16 (published 1 March) (click here or source) includes 30,494 pregnancies (16,039 Pfizer/Biontech and 14,455 Moderna). Adverse events include 29 miscarriages and one stillbirth.

Update 2 April source 20 added

Source 20 – 27 vaccinated women from USA

Twenty seven vaccinated women who delivered at Prentice Women’s Hospital in Chicago, (January-March 2021) (click here or source). 25/28 (one set of twins) infants had positive cord IgG. The exact vaccine is not reported but the authors note that at the time Pfizer/BioNTech and Moderna/NIH were available. Citation: MITHAL LB, OTERO S, SHANES ED, GOLDSTEIN JA, MILLER ES, Cord Blood Antibodies following Maternal COVID-19 Vaccination During Pregnancy, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.03.035.

Update 17 March – source 19 added

Source 19 – 20 vaccinated women from Israel

This MedRxiv preprint reports 20 pregnant women who received two doses of the Pfizer/BioNTech vaccine in late pregnancy in February 2021 (click here or 2021.03.11.21253352v1.full). All women efficiently transferred antibodies to the fetus. They were cared for at Hadassah Medical Center in Jerusalem. Citation: Amihai Rottenstreich, Gila Zarbiv, Esther Oiknine-Djian, Roy Zigron, Dana G. Wolf, Shay Porat. Efficient maternofetal transplacental transfer of anti- SARS-CoV-2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination medRxiv 2021.03.11.21253352; doi: https://doi.org/10.1101/2021.03.11.21253352 Update 10 September. Peer reviewed citation: Rottenstreich A, Zarbiv G, Oiknine-Djian E, Zigron R, Wolf DG, Porat S. Efficient maternofetal transplacental transfer of anti- SARS-CoV-2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Clin Infect Dis. 2021 Apr 3:ciab266. doi: 10.1093/cid/ciab266. Epub ahead of print. PMID: 33822014; PMCID: PMC8083549.

Update 10 March – sources 15 to 18 added

Source 18 – 6 postnatal vaccinated women in USA

The MedRxiv preprint describes six lactating women who received both doses of the Pfizer-BioNTech or Moderna vaccine between December 2020 and January 2021 (click here or 2021.02.23.21252328v1.full). They all developed IgA and IgG antibodies in breast milk within seven says. They were cared for at Providence Portland Medical Center, Oregon. Citation: Jill K. Baird, Shawn M. Jensen, Walter J. Urba, Bernard A. Fox, Jason R. Baird SARS-CoV-2 antibodies detected in human breast milk post-vaccination. medRxiv 2021.02.23.21252328; doi: https://doi.org/10.1101/2021.02.23.21252328

Source 17 – case report of 3rd trimester vaccination from USA

A 34-year-old woman received the Pfizer-BioNTech, mRNA vaccine at 32 weeks (click here or 13224_2021_Article_1436). The birth was uncomplicated and the baby had cord blood antibodies. The hospital is unnamed, but the authors were from University of Minnesota, Minneapolis. This is the first peer reviewed report of vaccination in pregnancy. Citation: Gill L, Jones CW. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies in Neonatal Cord Blood After Vaccination in Pregnancy. Obstet Gynecol. 2021 Mar 8. doi: 10.1097/AOG.0000000000004367. Epub ahead of print. PMID: 33684922.

Source 16 – 10 nursing mothers vaccinated in Israel

This MedRxiv preprint describes ten nursing mothers who received the Pfizer-BioNTech mRNA vaccine (click here or 2021.03.06.21252603v1.full). Clinical details and exact vaccine timings in supplementary table 1 (click here or media-1) From author affiliations the women were probably cared for at Lis Maternity & Women’s Hospital, Tel Aviv. Citation: Michal Rosenberg Friedman, Aya Kigel, Yael Bahar, Yariv Yogev, Yael Dror, Ronit lubetzky, Ariel Many, Yariv Wine BNT162b2 COVID-19 mRNA vaccine elicits a rapid and synchronized antibody response in blood and milk of breastfeeding women medRxiv 2021.03.06.21252603; doi: https://doi.org/10.1101/2021.03.06.21252603

