Frequently Asked Questions
Should you get vaccinated against COVID-19 if you are pregnant or breastfeeding? The research agrees: Yes!
There has been a lot of misinformation, confusion, and fear about COVID as it relates to pregnancy and newborns. This FAQ aims to resolve some doubts and provide a starting point to have a conversation with a healthcare professional. This information has been directly sourced from the German-language FAQ for pregnant women* at ZusammenGegenCorona.de, which appears to be continuously updated as new research and guidelines are published.
Yes, the Standing Vaccination Commission (Ständige Impfkommission, STIKO) generally recommends corona vaccination for pregnant women from the second trimester of pregnancy with the vaccine Comirnaty® from BioNTech/Pfizer at three to six week intervals. Newly available data on the risk of severe COVID-19 during pregnancy and on the effectiveness and safety of vaccination in pregnant women were systematically processed for the recommendation. Important: A COVID-19 vaccination in the first trimester of pregnancy is no reason for an abortion. A booster vaccination is also recommended for pregnant women from the second trimester of pregnancy with Comirnaty® from BioNTech/Pfizer .
The German Society for Gynecology and Obstetrics e.V. (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e. V.) recommends giving priority to vaccinating pregnant and breastfeeding women with mRNA-based vaccines against COVID-19. According to current studies, a COVID-19 vaccination in pregnant women does not lead to increased pregnancy-specific complications or an increased risk of death for the pregnant woman or the fetus. In addition, the vaccination shows no differences in side effects compared to non-pregnant women. Rather, the COVID-19 vaccination can potentially protect the newborn from infection through the maternal antibodies formed by vaccination and transmitted transplacentally or via breast milk. The published statement of the German Society for Gynecology and Obstetrics can be found here.
In order to protect pregnant women indirectly, vaccination is recommended for their close contacts, especially partners, as well as midwives and doctors.
Various studies are still ongoing on the so-called placental antibody transfer. Initial results reported that by Corona vaccination of pregnant women* with an mRNA vaccine, the amount of antibodies detected in most fetuses was measurable to that of the vaccinated mother. However, whether this can provide clinically relevant protection against coronavirus for the newborn (also called nest immunity) has not been clearly demonstrated at this time.
However, vaccine transfer across the placenta into the fetal bloodstream has not been detected in any of the studies. It is assumed that the mRNA of the vaccine is rapidly degraded in the metabolism of the mother or the child, respectively. More information can be found in the 38th issue of the Epidemiological Bulletin of the Standing Commission on Vaccination (STIKO).
More information on corona vaccination in pregnancy can be found here.
Yes. COVID-19 vaccination is recommended for people who breastfeeding/lactating. On September 16, 2021, the Standing Vaccination Committee (STIKO) published its update of the COVID-19 vaccination recommendation for pregnant and breastfeeding women*. It justifies its decision on the basis of newly available data on the safety and effectiveness of the vaccination in pregnant and breastfeeding women*. A systematic review was conducted on the efficacy, immunogenicity and safety of the COVID-19 vaccine in pregnant women*, and on the transfer of antibodies through breast milk and safety of the COVID-19 vaccine for the child when the mother* is vaccinated while breastfeeding. The result of the review: The available data support a general recommendation.
STIKO recommends that breastfeeding women* who have not yet been vaccinated be vaccinated with two doses of an mRNA vaccine at an interval of three to six ( Comirnaty® from BioNTech/Pfizer ) or four to six weeks ( Spikevax® (Vaccine Moderna) from Moderna ). With the update of the COVID-19 vaccination recommendation from November 2021, vaccination with Spikevax® (Vaccine Moderna) from Moderna is only recommended for people aged 30 and over.
In addition, it states:
COVID-19 vaccination of breastfeeding women* with mRNA-based vaccines…
- … has an equivalent antibody formation and a similarly low side effect profile as in pregnancy and in non-pregnant women.
- … can induce nest immunity as vaccine-induced antibodies can be detected in breast milk.
- … does not require a break or abstinence from breastfeeding, since the mRNA of the vaccine could not be detected in breast milk, or if so, only minimally.
After vaccination with an mRNA vaccine during breastfeeding, antibodies were detected in breast milk, the concentration of which depended on the COVID-19 vaccine used. This level of antibodies coincides with that in the breastfeeding person’s blood. The level is highest one to two weeks after the second vaccination dose. It is still unclear whether there is a protective effect of antibodies against COVID-19 in infants of vaccinated mothers.
