Covid-19 Vaccination - The Facts For Pregnant Women

See our expert midwives Lesley Gilchrist and Cathy Tabner talk through the evidence based facts of the COVID-19 vaccination in pregnancy and breastfeeding over on our IGTV.

Vaccine facts

• There are four COVID-19 vaccines approved for use in the UK: Pfizer-BioNTech, Oxford-AstraZeneca, Moderna and Janssen.
• The information gathered from the trials reported common minor localised reactions such as pain, redness or swelling at the injection site. Mild fatigue, headache or muscle pain were also common, subsiding within a few days. 10–20% of participants had a fever.
• Safety monitoring once authorised revealed an association between the Oxford-AstraZeneca vaccine and rare cases of serious thrombosis (blood clots).
• There are very rare reports of myocarditis and pericarditis (inflammation of the heart) after vaccination with Pfizer-BioNTech and Moderna vaccines.

Results from studies of pregnant women- Royal College of Obstetricians and Gynaecologists (RCOG)

• Pregnant women should be offered vaccination at the same time as the rest of the population, based on age and clinical risk.
• Pregnant women should be offered the Pfizer-BioNTech or Moderna vaccines, unless they have already had one dose of the Oxford-AstraZeneca vaccine, in which case they should complete the course with Oxford-AstraZeneca.
• Over 120,000 pregnant women from diverse ethnic backgrounds in the USA have received either a Pfizer-BioNTech or Moderna COVID-19 vaccine, with no evidence of harm identified.
• The rare syndrome of vaccine-induced thrombosis and thrombocytopenia (VITT) has been reported after the Oxford-AstraZeneca vaccine. Although pregnancy increases the risk of coagulopathy there is no evidence that pregnant or postpartum women are at higher risk of VITT than non-pregnant women.
• Two studies of over 100 women discovered antibodies from the vaccine in infant cord blood and breast milk, in the USA after Pfizer-BioNTech or Moderna vaccines.
• There is some suggestion that timing of vaccination in pregnancy or during breastfeeding may have an effect on the level of immunity passed to babies. Two studies found antibodies and their transfer were improved following a second dose of either vaccine.
• Continual transference of antibodies during breastfeeding was found but the degree of protection these antibodies offer to the baby, is not yet known.

Recommendations for pregnant women from the RCOG

• COVID-19 vaccines can be given at any time in pregnancy.
• In low-risk situations some women may choose to delay vaccination until 12 weeks of gestation, aiming for vaccination as soon as possible thereafter.
• If there is a higher chance of contracting infection, or a woman is at a higher risk of severe illness from COVID-19, the vaccine should be offered at the earliest opportunity, including in the first trimester.
• Breastfeeding women can receive a COVID-19 vaccine; there is no need to stop breastfeeding to have the vaccine.
• Women planning a pregnancy or fertility treatment can also receive a COVID-19 vaccine and do not need to delay conception.
• Women have a higher risk of their baby being born prematurely if they develop COVID-19 in their third trimester (after 28 weeks of gestation). This association is being seen during admissions to hospital, the reasons for which are not yet fully understood.
• Aim to have the vaccine before the third trimester, bearing in mind that it takes time for immunity to develop, and protection is higher after the second dose of the vaccine.
• Although there is a lack of safety data for the available vaccines relating to breastfeeding, there is no plausible mechanism by which any vaccine ingredient could pass to a breastfed baby through breast milk. Women are advised not to stop breastfeeding in order to be vaccinated against COVID-19.
• Pfizer-BioNTech and Moderna vaccines showed that these vaccines in rats had no effect on fertility.

Maternal risks of contracting COVID-19 in pregnancy- RCOG

• Most women with COVID-19 in pregnancy will have no symptoms. However, some women will develop critical illness from COVID-19.
• The risk of severe illness from COVID-19 is higher for pregnant women than for non-pregnant women, particularly in the third trimester.
• There is growing evidence that pregnant women are more likely to be admitted to an intensive care unit than non-pregnant women with COVID-19.

Risks to the unborn baby if mother contracts COVID-19 in pregnancy- RCOG

• If you contract COVID-19 and have symptoms during pregnancy this is associated with a two to three times greater risk of preterm birth.
• Although the overall risk of stillbirth is small, the risk is approximately doubled if they contract COVID-19.

If COVID-19 is contracted during pregnancy, needing hospital treatment is more common if:

• You are of Black, Asian and minority ethnic (BAME) background.
• Have a BMI of 25 kg/m2 or more.
• Have pre-pregnancy medical conditions, such as pre-existing diabetes and chronic hypertension.
• You are 35 years or older.
• You live in areas or households of increased socioeconomic deprivation (data not specific to pregnancy).

If you decide not to be vaccinated during pregnancy or whilst breastfeeding you can use the following precautions to protect yourself:

• Regular and thorough handwashing or using hand sanitiser throughout the day.
• Avoid crowded indoor spaces and think about who you are meeting and how many.
• Meet people outdoors if possible.
• If you are inside open the windows and doors to allow air to circulate.
• If you enter crowded places where its difficult to maintain a distance use a face covering.

FAQ'S ON THE VACCINE

• No – although you won’t benefit from the full protection of the vaccine during your pregnancy your baby will benefit from your antibodies, especially if you’re breastfeeding. It is important to arrange to receive your second vaccination within 12 weeks of the first – it is safe to receive the jab whilst breastfeeding .

• There’s no evidence that having the vaccines at the same time will cause any problems. The important thing is being fully vaccinated by 28 weeks of pregnancy

• Anyone over the age of 18 can book a vaccine appointment by going onto NHS website: https://www.nhs.uk/nhs-services/covid-19-services/covid-19-vaccination-services/book-covid-19-vaccination/ or by telephone - ring 119 or in some areas by contacting your GP .

Further information can be explored here:

Pregnancy and coronavirus (COVID-19) - NHS (www.nhs.uk)
References can be found here: Coronavirus (Covid-19) Infection in Pregnancy (RCOG)