Last update April 23, 2022

COVID-19 vaccine

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

"The vaccine (COVID-19) can be offered to a breastfeeding woman who is part of a group recommended for vaccination (e.g. health workers); discontinuing breastfeeding after vaccination is currently not recommended". (WHO 2021/01/25)

Several types of vaccines are currently in development against COVID-19, among those in production there are (WHO 2021/01/26):

  • Messenger ribonucleic acid vaccines (mRNA): BNT162b2-Tozinameran-Comirnaty (Pfizer-BioNTech), MRNA-1273 (Moderna & NIH) and CVnCoV (Cure Vac). This type of vaccine uses portions of mRNA replicated from coronavirus n-19 to induce the synthesis and production of coronavirus n-19 surface proteins from muscle cells located at the site of injection that then act as triggers for the production of antibodies against the COVID-19 virus by the immune system.
  • Viral vector-based vaccines: AZD1222-Vaxzevria Oxford-AstraZeneca vaccine (Covishield in India), Gam-COVID-Vac (Gamaleya-Sputnik V), Cansino vaccine and Ad26.COV2.S-Janssen COVID-19 Vaccine (Johnson & Johnson). These vaccines use a non-pathogenic strain of human adenovirus that has been modified to contain genetic material that resembling a portion of coronavirus 2019-nCoV that can induce the immune system to react in a way similar to what was previously described with mRNA vaccines.
  • Inactivated virus vaccines: Coronavac from Sinovac, Covaxin (BBV152-Bharat Biotech) and Sinopharm vaccines.These vaccines are manufactured with dead viruses that do not have the capacity to reproduce or infect. These vaccines cause our immune system to react and start the production of specific antibodies against the COVID-19 virus.

Currently breastfeeding women have been excluded from all pre-marketing clinical trials. (Palacios 2020, Costantine 2020, CDC 2020/12/15, ABM 2020/12/14)

There were no significant differences between nursing mothers and non-lactating women in terms of side effects and the rate of antibodies generated after the COVID-19 vaccine. (Romero 2022/03, Falsaperla 2021/10, Perl 2021/04, Gray 2021/03) 

COVID vaccines cause rare and minimal adverse effects in breastfeeding or nursing infants.(Romero 2022/03, Falsaperla 2021/10, ​​​​​​Low 2021/10, McLaurin 2021/06) Infants of vaccinated mothers did not present any serious problems attributable to vaccination. (Low 2021/10, Perl 2021/04, Gray 2021/03)  Few cases of transient increase or decrease in milk production, change to a blue-green color of the milk and irritability-insomnia have been published in the infant, more frequent after the second dose of vaccine.(Lamers 2022/04, Bertrand 2021/09)

As expected (Baird 2021/02, InfantRisk 2020/12, ABM 2020/12) as after vaccination against other viruses, in the milk of lactating mothers vaccinated against COVID-19 appear high positivity rates for IgA and IgG antibodies generated by the vaccine, which would protect the infant from COVID-19. (Whited 2022/03, Falsaperla 2021/10, Valcarce 2021/08, Collier 2021/05, Perl 2021/04, Kelly 2021/03, Gray 2021/03) 

The IgA and IgG antibody response in breast milk is greater and more frequent with mRNA-m vaccines (Pfizer and Moderna) than with adenovirus-vectored vaccines (AstraZeneca and Janssen). (Selma 2022/04, Juncker 2022/03)

The longer breastfeeding (> 23 months) there is a higher rate of IgG and IgA antibodies in breast milk among lactating women vaccinated with the COVID19 vaccine. (Ramírez 2021/08)

It is highly improbable that any of the components that are part of the vaccines produced against COVID-19 could be excreted through human breastmilk, and even in this could happen, they would all be digested in the gastrointestinal tract of the breastfeeding child (InfantRisk 2020/12) After vaccination, no COVID-19 vaccine-related messenger RNA has been detected in breast milk.(Golan 2021/10)