It is assumed that the mRNA of the vaccine is rapidly degraded in the metabolism of the mother or child. The transfer of mRNA vaccine into breast milk could only be detected in minimal parts. A breastfeeding break after the corona vaccination is not necessary. More information for breastfeeding and pregnant women can be found in the Epidemiological Bulletin of the Robert Koch Institute.
You can find more information on the corona vaccination during breastfeeding here .
Despite current access restrictions in the hospitals, expectant mothers/birthing people are usually allowed to take one companion with them into the delivery room. An accompanying person may also stay with the them in the first few hours after the birth. Most hospitals allow visitors to the maternity ward to a limited extent. However, the regulations may differ depending on the region. Please note the policy at your local hospital or birth center.
Edit to add: Empowered Birth Movement believes having two support people is an important right — we encourage parents and healthcare providers alike to advocate for this change in institutional policy. Please contact email@example.com to join our advocacy campaign or share your story.
Transmission from the mother to her newborn, even in the womb, cannot be ruled out. In most cases, children whose mothers have tested positive for coronavirus show no signs of illness after birth. So far, only isolated cases of illness in newborns have been described, which may be the result of infection in the womb. However, expectant mothers should protect themselves from infection as much as possible and follow the rules of conduct summarized in the AHA formula: Keep your distance (at least 1.5 meters), follow hygiene rules (proper coughing and sneezing, thorough hand washing) and – where space is tight – wear a mask in everyday life.
Since September 17, 2021, the Standing Committee on Vaccination (STIKO) also recommends the Corona vaccination in general for pregnant and breastfeeding women (more here).
However, if a mother is infected, transmission to the newborn is possible through close contact and droplet infection. An article with more information about pregnancy and the coronavirus can be found here.
The available data on the safety of COVID-19 vaccines does not provide any evidence of an increased occurrence of serious pregnancy-related side effects in the form of malformations, miscarriages or premature births. The German Society for Gynecology and Obstetrics goes into more detail in its recommendation for the COVID-19 vaccination for pregnant and breastfeeding women .
Rather, there is a risk of malformations due to complications in severe COVID-19 courses. The increased risk of preeclampsia due to a corona infection can have serious consequences for mother and child. You can find more information on this in the epidemiological profile of the Robert Koch Institute.
The Robert Koch Institute (RKI) is currently reviewing previously published systematic reviews and studies on the influence of SARS-CoV-2 infection on the course and outcome of pregnancy. In addition, data from the “COVID-19 Related Obstetric and Neonatal Outcome Study in Germany” (CRONOS) project of the research network of the German Society for Perinatal Medicine (DGPM), which has been studying women with laboratory-confirmed SARS-CoV-2 infection in pregnancy since April 3, 2020, are being considered. As of August 21, 2021, 2,803 positively tested pregnant women have already been recorded in the registry established from this study.
In the 38th Epidemiological Bulletin, the RKI published interim results of various studies on pregnant women. The institute rated one research study, which included a total of 192 studies of pregnant women, as particularly comprehensive. The review study described an increased risk of preterm birth before the 37th week of pregnancy in pregnant women with COVID-19 compared with mothers without COVID-19. The same conclusion was reached in another study, which also defined the severity of the disease in particular as a decisive factor: Pregnant women with severe courses of the disease had a higher incidence of preterm birth than pregnant women with mild COVID-19 disease. The study also found a higher risk of stillbirths in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative pregnant women.
Regarding the study results, the RKI points out that the increased preterm birth rate could also be a medically induced increase, as the general rates of spontaneous preterm births remained the same compared to pre-pandemic times. Taking into account the various study results, the RKI summarizes that pregnant women have an increased risk of suffering complications in the context of certain infectious diseases such as COVID-19 and thus justifies the general vaccination recommendation for pregnant and breastfeeding women made earlier.
Among other things, bleeding between periods, increased or absent menstruation and other menstrual irregularities were reported (published in the safet report of the Paul Ehrlich Institute, page 26). Taking into account the number of vaccinated women* in the relevant age groups and the frequency of menstrual disorders, the Paul Ehrlich Institute (PEI) rates the number of reports as “not unusually high”, although it can be assumed that some, particularly temporary menstrual disorders, are not reported will. It has therefore not been finally clarified whether the vaccination has an influence on the female cycle. A possible connection is being further investigated.