Source 15 – 131 reproductive-age vaccine recipients from USA

This MedRxiv preprint includes 84 pregnant, 31 lactating, and 16 non-pregnant women who received either the Pfizer/BioNTech or Moderna mRNA vaccines (click here or 2021.03.07.21253094v1.full). From author affiliations the hospitals were probably Massachusetts General Hospital, and Brigham and Women’s Hospital, both in Boston, Massachussetts. Citation: Kathryn J Gray, Evan A Bordt, Caroline Atyeo, Elizabeth Deriso, Babatunde Akinwunmi, Nicola Young, Aranxta Medina Baez, Lydia L Shook, Dana Cvrk, Kaitlyn James, Rose De Guzman, Sara Brigida, Khady Diouf, Ilona Goldfarb, Lisa M Bebell, Lael M Yonker, Alessio Fasano, Sayed A Rabi, Michal A Elovitz, Galit Alter, Andrea G Edlow COVID-19 vaccine response in pregnant and lactating women: a cohort study medRxiv 2021.03.07.21253094; doi: https://doi.org/10.1101/2021.03.07.21253094 Update 14 March. For peer reviewed publication (click here or source). Citation: Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, Medina Baez A, Shook LL, Cvrk D, James K, De Guzman R, Brigida S, Diouf K, Goldfarb I, Bebell LM, Yonker LM, Fasano A, Rabi SA, Elovitz MA, Alter G, Edlow AG, COVID-19 vaccine response in pregnant and lactating women: a cohort study, American Journal of Obstetrics and Gynecology (2021), doi: https://doi.org/10.1016/j.ajog.2021.03.023.

Update 6 March – sources 13 and 14 added. (We do not plan to update these unless the links change).

Source 14 – UK Yellow card reports for COVID-19 vaccine AstraZeneca

Available here. The latest (25 Feb) report (click here or COVID-19_AstraZeneca_Vaccine_Analysis_Print) included 1 vaccine exposure before pregnancy, 30 during pregnancy and 9 postnatal (p 23). The adverse events included 4 spontaneous abortions, 1 or 2 preterm births, and ten cases of morning sickness (p 41). This was out of 42,917 reports, of 157,637 reactions, of which 244 were fatal. Readers should note that “Conclusions on the safety and risks of the vaccines cannot be made on the data shown in the Print alone” and “The overall safety experience with both vaccines is so far as expected from the clinical trials.”  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/966183/COVID-19_AstraZeneca_Vaccine_Analysis_Print.pdf Accessed 6 March (Not updated unless links change)

Source 13 – UK Yellow Card reports for COVID-19 mRNA Pfizer- BioNTech vaccine

Available here. The latest (4th March) report (click here or COVID-19_mRNA_Pfizer-_BioNTech_Vaccine_Analysis_Print__2_) included 1 vaccine exposure before pregnancy, 37 during pregnancy and 9 postnatal (p 24). The adverse events included 16 spontaneous abortions, 2 or 3 preterm births, and four cases of morning sickness (p 42). This was out of 29,715 reports, of 85,179 reactions, of which 212 were fatal. Readers should note that “Conclusions on the safety and risks of the vaccines cannot be made on the data shown in the Print alone” and “The overall safety experience with both vaccines is so far as expected from the clinical trials.” https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/966631/COVID-19_mRNA_Pfizer-_BioNTech_Vaccine_Analysis_Print__2_.pdf Accessed 6 March. (Not updated unless links change)

Update 28 Feb – sources 11 and 12 added

Source 12 – Janssen register trial of Ad26.COV2.S in pregnancy

Janssen have registered an RCT of the vaccine Ad26.COV2.S in pregnant women (click here). Planned sample size 824. Anticipated primary completion date January 16, 2023

Source 11 – Pfizer/BioNTech register trial of BNT162b2 in pregnancy

Pfizer/BioNTech have registered an RCT of the vaccine BNT162b2 in pregnant women (click here). Planned sample size 4,000. Estimated primary completion date January 8, 2023

