Pregnancy testing prior to vaccination

UK Health Security Agency (UKHSA – formerly known as PHE) Immunisation Against Infectious Disease (the Green Book) advises that routine questioning about last menstrual period and/or pregnancy testing is not required before offering the vaccine. Women who are pregnant, planning pregnancy or in the immediate postpartum can be vaccinated with a suitable product.

Fertility and pre-conception Covid-19 vaccine advice

The British Fertility Society and Association of Reproductive and Clinical Scientists have produced a document addressing questions asked about COVID-19 vaccines and fertility. This states that there is absolutely no evidence, and no theoretical reason that any of the vaccines can affect the fertility of women or men.

UK Health Security Agency (UKHSA) state that there is no need to avoid getting pregnant after COVID-19 vaccination. They go on to advise that there is no evidence that COVID-19 vaccines have any effect on fertility or the chances of becoming pregnant after vaccination.

Vaccination during pregnancy

Risk

The Green book advises that there is no known risk associated with giving inactivated, recombinant viral or bacterial vaccines or toxoids during pregnancy. Since inactivated vaccines cannot replicate, they cannot cause infection in either the mother or the foetus.

UKTIS provide advice on the use of ‘non-live’ vaccines’ in pregnancy.

A recent UKHSA study has reported a similar very low risk of still birth, prematurity and low birth weight in vaccinated and unvaccinated women.

Recommendations

UKHSA advise pregnancy is considered a clinical risk group. Pregnant women are therefore eligible for the autumn 2022 booster programme.

Vaccine selection

Comirnaty and Spikevax vaccines are the preferred vaccines to offer to pregnant women based on extensive post-marketing experience of their use in the USA with no safety signals so far.

For those under 18 years (regardless of pregnancy status), Comirnaty is preferred.

Clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the limited evidence of safety data for the vaccine in pregnancy.

Further information

The following resources are readily available for further information:

• UKTIS have produced a monograph on the use of non-live vaccines in pregnancy which provides further information.
• The RCOG have developed a range of information resources for healthcare professionals and pregnant women about COVID-19 vaccination.
• Up to date leaflets and posters on vaccination in pregnancy to share with women who are pregnant, planning a pregnancy or breastfeeding are available from the UK Health Security Agency.
• The Royal College of Midwives also has a number of useful resources for maternity staff to support pregnant women to get the vaccine.

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