Menstrual cycle disorders after vaccination do not necessarily have to be attributed to the vaccine administered. Typical vaccination reactions such as fever, tiredness or muscle pain mean stress for the body. And stress is a common trigger for menstrual cycle disorders. Another possibility is that the vaccination stimulates the immune system to release signaling substances, which in turn activate immune cells throughout the body. There are many immune cells in the lining of the uterus, so they are also stimulated and this could lead to possible irregularities in the menstrual cycle.
A disturbed cycle usually settles down again on its own. However, if the irregularities persist for more than three months after the vaccination, this should be checked by a doctor. Affected persons can report menstrual disorders as a possible vaccination complication at side effects
The Standing Vaccination Commission (STIKO) recommends the COVID-19 booster vaccination for all people aged 12 and over, including pregnant people from the second trimester of pregnancy. The booster vaccination of pregnant people can be given three months after the last vaccine dose of the primary immunization. Regardless of which vaccine was previously used, the booster vaccination should be given with BioNTech/Pfizer ‘s Comirnaty® mRNA vaccine.
A recommendation must always be based on good data. Initially, there were only a few data on the vaccination of pregnant women*. For this reason, the Standing Vaccination Commission (STIKO) initially did not recommend general vaccination of pregnant and breastfeeding people. Nonetheless, physicians were able to discuss with pregnant individuals, independently of the general recommendation, whether vaccination seemed particularly appropriate for them.
With the update of the COVID-19 vaccination recommendation for pregnant and breastfeeding women* from September 17, 2021, STIKO used newly available data for its decision and rated the corona vaccination for pregnant and breastfeeding people as safe and effective. The recommendation is based on a systematic review of the scientific evidence. As part of a so-called umbrella review, previously published systematic reviews on the influence of a SARS-CoV-2 infection on the course and outcome of the pregnancy were analyzed. These data were supplemented by additional recent studies from 2021 after a corresponding systematic literature search. You can read the detailed scientific justification in the Epidemiologisches Bulletin .
Due to the current data situation, no conclusive statements can be made about the effect of an infection on the unborn child. Overall, however, transmission of a maternal SARS-CoV-2 infection to the newborn appears to be rare and to cause symptoms in the newborn only in rare cases. In principle, however, infection, for example with high fever in the pregnant person during the first third of pregnancy (also called the trimester) can increase the risk of complications and malformations. Therefore, corona vaccination is particularly important for women* of childbearing potential to ensure protection against severe COVID-19 infection before the onset of pregnancy or during the first trimester. Some study results also show that pregnant people with severe COVID-19, in particular, had more frequent preterm births and the newborns more often required care in an intensive care unit for premature infants and newborns. Stillbirths or deaths have been little described in newborns, although individual studies show a higher risk of the baby being stillborn in the case of severe COVID-19 in the mother*.
Information on the subject of vaccination and testing for members of the public is available in English, Turkish, Russian and Arabic at the country-wide and free-to-call telephone number 0800 0000837.
The free and barrier-free help hotline “Schwangere in Not” (Pregnant Women in Need) at 0800 40 40 020 is a first point of contact for women seeking help from local pregnancy counseling centers via qualified counselors. Counseling in foreign languages is also offered there. Information on financial support and maternity benefits can be found on the website of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.
Information for Ukrainian Refugees
інформація українською мовою
According to the Ordinance on Coronavirus Entry Regulations, the 3G rules apply when crossing the border to Germany. This means anyone aged 12 or over should present a negative test result or proof of vaccination or recovery when entering the country. On account of the emergency situation owing to the war in Ukraine, a pragmatic solution is now in place: People entering from Ukraine who would not be considered vaccinated or recovered in Germany, or are unable to provide proof, can also be tested after their arrival in Germany. It remains important that the hygiene rules continue to be followed, particularly with respect to the obligation to wear a mask.
Yes. According to the Ordinance on Coronavirus Testing, Ukrainian refugees are entitled to a point-of-care antigen test. This entitlement also applies to people who are not insured with the statutory health insurance. For a citizens’ test, an official photo ID needs to be presented in order to confirm that person’s identity. A problem here, however, is that particularly the children travelling from war zones often do not possess any form of identification. Due to the current situation, a pragmatic approach is required with regard to the documentation requirements. A non-bureaucratic approach to proving identity by presenting proof (e.g. driving licence, document on a mobile phone) has been recommended.