Update 24 Feb – source 10 added

Source 10 – Janssen Ad26.COV2.S Vaccine FDA briefing document

See p 52 for pregnancy data (click here or VRBPAC-02.26.21-Meeting-Briefing-Document-FDA). “Eight pregnancies were reported through January 22, 2021 (4 vaccine, 4 placebo). In 7 participants (3 vaccine, 4 placebo) vaccination was within 30 days after LMP, and in 1 vaccine recipient vaccination was prior to LMP. Unsolicited AEs related to pregnancy include spontaneous abortion (1 vaccine, 0 placebo), incomplete abortion (0 vaccine, 1 placebo), elective abortion (0 vaccine, 2 placebo) and ectopic pregnancy (1 vaccine, 0 placebo). Among participants in the vaccine group, two pregnancies are ongoing with outcomes unknown at this time.” Note: Janssen is a subsidiary of Johnson & Johnson, and the Ad26.COV2.S vaccine is usually referred to in the press as the “Johnson & Johnson vaccine”. Citation: Vaccines and Related Biological Products Advisory Committee Meeting. February 26, 2021. FDA Briefing Document. Janssen Ad26.COV2.S Vaccine for the Prevention of COVID-19. Accessed 24 Feb 2021 https://www.fda.gov/media/146217/download

Update 21 Feb – Source 9 added – special HT Keelin O’Donogue. One out of 31,000 vaccinations!

Source 9 – one pregnant woman tested positive following vaccination

This preprint reports 31,069 people who received at least one dose of a COVID-19 vaccine via the Mayo Clinic health system, in Arizona, Florida, Minnesota, or Wisconsin, between December 1^st 2020 and February 8^th 2021. Of the 263 who subsequently received a positive PCR test, one (0.4%) was pregnant (table 3) (click here or Pawlowski pre print). In a propensity matched cohort of 2,630 unvaccinated individuals who also tested positive, seven (0.3%) were pregnant. Citation: Colin Pawlowski, Patrick Lenehan, Arjun Puranik, Vineet Agarwal, AJ Venkatakrishnan, Michiel J.M. Niesen, John C. O’Horo, Andrew D. Badley, John Halamka, Venky Soundararajan. FDA-authorized COVID-19 vaccines are effective per real-world evidence synthesized across a multi-state health system. medRxiv 2021.02.15.21251623; doi: https://doi.org/10.1101/2021.02.15.21251623&nbsp;

Update 20 Feb – Source 8 added

Source 8 – 15,131 post vaccine pregnancies reported to V-safe

Up to 20 January 8,633 pregnancies related to, or following, the Pfizer-BioNTech vaccine and 6,498 after the Moderna vaccine had been self-reported to the CDC using the V-safe vaccine tracker (click here or 06-COVID-Shimabukuro). Over the same period nearly 22m people had received at least one vaccine dose, and 2M had registered with the V-safe vaccine tracker.  As of January 22nd, 227 pregnancies had also been enrolled in the V-safe pregnancy registry. Citation: Advisory Committee on Immunization Practices (ACIP): COVID-19 vaccine Safety update—January 2021 (slide deck)

Update 6 Feb – source 7 added

Source 7 – IgG in cord blood post SARS-CoV-2 vaccine

This Medxiv preprint reports detection of anti-SARS-CoV-2 IgG in a baby whose mother had received the Moderna mRNA COVID-19 vaccine three weeks prior to birth (click here or 2021.02.03.21250579v1.full). The baby was healthy, with normal newborn nursery course and subsequent well-infant evaluation. The hospital is unnamed but the authors were affiliated with Charles E. Schmidt College of Medicine, Boca Raton, Florida. Citation: Paul D Gilbert, Chad A Rudnick. Newborn antibodies to SARS-CoV-2 detected in cord blood after maternal vaccination. medRxiv 2021.02.03.21250579; doi: https://doi.org/10.1101/2021.02.03.21250579 Update 7 April. Peer reviewed paper published in BMC Pediatrics (click here or source). Citation: Paul G, Chad R. Newborn antibodies to SARS-CoV-2 detected in cord blood after maternal vaccination – a case report. BMC Pediatr. 2021 Mar 22;21(1):138. doi: 10.1186/s12887-021-02618-y. PMID: 33752624; PMCID: PMC7982334.

