Mixed Messages on COVID Vaccines in Pregnancy and Breastfeeding

Drs. Adhikari and Spong wrote an excellent viewpoint yesterday that is public available in JAMA (COVID-19 Vaccination in Pregnant and Lactating Women). They discuss the history of vaccines during pregnancy, mRNA vaccines, the struggle to reconcile conflicting guidelines, and the misfortune of excluding pregnant and breastfeeding women from research.

Another high profile group wrote for the Lancet Breastfeed or be vaccinated—an unreasonable default recommendation: "Those individuals immediately impacted by the advice, of course, are breastfeeding women working as front-line health-care providers and caregivers, who might be required to choose between their own health, their infant's health, and potentially, their job because not being vaccinated might be disadvantageous in the workplace."

While this issue has come to the forefront in light of the question of COVID-19 vaccination, it is the same dilemma we have with almost every new drug with regard to pregnancy and lactation. We agree with the Academy of Breastfeeding Medicine’s mantra: it’s time we protected these women through research, not from it.

Kaytlin Krutsch, PharmD, MBA, BCPS