Neither of the types of vaccines currently in development against COVID-19 contain live viruses within their components and therefore cannot provoke the disease or cause any alterations to the genetic material of their host. (CDC 2020/12/18 y 2020/12/13) Except for three live attenuated virus vaccines (small pox, yellow fever and oral polio-Sabin) that are known to rarely bring about negative effects on breastfeeding children, all vaccines are to be regarded as safe for use during lactation and therefore can be prescribed to breastfeeding women. (CDC 2020/02) 

Breastfeeding women are not considered to be a high-risk group for COVID-19, specially since they tend to be young and usually healthy and therefore until now there are no specific reasons that would warrant the use of the vaccine in this group. Several Health institutions, medical societies and also expert consensus have suggested that the vaccine should be prescribed for breastfeeding women if they would also belong to a high-risk group such as healthcare workers or people afflicted by a chronic disease or condition known to be a risk factor. (Mayo 2021/03, Davanzo 2021/02, Saus 2021/02, Chervenak 2021/02, WHO 2021/01, Sax 2021, IHAN 2021, AELAMA 2021, NHS 2021, HIFN 2020, MS España 2020/12, ACOG 2020/12, CDC 2020/12 y 2020/12) 

Vaccinating against COVID-19 should not be an impediment to begin lactation nor a cause for its interruption. (Davanzo 2021/02, Chervenak 2021/02, ACOG 2020/12) At the end of the year 2020; AstraZeneca, Moderna and Pfizer withdrew from their respective drug leaflets the previous recommendation of not administering their vaccines to lactating mothers. (Moderna 2021, AstraZeneca 2021, Pfizer 2020) 

As it may happen with other vaccinations, after the COVID-19 vaccination, palpable axillary lymph nodes may appear on the same side of the vaccine injection. A clinical follow-up of the nodes would be enough to rule out a presumed malignancy at the level of the breast. Costly and unnecessary complementary examinations should be avoided.(Low 2021/10, Edmonds 2021, Mehta 2021) This is a transitory side effect that usually does not disrupt the continuity of breastfeeding.


See below the information of this related product:

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

References

  1. Anderson PO. COVID-19 Drugs and Breastfeeding Update. Breastfeed Med. 2022 Apr 6. Consulted on May 5, 2022 Abstract
  2. Selma-Royo M, Bäuerl C, Mena-Tudela D, Aguilar-Camprubí L, Pérez-Cano FJ, Parra-Llorca A, Lerin C, Martínez-Costa C, Collado MC. Anti-SARS-CoV-2 IgA and IgG in human milk after vaccination is dependent on vaccine type and previous SARS-CoV-2 exposure: a longitudinal study. Genome Med. 2022 Apr 21;14(1):42. Consulted on April 23, 2022 Abstract
  3. Lamers M, van der Mijle A, van Hunsel F, de Vries L, van Puijenbroek E, Ceulemans M. Letter to the Editor: COVID-19 Vaccination During Breastfeeding and Its Possible Negative Effect on Milk Production and Supply: A Preliminary Observation. Breastfeed Med. 2022 Apr 14. doi: 10.1089/bfm.2022.0057. Consulted on April 18, 2022 Abstract
  4. Whited N, Cervantes J. Antibodies Against SARS-CoV-2 in Human Breast Milk After Vaccination: A Systematic Review and Meta-Analysis. Breastfeed Med. 2022 Mar 22. Consulted on March 30, 2022 Abstract
  5. Romero Ramírez DS, Suárez Hernández MI, Fernández Vilar AM, Rivero Falero M, Reyes Millán B, González Carretero P, Pérez MML, Carretero Pérez M, Martín Pulido S, Pera Villacampa L, García Bello MÁ, Mesa Medina OM, Roper S. Evaluation of Adverse Effects in Nursing Mothers and Their Infants After COVID-19 mRNA Vaccination. Breastfeed Med. 2022 Mar 9. Consulted on March 22, 2022 Abstract
  6. Juncker HG, Mulleners SJ, Coenen ERM, van Goudoever JB, van Gils MJ, van Keulen BJ. Comparing Human Milk Antibody Response After 4 Different Vaccines for COVID-19. JAMA Pediatr. 2022-03-14. Consulted on March 15, 2022 Abstract Full text (link to original source)
  7. Low JM, Lee LY, Ng YPM, Zhong Y, Amin Z. Breastfeeding Mother and Child Clinical Outcomes After COVID-19 Vaccination. J Hum Lact. 2021 Oct 29:8903344211056522. Consulted on Oct. 30, 2021 Abstract
  8. Falsaperla R, Leone G, Familiari M, Ruggieri M. COVID-19 vaccination in pregnant and lactating women: a systematic review. Expert Rev Vaccines. 2021 Oct 11:1-10. Consulted on Oct. 20, 2021 Abstract Full text (link to original source)
  9. Golan Y, Prahl M, Cassidy A, Lin CY, Ahituv N, Flaherman VJ, Gaw SL. Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk. JAMA Pediatr. 2021 Oct 1;175(10):1069-1071. Consulted on Oct. 5, 2021 Abstract Full text (link to original source)
  10. Bertrand K, Honerkamp-Smith G, Chambers CD. Maternal and Child Outcomes Reported by Breastfeeding Women Following Messenger RNA COVID-19 Vaccination. Breastfeed Med. 2021 Sep;16(9):697-701. Consulted on Sept. 20, 2021 Abstract
  11. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, Burchfield DJ, Li N, Larkin J 3rd. Detection of SARS-CoV-2-Specific IgA in the Human Milk of COVID-19 Vaccinated Lactating Health Care Workers. Breastfeed Med. 2021 Aug 20. Consulted on Aug. 21, 2021 Abstract
  12. Ramírez DSR, Pérez MML, Pérez MC, Isis M, Hernández S, Hospital SMP, Villacampa LP, Vilar AMF, Falero MR, Carretero PG, Millán BR, Roper S, Bello MÁG. SARS-CoV-2 Antibodies in Breast Milk After Vaccination. Pediatrics. 2021 Aug 18. pii: e2021052286. Consulted on Aug. 20, 2021 Abstract Full text (link to original source) Full text (in our servers)
  13. McLaurin-Jiang S, Garner CD, Krutsch K, Hale TW. Maternal and Child Symptoms Following COVID-19 Vaccination Among Breastfeeding Mothers. Breastfeed Med. 2021 Jun 25. Consulted on June 28, 2021 Abstract
  14. EBCOG. Martins I, Louwen F, Ayres-de-Campos D, Mahmood T. EBCOG position statement on COVID-19 vaccination for pregnant and breastfeeding women. Eur J Obstet Gynecol Reprod Biol. 2021 May 14. pii: S0301-2115(21)00244-X. Consulted on May 20, 2021 Abstract Full text (link to original source)
  15. 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, et al. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. 2021 May 13. Consulted on May 15, 2021 Abstract
  16. Martins I, Louwen F, Ayres-de-Campos D, Mahmood T. EBCOG position statement on COVID-19 vaccination for pregnant and breastfeeding women. Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:256-258. Consulted on May 15, 2021 Abstract
