Written by Dr Sarah Merritt MRCOG

As from 16th April 2021 new guidance has been issued by the Joint Committee on Vaccination and Immunisation (JCVI) stating that the COVID -19 vaccines should now be “Offered to pregnant women at the same time as the rest of the population, in line with the age group role out”

Prior to this only pregnant women were offered the vaccine, who either had:

  • high risk medical conditions who would be at greater risk of severe illness if they were infected with COVID -19
  • NHS and care workers who are at increased risk of exposure and therefore catching COVID -19
  • Those who are at high risk of COVID-19 due to health or personal factors such as age, ethnicity, BMI of more than 40 and developed gestational diabetes

It is entirely a woman’s choice as to whether she wants the vaccine or not as trials directly testing the vaccine in pregnant and breastfeeding women have not occurred.  The large trials that have given us so much data regarding the safety of vaccines and effectiveness did not include pregnant women.  The majority of clinical trials, testing any medication, usually do not include pregnant women.  The evidence for safety has come mainly from the USA, where monitoring of over 100,000 pregnant women who had the COVID-19 vaccine did not raise any concerns as to its safety. The COVID -19 vaccine is not live and so can not cause infection in a pregnant woman or their baby.

There is no stipulation as to when in pregnancy a woman should have the vaccine, and women planning a pregnancy do not need to delay their vaccine, nor do women have to take a pregnancy test before their vaccine.  As infection with COVID causes more serious complications in the third trimester for pregnant women then some women may choose to delay having a vaccine until after the 13th week. During the first 12 weeks, all of the main organs form, and development occurs.

We know that although the risk of having severe infection with COVID-19 is low, studies over the past year and a half have shown that admission to hospital and severe illness resulting in ITU admission may be more common in pregnant women, when compared to those not pregnant, especially if infection occurs in the third trimester.  The rates of still birth and preterm delivery is also more likely when compared to pregnant women without COVID-19.  Women with underlying health conditions are at more risk of severe illness.

As there are safety concerns with AstraZeneca regarding blood clots then pregnant women are advised NOT to have this vaccine.  During pregnancy all women are at an increased risk of having blood clots or venous thrombo embolism.  The government advise is that all individuals under the age of 40 should be offered an alternative vaccine regardless, which would involve the majority of pregnant women anyway.  Most of the safety information is from the Pfizer and Moderna vaccines which should be offered to pregnant women.

Importantly, the decision is each woman’s choice.  No vaccine is 100% effective and so it is vitally important that all women and their families adhere to the governments guidance regarding socially distancing, wearing face masks, meeting up and washing hands.

The latest patient information leaflet from the Royal College of Obstetricians and Gynaecologists (RCOG) which was updated on the 28th May 2021 can be viewed at:

https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf

As with all information during the pandemic and as our knowledge regarding COVID-19, its variants and the vaccinations evolves, information may change and will be updated.

 

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