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ACOG: Pregnant and Postpartum Individuals Should Stick With Pfizer or Moderna Vaccine

pregnant woman taking vaccination

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Key Takeaways

  • As the FDA and CDC call for a pause on the Johnson & Johnson vaccine, ACOG specifies that pregnant and postpartum women should opt for Moderna or Pfizer vaccines if they want to get vaccinated.
  • The organizations want to investigate six cases of a rare but serious blood clotting event in the brain called cerebral venous sinus thrombosis (CVST).
  • At this time, there is no known characteristic that would predispose someone to CVST after vaccination, like pregnancy.

The American College of Obstetricians and Gynecologists (ACOG) is advising people who are pregnant and postpartum to opt for the Pfizer-BioNTech or Moderna COVID-19 vaccines while health organizations investigate reports of serious blood clots linked to the Johnson & Johnson vaccine.

In a statement released on April 13—the same day the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) recommended a pause of the Johnson & Johnson vaccine—ACOG indicated that the Johnson & Johnson vaccine would not be available to anyone for the time being.

"Because the CDC and the FDA have placed the Johnson & Johnson vaccine program on hold out of an abundance of caution, it is not currently available for anyone, including women of reproductive age. Those who wish to be vaccinated in the interim should be aware that the Pfizer and Moderna COVID-19 vaccines remain available," the statement reads.

Why Is J&J On Pause?

The CDC and FDA are aware of six post-vaccination reports of an extremely rare and serious blood clotting problem called cerebral venous sinus thrombosis (CVST), which prevents blood from draining out of the brain. One of the cases was lethal.

All six incidents occurred in women between the ages of 18 and 48 who received the Johnson & Johnson vaccine, and symptoms developed 6 to 13 days after vaccination. 

The condition is particularly dangerous because it occurred alongside low levels of blood platelets. This means the blood thinner medication that would typically be used to treat a clot is unsafe in this situation.

The CDC's Advisory Committee on Immunization Practices (ACIP) is investigating the link between CVST and the vaccine, a move that shows the system of vaccine safeguards is working.

"The intensity of the work by the CDC and FDA to pause the vaccinations is a testament to the validity of the system to provide safety in the delivery of the vaccine," Jessica Shepherd, MD, an OB-GYN and Chief Medical Officer of Verywell Health, says. "This halt in J&J distribution should not deter vaccine education—it's teaching us how to evaluate risk. This pandemic has proven that there is a much larger risk of getting COVID-19 than experiencing a serious vaccine side effect. Decreasing transmission is still the goal."

The risk of a blood clot from the Johnson & Johnson vaccine is still significantly lower than the risk of a clot from COVID-19: 0.0001% compared to 20%.

Are Pregnant Women More At-Risk?

The fact that ACOG released a statement raises the question: Are pregnant women at an increased risk of CVST from the vaccine? And because all the reports occurred in women under 50, should women of reproductive age be concerned?

While pregnant people and people on birth control pills are at a higher risk for blood clots in general (increased estrogen levels can cause the blood to clot easily), that type of clotting refers to deep vein thrombosis, which typically occurs in the leg and can be treated with blood thinners.

ACOG says there's no evidence to support the idea that something like pregnancy increases the risk of CVST after vaccination.

"At this time, there is no clear phenotype of women who are more or less likely to experience this rare complication," the statement says. "However, until there is a better understanding of the frequency and impact of this finding, it will be important to encourage pregnant and postpartum women who wish to be vaccinated to receive the mRNA vaccines: Pfizer or Moderna."

ACOG Stance on COVID-19 Vaccines

ACOG officially recommends that pregnant and lactating individuals be offered a COVID-19 vaccine. But because of a lack of clinical trial research in these groups, the organization says the ultimate decision about whether or not to get vaccinated is a personal choice. ACOG encourages a discussion with a healthcare provider.

How to Switch Your Vaccine If You're Signed Up For J&J

Shepherd explains it might be difficult for you to personally switch your vaccine appointment if you are registered for the Johnson & Johnson shot in the coming days, since batches of brands are delivered to sites based on availability. But the good news is entire vaccine sites are starting to substitute Johnson & Johnson doses with Pfizer or Moderna, so you shouldn't have to do anything.

The CDC and the White House's COVID-19 Response Team are working to make sure anyone slated for a Johnson & Johnson vaccine can get Pfizer or Moderna instead.

“Our partners are working to reschedule people who have the J&J vaccine appointments in the days ahead. This may be a bit bumpy," Anne Schuchat, MD, principal deputy director of the CDC, said during a joint media call on Tuesday. "We want to make sure that we're getting the word out to the public and to our providers, but we do want to make sure that people who are scheduled to have vaccination will be able to get that when [other] vaccines are available.”

What This Means For You

If you are pregnant or a new parent, you can still get a COVID-19 vaccine if you wish. Health organizations recommend choosing Pfizer or Moderna. If you recently received the Johnson & Johnson vaccine, don't panic. The chance of experiencing the type of blood clot described is extremely rare. To be proactive, make sure you do document any side effects you're experiencing. Severe headache, abdominal pain, leg pain, or shortness of breath are reasons to seek medical attention.

To be proactive, consider participating in the CDC’s V-Safe program, an app-based tool used to gather data, including side effects on the COVID-19 vaccines.  This will help health officials learn more about vaccine side effects too.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysisEClinicalMedicine. 2020;29-30:100639. doi:10.1016/j.eclinm.2020.100639

  2. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databasesBMJ. 2019;364:k4810. doi: 10.1136/bmj.k4810

  3. American College of Obstetricians and Gynecologists. Vaccinating pregnant and lactating patients against COVID-19. Updated March 24, 2021.