  17. Perl SH, Uzan-Yulzari A, Klainer H, Asiskovich L, Youngster M, Rinott E, Youngster I. SARS-CoV-2-Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. 2021 Apr 12. Consulted on April 15, 2021 Abstract Full text (link to original source) Full text (in our servers)
  18. Kelly JC, Carter EB, Raghuraman N, Nolan LS, Gong Q, Lewis AN, Good M. Anti-severe acute respiratory syndrome coronavirus 2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination. Am J Obstet Gynecol. 2021 03 31. Consulted on March 31, 2021 Abstract
  19. Kelly JC, Carter EB, Raghuraman N, Nolan LS, Gong Q, Lewis AN, Good M. Anti-SARS-CoV-2 antibodies induced in breast milk after Pfizer-BioNTech/BNT162b2 vaccination: SARS-CoV-2 antibodies in breast milk after vaccination. Am J Obstet Gynecol. 2021 03 30. Consulted on March 30, 2021 Abstract Full text (link to original source) Full text (in our servers)
  20. 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. Am J Obstet Gynecol. 2021 Mar 24. pii: S0002-9378(21)00187-3. Consulted on March 26, 2021 Abstract Full text (link to original source) Full text (in our servers)
  21. Mayo S, Monfort S. Breastfeeding and COVID-19 Vaccine: Yes We Can. J Hum Lact. 2021 Mar 16:8903344211004443. Consulted on March 17, 2021 Abstract
  22. Davanzo R, Agosti M, Cetin I, Chiantera A, Corsello G, Ramenghi LA, Staiano A, Tavio M, Villani A, Viora E, Mosca F. Breastfeeding and COVID-19 vaccination: position statement of the Italian scientific societies. Ital J Pediatr. 2021 Feb 27;47(1):45. Consulted on Feb. 28, 2021 Abstract Full text (link to original source)
  23. Baird Jill K, Shawn M. Jensen, Walter J. Urba, Bernard A. Fox, Jason R. Baird doi: https://doi.org/10.1101/2021.02.23.21252328 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 Consulted on Feb. 25, 2021 Abstract Full text (link to original source) Full text (in our servers)
  24. Saus-Ortega C. COVID-19 Vaccines and Breastfeeding. J Hum Lact. 2021 Feb 12:890334421995102. Consulted on Feb. 15, 2021 Abstract
  25. Chervenak FA, McCullough LB, Bornstein E, Johnson L, Katz A, McLeod-Sordjan R, Nimaroff M, Rochelson BL, Tekbali A, Warman A, Williams K, Grünebaum A. Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients. Am J Obstet Gynecol. 2021 Feb 1. pii: S0002-9378(21)00082-X. Consulted on Feb. 10, 2021 Abstract Full text (link to original source) Full text (in our servers)
  26. Edmonds CE, Zuckerman SP, Conant EF. Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of Coronavirus Disease (COVID-19) Vaccination. AJR Am J Roentgenol. 2021 Feb 5. Consulted on Feb. 10, 2021 Abstract
  27. AstraZeneca. COVID-19 Vaccine AstraZeneca. Drug Summary. 2021 Consulted on Jan. 29, 2021 Full text (in our servers)
  28. WHO. Draft landscape and tracker of COVID-19 candidate vaccines. WHO. 26 January 2021. Publication. Consulted on Jan. 27, 2021 Abstract Full text (link to original source)
  29. Sinovac Life Sciences. CoronaVac. Ficha técnica. 2021 Consulted on Jan. 27, 2021 Full text (in our servers)
  30. WHO Interim recommendations for use of the Moderna mRNA-1273 vaccine against COVID-19. Interim guidance 25 January 2021. 2021 Consulted on Jan. 25, 2021 Abstract Full text (link to original source) Full text (in our servers)
  31. NHS. Public Health England. A guide to COVID-19 vaccination. All women of childbearing age, those currently pregnant or breastfeeding. Leaflet. 2021 Consulted on Jan. 20, 2021 Full text (link to original source) Full text (in our servers)
  32. Mehta N, Sales RM, Babagbemi K, Levy AD, McGrath AL, Drotman M, Dodelzon K. Unilateral axillary Adenopathy in the setting of COVID-19 vaccine. Clin Imaging. 2021 Jan 19;75:12-15. Consulted on Jan. 20, 2021 Abstract
  33. IHAN. Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia. Comunicado IHAN: vacunación frente a COVID-19 y lactancia materna. None 2021 Consulted on Jan. 13, 2021 Full text (link to original source) Full text (in our servers)
  34. AELAMA (Asociación Española de Lactancia Materna). Gómez Fernández-Vegue, M. Consideraciones acerca de las vacunas frente a la COVID-19 y la lactancia materna. None 2021 Consulted on Jan. 13, 2021 Abstract Full text (link to original source)
