Covid Vaccination in Pregnancy

Written by

Rob Buist

Published on

Blog, Resources

I am sure you have been aware of a great deal of published information regarding Covid vaccinations lately.

My professional body, the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) and the relevant Australian Federal advisory body ATAGI (I have no idea what that stands for) now recommend:

“That pregnant women are routinely offered Pfizer mRNA vaccine at any stage of pregnancy. This is because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.”

Fair enough (although those of you who are paying attention will note the ATAGI has changed its advice re the AZ vaccine on several occasions considering emerging information so this may not be the final word on this matter).

There are two fundamental reasons for this shift in view:

  1. It now appears that – contrary to earlier reports – pregnant women who contract Covid are at increased risk of severe illness when compared to non-pregnant women of a similar age. This can also lead to adverse outcomes for their babies, including premature birth, and
  2. Surveillance date from overseas has not identified any safety concerns with mRNA vaccines given at any stage of pregnancy. It also appears there is antibody in cord blood and breastmilk, and this may provide immunity to babies.

These two factors have led the American Center for Diseases Control and Prevention (CDC) and the American College of Obstetrics and Gynecology (ACOG) to state:

“Covid vaccines should not be withheld from pregnant persons.”

A recent study published in the prestigious New England Journal of Medicine (NEJM) reported on 827 women who had received a Covid vaccine in pregnancy. The study authors found no greater rate of pregnancy complications (miscarriage, preterm birth, and giving birth to a small for dates baby) than in the general pregnant population.

There are a few “Howevers” in all of this.

  • While RANZCOG and ATAGI have recommended offering pregnant women the vaccine, they (you) are not currently a priority group which means pregnancy alone – even if supply issues permit – will not get you a vaccine. Go figure.
  • Australia (and NZ) has incredibly low rates of Covid in the community compared to the rest of the world and this is likely to be the case for some time. This does need to be remembered when considering known or possible risks of vaccines. (I recognize there is a counter argument to this view: that we cannot open our borders until we are all vaccinated so get vaccinated. However, the simple fact is our borders are not opening any time soon.)
  • Covid vaccines were – of necessity – hastily developed and admittedly exceedingly rare adverse effects have only emerged after their implementation. In the case of AstraZeneca this is the now well-known blood clot problem but reports of inflammation of the heart muscle (myocarditis) are emerging following administration of the Pfizer vaccine.
  • 827 is a small number for a study involving pregnancy outcomes. Most serious pregnancy complications – thank goodness – occur at rates of less than one percent so you would need a study involving – preferably – tens of thousands of women in order to prove pretty much anything categorically. (Although then again, I accept there is now considerable experience with Covid vaccines in pregnancy overseas without apparent problems emerging.)

OK so what do I recommend?

  1. If you are contemplating trying for a pregnancy soon, please do everything you can – even at the expense of delaying trying to fall pregnant – to get vaccinated.
  2. If you are pregnant and you are at increased risk of contracting Covid go ahead and get vaccinated (if you can) as per the advice of RANZCOG and ATAGI. This will apply to the current official recommendations, but I would include:
    • Front line health care workers and their families.
    • Women who work in transport (e.g., drive an Uber, work at the airport or hotels involved in the quarantine process.
    • Women who have other medical conditions that may predispose them to severe illness. Chronic hypertension is a good example.

Otherwise – at risk of me being labelled vaccine hesitant – I suggest holding off just for now (and as I pointed out above, pregnant women are currently not designated a priority group in Australia). My advice is likely to change in the – possibly near – future but this is where things stand for me currently.

Stay safe