Update 25 Jan – source 6 added

Source 6 – Astra Zeneca/Oxford. Safety & Efficacy report, Lancet

The supplementary appendix of the interim safety and efficacy report of four trials of the Astra Zeneca/Oxford (ChAdOx1 nCoV-19) vaccine reports one spontaneous abortion in the intervention group and one in the control group. For main paper (click here or PIIS0140673620326611) appendix (here or mmc1). These cases are presumably included in Source 3. Citation: Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, Angus B, Baillie VL, Barnabas SL, Bhorat QE, Bibi S, Briner C, Cicconi P, Collins AM, Colin-Jones R, Cutland CL, Darton TC, Dheda K, Duncan CJA, Emary KRW, Ewer KJ, Fairlie L, Faust SN, Feng S, Ferreira DM, Finn A, Goodman AL, Green CM, Green CA, Heath PT, Hill C, Hill H, Hirsch I, Hodgson SHC, Izu A, Jackson S, Jenkin D, Joe CCD, Kerridge S, Koen A, Kwatra G, Lazarus R, Lawrie AM, Lelliott A, Libri V, Lillie PJ, Mallory R, Mendes AVA, Milan EP, Minassian AM, McGregor A, Morrison H, Mujadidi YF, Nana A, O’Reilly PJ, Padayachee SD, Pittella A, Plested E, Pollock KM, Ramasamy MN, Rhead S, Schwarzbold AV, Singh N, Smith A, Song R, Snape MD, Sprinz E, Sutherland RK, Tarrant R, Thomson EC, Török ME, Toshner M, Turner DPJ, Vekemans J, Villafana TL, Watson MEE, Williams CJ, Douglas AD, Hill AVS, Lambe T, Gilbert SC, Pollard AJ; Oxford COVID Vaccine Trial Group. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021 Jan 9;397(10269):99-111. doi: 10.1016/S0140-6736(20)32661-1. Epub 2020 Dec 8. Erratum in: Lancet. 2021 Jan 9;397(10269):98. PMID: 33306989; PMCID: PMC7723445.

Update 18 Jan – source 5 added

Source 5 – BioNTech/Pfizer. Safety and Efficacy report, NEJM

The Safety and Efficacy report of the phase 2/3 placebo controlled trial of the BioNTech/Pfizer (BNT162b2 mRNA) Covid-19 Vaccine (click here or nejmoa2034577) includes four pregnancies in the vaccine group and five in controls. These will overlap with those in studies 1 and 4.  Citation; Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Jansen KU, Gruber WC; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec 31;383(27):2603-2615. doi: 10.1056/NEJMoa2034577. Epub 2020 Dec 10. PMID: 33301246; PMCID: PMC7745181.

Update 15 Jan – source 4 added

Source 4 – Comirnarty. EMA asessment report

See p 109 for pregnancy data (click here or comirnaty-epar-public-assessment-report_en). Comirnarty is the EU name for the BioNTech/Pfizer vaccine. The data therefore likely overlap with Source 1. Citation: European Medicines Agency. 21 December 2020. EMA/707383/2020. Committee for Medicinal Products for Human Use (CHMP). Assessment report. Comirnaty. Common name: COVID-19 mRNA vaccine (nucleoside-modified) Procedure No. EMEA/H/C/005735/0000. Accessed 14 January 2021. https://www.ema.europa.eu/en/documents/assessment-report/comirnaty-epar-public-assessment-report_en.pdf&nbsp;

Update 14 Jan – Sources 1-3 added

Source 3 – Astra Zeneca/Oxford. MHRA public assessment report

See p 48 onward for pregnancy data (click here or UKPAR_COVID_19_Vaccine_AstraZeneca_05.01.2021). Citation: Medicines and Healthcare products Regulatory Agency. Public Assessment Report. Authorisation for Temporary Supply. COVID-19 Vaccine AstraZeneca, solution for injection in multidose container COVID-19 Vaccine (ChAdOx1-S [recombinant]). Department of Health and Social Care (DHSC) AstraZeneca AB. Accessed January 14 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/949772/UKPAR_COVID_19_Vaccine_AstraZeneca_05.01.2021.pdf&nbsp;

Source 2 – Moderna. FDA briefing document

See p 44 onward for pregnancy data (click here or VRBPAC-12.17.20-Meeting-Briefing-Document-FDA_0). Citation: U.S. Food and Drug Administration. Vaccines and Related
Biological Products Advisory Committee meeting—December 17, 2020—FDA briefing document—Moderna COVID-19 vaccine. Accessed January 14, 2021. https://www.fda.gov/media/144434/download

Source 1 – BioNTech/Pfizer. FDA briefing document

See p 42 onwards for pregnancy data (click here or VRBPAC-12.10.20-Meeting-Briefing-Document-FDA). Citation: U.S. Food and Drug Administration. Vaccines and Related Biological Products Advisory Committee Meeting, December 10, 2020. FDA Briefing Document. Pfizer-BioNTech COVID-19 Vaccine. Accessed January 14 2021. https://www.fda.gov/media/144245/download&nbsp;

Jim Thornton