  35. WHO Interim recommendations for use of the Pfizer– BioNTech COVID-19 vaccine, BNT162b2, under Emergency Use Listing. None 2021 Consulted on Jan. 10, 2021 Abstract Full text (link to original source) Full text (in our servers)
  36. Moderna - BioTech. COVID-19 Vaccine Moderna. Ficha técnica. 2021 Consulted on Jan. 10, 2021 Full text (in our servers)
  37. MS España. Ministerio de Sanidad. Ministerio de Ciencia e Innovación. Gobierno de España. ¿Puedo vacunarme si estoy embarazada o quiero quedarme embarazada? ¿Y si tengo un bebé lactante?. 2020. Actualización: 30/12/2020 Consulted on Dec. 30, 2020 Full text (link to original source) Full text (in our servers)
  38. Pfizer - BioNTech Comirnaty. Ficha técnica. 2020 Consulted on Dec. 21, 2020 Full text (in our servers)
  39. HIFN - Hospital Infant Feeding Network. There is an urgent need to amend UK guidance on administration of the mRNA-based Covid-19 vaccines to lactating people - in line with American guidance - and to commit to immediate collection of safety data in this population. Statement from the GP Infant Feeding Network, the Hospital Infant Feeding Network and Breastfeeding for Doctors. 2020 Consulted on Dec. 21, 2020 Full text (link to original source) Full text (in our servers)
  40. CDC - Centers for Disease Control and Prevention. Vaccination Considerations for People who are Pregnant or Breastfeeding. CDC 2020/12/15 Consulted on Dec. 20, 2020 Full text (link to original source)
  41. Infant Risk Center. COVID-19 Vaccine in Pregnancy and Breastfeeding. InfantRisk 2020/12/18 Consulted on Dec. 20, 2020 Full text (link to original source) Full text (in our servers)
  42. CDC - Centros para el control y prevención de enfermedades. Información para entender cómo actúan las vacunas contra el COVID-19. CDC 2020/12/18. Consulted on Dec. 20, 2020 Full text (link to original source) Full text (in our servers)
  43. CDC - Centers for Disease Control and Prevention. Understanding mRNA COVID-19 Vaccines. CDC 2020/12/18 Consulted on Dec. 20, 2020 Full text (link to original source)
  44. NHS - National Health Service UK. Coronavirus (COVID-19) vaccine. NHS, 2020/12/18 Consulted on Dec. 20, 2020 Full text (link to original source) Full text (in our servers)
  45. ABM - The Academy of Breastfeeding Medicine. Considerations for COVID-19 Vaccination in Lactation. ABM 2020/12/14 Consulted on Dec. 15, 2020 Full text (link to original source) Full text (in our servers)
  46. CDC - Centers for Disease Control and Prevention. COVID-19 ACIP Vaccine Recommendations. Current COVID-19 Vaccine Recommendations. MMWR 2020/12/13 Consulted on Dec. 15, 2020 Full text (link to original source)
  47. ACOG - American College of Obstetricians and Gynecologists Vaccinating Pregnant and Lactating Patients Against COVID-19. ACOG 2020/12/13 Consulted on Dec. 15, 2020 Full text (link to original source) Full text (in our servers)
  48. Palacios R, Patiño EG, de Oliveira Piorelli R, Conde MTRP, Batista AP, Zeng G, Xin Q, Kallas EG, Flores J, Ockenhouse CF, Gast C. Double-Blind, Randomized, Placebo-Controlled Phase III Clinical Trial to Evaluate the Efficacy and Safety of treating Healthcare Professionals with the Adsorbed COVID-19 (Inactivated) Vaccine Manufactured by Sinovac - PROFISCOV: A structured summary of a study protocol for a randomised controlled tr... Trials. 2020 Oct 15;21(1):853. Consulted on Oct. 20, 2020 Abstract
  49. Costantine MM, Landon MB, Saade GR. Protection by Exclusion: Another Missed Opportunity to Include Pregnant Women in Research During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol. 2020 Jul;136(1):26-28. Consulted on July 30, 2020 Abstract
  50. CDC - Centers for Disease Control and Prevention. Vaccination Safety for Breastfeeding Mothers. CDC 2020/02/04 Consulted on Feb. 5, 2020 Full text (link to original source) Full text (in our servers)
  51. NHS - National Health Service UK. Coronavirus (COVID-19) vaccine. 2021 Full text (link to original source)
  52. Sax PE. Covid-19 Vaccine — Frequently Asked Questions. N Engl J Med. 2021 Full text (link to original source)

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