According to the current legal situation, when presenting proof of vaccination for entry into Germany or for purposes stipulated in the COVID-19 Protective Measures Exemption Ordinance, vaccinations are only recognized when performed with vaccines that are authorized in the EU. Under the current law, and taking account of the relevant age-appropriate recommendations, people who were already vaccinated abroad with a COVID-19 vaccine not approved in the EU require a further vaccination series with a vaccine that is approved by the European Commission in order to attain “vaccinated” status in the EU.
At this point in time, after a previous vaccination with a COVID-19 vaccine not authorized in the EU, the Standing Committee on Vaccination (STIKO) recommends beginning the vaccination series at the earliest after more than 28 days have passed since the last vaccine dose. In such cases, the people who are to be vaccinated should be informed that local and systemic reactions may occur with increased frequency. It is currently being examined whether it would be possible to recognize the vaccines that are only listed by WHO if further conditions are met (e.g. an additional vaccine dose with an mRNA vaccine).
Yes. According to section 1 (1) of the Coronavirus Vaccination Ordinance, people who have no health insurance coverage are still entitled to vaccination against the SARS-CoV-2 coronavirus if their place of residence or habitual residence is in the Federal Republic of Germany. In the case of Ukrainian refugees, the assumption of a “habitual residence” is to be made. At present, both doctors and pharmacists are performing COVID-19 vaccinations. In addition, it is possible to book vaccinations at vaccination centers or make use of local mobile vaccination services that are provided by the Federal States.
There is also an entitlement to be issued a digital EU COVID vaccination certificate. In line with section 1 of the Coronavirus Vaccination Ordinance criterion and conditions, a digital EU COVID vaccination certificate may be issued retrospectively in Germany if the vaccine that was administered is authorized within the EU. Digital vaccination certificates can be issued retrospectively free of charge at doctors’ offices and pharmacies. Documentation of the vaccination needs to be presented that enables suitable steps to be taken in order to verify that a genuine COVID-19 vaccination certificate was indeed issued, specifically with regard to the identity of the person vaccinated and the authenticity of the vaccination documentation. Proof of vaccination can be provided in German, English, French, Italian or Spanish, in written or digital form.
Useful information on medical care in Germany is available in Ukrainian at www.germany4ukraine.de. Find information in Ukrainian on coronavirus testing as well as coronavirus vaccination at the ZusammenGegenCorona website. The Federal Ministry of Health is currently in the process of translating additional information materials into Ukrainian, such as the guidelines on coronavirus vaccination for children and adolescents.
You can find extensive information in Ukrainian on the measures to protect against coronavirus, including vaccination, at the website of the Federal Centre for Health Education (BZgA).
The RKI provides FAQs, recommendations and information on refugees and health and, in particular, on vaccination. A vaccination calendar as well as information leaflets on vaccination are available in various languages. Of these materials, the following information is available in Ukrainian: a vaccination calendar, information leaflets on COVID-19 vaccines (mRNA-based, vector-based and protein-based), on the MMR vaccine, on the DTaP-IPV vaccine (tetanus, diphtheria, pertussis and polio) the DTaP-IPV-HB-Hib (tetanus, diphtheria, pertussis, polio, haemophilus influenzae type B and hepatitis B), and the varicella vaccine.
Furthermore, the RKI has prepared guidance on vaccinating refugees that is aimed at the facilities likely to be carrying out such vaccinations. This is available here.
Yes, sufficient quantities of all the COVID-19 vaccines authorized in the EU are available. The vaccines for use in Germany can be ordered by doctors but also by other service providers via pharmacies. Vaccination remains possible in a straightforward manner across the country.
At this time, there is no reason to assume the general population is exposed to an increased risk of infection through refugees. Rather, refugees are themselves more exposed due to being forced to stay in confined spaces while fleeing and after they arrive in the destination country. The overall COVID-19 vaccination rate is still very low in Ukraine, with around 35% of the population having received a second dose. Similarly, with other infectious diseases such as measles, diphtheria and polio, the vaccination rates in Ukraine are comparatively low. It is important to provide these people with vaccinations and enable access to diagnosis and treatment promptly. According to the Coronavirus Vaccination Ordinance and the Asylum Seekers Benefits Act, refugees from Ukraine are entitled to vaccination. It is in everyone’s best interests if unvaccinated and partially vaccinated people are entitled to and make use of this offer so as to enhance the protection of the population as a whole.
The RKI provides general information on the topics of refugees and health: www.rki.de/flucht