Updates in COVID-19 vaccinations: safety concerns, bivalent vaccines and more

Key takeaways:

• No safety concerns with COVID-19 vaccines during pregnancy and lactation.
• Bivalent vaccine uptake recommended along with possible delays if there is a history of SARS-CoV-2 infection.

BALTIMORE — COVID-19 vaccinations are safe and recommended, even for women who are pregnant or lactating, according to a presenter at a late-breaking session at the ACOG Annual Clinical & Scientific Meeting.

Since July 2021, ACOG has recommended that all eligible people aged 6 months and older, including pregnant and lactating women, receive a COVID-19 vaccine or series. Studies continue to demonstrate no safety concerns related to COVID-19 vaccines during pregnancy and lactation, noted Linda O. Eckert, MD, professor in the division of women’s health in the department of obstetrics and gynecology at the University of Washington, Seattle.

“We have a lot of compelling data now about safety. It's been really encouraging to see how much data has been accumulated in the last 2.5 years since we've been using these vaccines,” Eckert said during the presentation. “It's important to continue to monitor safety and that monitoring is happening, but all the safety information we have so far has continued to be extremely reassuring.”

According to Eckert, updates published in March 2023 suggest:

• a single bivalent mRNA vaccine for all unvaccinated women, including pregnant women, and all people who completely or partially completed a monovalent vaccine series but have not received a bivalent mRNA vaccine;
• people aged 6 years or older who are immunocompromised and received a bivalent mRNA vaccine do not require additional COVID-19 vaccinations at this time;
• COVID-19 vaccinations can be administered along with other vaccines, including influenza and Tdap;
• acetaminophen should be suggested for pregnant women experiencing fevers after vaccination; and
• anti-D immunoglobulin can be administered to someone planning to or who recently received a COVID-19 vaccination.

For women with a history of SARS-CoV-2 infection, the updates recommend deferring vaccination until after they have recovered from acute illness, delaying vaccination for 3 months from start of symptoms and considering SARS-CoV-2 strain when deciding whether to delay vaccination after infection.