• Linda Von Zeuner

I am pregnant. Should I get vaccinated against Covid-19?


Our vaccine rollout has started for the teachers and since plenty of teachers are younger women as well, the question has arisen whether it is safe to be vaccinated if you are pregnant, which is a concern I wholeheartedly understand.


Allow me to shed some light, and help you bear the burden of this decision. I am sure you have got enough on your mind!



Numerous vaccines are being, and have been evaluated for prevention of COVID-19, but pregnant and lactating women have been excluded from these trials for ethical reasons.


The vaccines currently in use (in South Africa) are either mRNA based (Pfizer) or Viral vector based (Johnson and Johnson).


Vaccines that are contraindicated in pregnancy are any live attenuated vaccine, for instance MMR, since they theoretically pose a risk of infection to the unborn fetus.


All of the vaccines (including those not currently available in South Africa) do not contain any form of a virus that REPLICATES, thus, they do not cause disease, but non specific side effects from activation of the immune system may occur.


Based on how mRNA and viral vector vaccines work, they are unlikely to pose a risk to pregnant women, the fetus or breastfeeding newborns, in fact, you will be providing antibodies to your babies so they are protected from COVID-19 as well.





Data from animal studies, vaccinated pregnant women and small prospective cohort studies have NOT shown harmful effects and have demonstrated a maternal immune response and transfer of maternal antibodies across the placenta and into breastmilk to confer passive immunity against SARS-COV-2 infections after maternal vaccination. Vaccine generated antibodies were present in umbilical cord blood and breastmilk samples.



All pregnant patients are advised to undergo vaccination, worldwide.


Patients who are at higher risk of exposure to SARS-COV-2 or at highest risk of having severe disease (patients with diabetes, obesity or hypertension) may benefit most.


Pregnancy itself is associated with an increased risk of severe infection, but some patients may elect to defer vaccination weighing their personal risk of COVID-19 exposure and disease severity against the limited but increasingly data regarding the safety and efficacy of COVID-19 vaccines during pregnancy.


COURSE OF COVID-19 DURING PREGNANCY:


  1. Evidence suggests that pregnancy does not increase susceptibility to SARS-COV-2 infection but it does appear to worsen the clinical course of COVID-19 compared to non pregnant females of the same age.

  2. Most infected pregnant women (over 90%) recover without undergoing hospitalisation, rapid deterioration can occur and symptomatic pregnant patients appear to be at an increased risk of severe disease and death compared to symptomatic non-pregnant females of similar age.

  3. Risk factors for severe disease and death in pregnancy include older mean age (35 and older), obesity, and pre-existing medical comorbidities, especially hypertension and diabetes.

  4. The risk of miscarriage does not appear to be increased, but data on first and second trimester infections are limited.

  5. Preterm and caesarian delivery have been increased in most studies and the increased risk appears to be limited to patients with severe or critical disease.

  6. No increased risk of congenital anomalies has been reported.

  7. Risk of stillbirth in pregnant mothers with SARA-COV-2 infection are still the same as the general population.

  8. Over 95% of newborns of SARS-COV-2 positive mothers have been in good condition at birth. Most are asymptomatic, some develop symptoms of mild infection. Neonatal morbidity (requiring ICU/ ventilation) have largely been attributed to preterm birth and critical maternal COVID-19.

  9. An analysis of 12 countries with pregnant patients with confirmed or suspected SARS-COV-2 reported all cause early neonatal death rates of (0.2-0.3%), which were no higher than pre-COVID data. These numbers are not South African statistics but are significant nonetheless.



IF YOU DO CHOOSE TO BE VACCINATED:




  • Do not receive your vaccine in 14 days of receiving another vaccine such as Tetanus or Influenza.

  • If you become pregnant after receiving a first dose of Pfizer, you can still get the second dose at the same time than you would if you had not been pregnant.

  • Anti-D immunoglobulin (what you get after birth if you and your baby's blood group is not compatible) doesn't interfere with the immune response of the vaccine.

  • If you experience any immune response symptoms, Paracetamol is safe to use.


On a last note...


This virus has stolen so much from us, no single person has been through this unscathed, no matter in what walk of life or social circumstance you find yourself in.


If you have been planning a family, there is no reason to postpone it due to COVID-19 risk. Pregnancy related risks have not been well established, but the evidence suggests that the risks are not high enough to postpone a wanted pregnancy.






SOURCES:(via UPTODATE)


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