COVID-19 Vaccination and Maternal-Fetal Death Risk
Based on extensive safety data from over 180,000 vaccinated pregnant individuals, COVID-19 vaccination does not cause maternal or fetal death—in fact, vaccination significantly reduces these risks by preventing severe COVID-19 disease during pregnancy. 1, 2
Direct Evidence on Maternal and Fetal Deaths from Vaccination
The available evidence demonstrates no causal link between COVID-19 vaccination and maternal or fetal death:
Large-scale surveillance data from 177 studies involving 638,791 pregnant participants across 41 countries found no increase in stillbirth rates among vaccinated pregnant individuals compared to unvaccinated individuals. 2
A retrospective cohort of 106,428 deliveries showed vaccinated pregnant people had significantly lower stillbirth rates (0.3%) compared to unvaccinated matched controls (0.6%; p<0.0002). 3
Real-world data from 90,000 pregnant women collected through the V-safe COVID-19 vaccine pregnancy registry did not identify any safety signals related to maternal or fetal death. 4
Observational studies comparing perinatal outcomes between vaccinated and unvaccinated pregnant people had reassuring findings and did not demonstrate harmful effects on pregnancy or the newborn, including no increased risk of fetal death. 1
The Actual Risk: COVID-19 Infection During Pregnancy
The evidence clearly shows that unvaccinated pregnant individuals face substantial mortality risk from COVID-19 infection itself:
Pregnant women with symptomatic COVID-19 have 2-3 fold higher rates of ICU admission, invasive ventilation, and mortality compared to symptomatic non-pregnant women. 4
COVID-19 infection during pregnancy increases the risk of fetal death with an adjusted odds ratio of 2.21. 4
Overall mortality rates among pregnant women with COVID-19 approximate 0.2%, with rates of invasive ventilator support at 1.0%. 5
During the 2002 SARS pandemic (a related coronavirus), maternal case fatality was 25% with high miscarriage rates, demonstrating the severe risk posed by coronavirus infections during pregnancy. 5
Protective Effect of Vaccination
Vaccination provides substantial protection against the actual causes of maternal-fetal death:
Low to very low-certainty evidence suggests vaccination during pregnancy with mRNA vaccines reduces severe cases or hospitalizations in pregnant persons with COVID-19 by 72% (95% CI 42-86%). 2
Vaccinated pregnant people had lower rates of COVID-19 during pregnancy (4.0%) compared with unvaccinated matched people (5.3%; p<0.0001). 3
Boosted individuals had even lower COVID-19 rates (3.2%) compared with vaccinated unboosted matched people (5.6%; p<0.0001). 3
Boosted pregnant people were less likely to have a stillbirth (0.3%) compared with vaccinated unboosted matched people (0.5%; p<0.025). 3
FDA Safety Assessment
The FDA label for mRNA COVID-19 vaccines explicitly states:
"Pregnant individuals infected with SARS-CoV-2 are at increased risk of severe COVID-19 compared with non-pregnant individuals." 6
Developmental toxicity studies in rats receiving the vaccine showed "no vaccine-related adverse effects on female fertility, fetal development, or postnatal development." 6
Available data on COVID-19 vaccines administered to pregnant individuals are insufficient to inform vaccine-associated risks in pregnancy, but no safety signals have been identified. 6
Current Guideline Recommendations
Major medical organizations unequivocally recommend COVID-19 vaccination during pregnancy:
The CDC recommends COVID-19 vaccination for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant, or might become pregnant in the future. 4
The Society for Maternal-Fetal Medicine (SMFM) and the American College of Obstetricians and Gynecologists (ACOG) have echoed that pregnancy is a risk factor for severe COVID-19 infection. 5
These recommendations are based on the principle that vaccines should demonstrate potential to reduce morbidity in the pregnant woman and/or her fetus, with lack of evidence of adverse pregnancy outcomes or potential harm. 5
Common Pitfalls to Avoid
Do not confuse correlation with causation: Any adverse pregnancy outcome occurring after vaccination does not establish causation, as the background rate of major birth defects is 2-4% and miscarriage is 15-20% in all clinically recognized pregnancies. 6
Do not overlook the comparison group: The critical question is not whether any deaths occurred after vaccination, but whether vaccination increases or decreases the risk compared to being unvaccinated—and all evidence shows vaccination decreases risk. 1, 2, 3
Do not ignore the mechanism: mRNA vaccines do not contain live virus, cannot replicate, and vaccine-related mRNA has not been detected in breast milk studies, making biological plausibility for causing maternal-fetal death extremely low. 7