Hayadan > Is it recommended for pregnant women to get vaccinated against the corona virus?

Is it recommended for pregnant women to get vaccinated against the corona virus?

The question that repeats many times - both in responses to records and in private - comes from pregnant women who want to know if they should take the vaccine for Covid-19. I do not intend to provide recommendations in this record, among other things because every pregnant woman is a special case in herself. I will try to provide all the scientific knowledge we have today, in the hope that it will help women make a more informed decision

Corona vaccine. Photo: depositphotos.com

Let's start.

Is the virus dangerous for pregnant women?

The answer to the question comes from a meta-review - that is, a review that included 77 studies that together examined 11,432 women. There is good news and bad news here.

The good news is that compared to non-pregnant women, the pregnant women were less likely to report symptoms of high fever or muscle pain. Why? We are not sure.

The bad news is that the pregnant women were more likely to arrive at the hospital due to the disease, and if they did arrive - their chances were higher to be sent to the intensive care unit and find themselves connected to a ventilator. And if that is not enough, the rate of premature births was slightly higher than that of women who were not infected with the virus. A quarter of the babies born (premature or not) were hospitalized in the neonatal intensive care unit - a higher rate than can be found in babies born to women without covid-19. By comparison, the intensive care unit hospitalization rate for babies born to women who are not ill is 6-9 percent[1]. For the children of sick women, the chance of hospitalization jumps to 25 percent[2].

In conclusion: Covid-19 is particularly dangerous for pregnant women who arrive at the hospital, increases their chances of reaching the intensive care unit and being connected to ventilators, increases the risk of the baby being hospitalized in the neonatal intensive care unit and premature birth. The risks are especially high for pregnant women with underlying diseases and overweight and increases with the age of the child.

Given this diagnosis, it is possible to understand why pregnant women are considered a population at risk in the eyes of the various ministries of health. The guidance from the World Health Organization is to assume that carriers of Covid-19 may need special medical assistance and it is important that they and their babies receive the same assistance if necessary[3].

Can the fetus be infected with the virus?

This is not a simple question, partly because it is difficult to understand whether a newborn baby (and only then can he be tested) was infected during birth from his sick mother, or whether he was infected while in the womb. Either way, the studies show that the chance of infection is very low. In one study from the beginning of 2020, conducted on nine mothers, not a single baby was born infected with the virus[4]. In another study from China, three newborn babies were found to be infected with the virus[5]. And in an October study of 101 babies, only two (2%) were born with the disease or contracted it at birth, and none of them showed signs of distress. It is also worth noting that the babies were not infected during breastfeeding either - which probably means that the virus does not pass through the mother's milk[6]. The Centers for Disease Control and Prevention (CDC) in the United States also agrees with this assessment[7].

Last but not least, similar results come from two viruses similar to the corona virus - SARS and MERS - in which no babies were detected who were infected with the viruses during pregnancy [8].

In conclusion: Fetuses are probably not infected with the virus during pregnancy, and even if they are - the chance of this is very low (at the level of a few percentages).

Are the new strains more dangerous for pregnant women?

It cannot be ignored that the new varieties may be more (or less) dangerous for pregnancy. It's hard to find studies on the subject, because the new varieties are - well, new. However, senior officials at the Ministry of Health in Israel stated just last week that the proportion of pregnancies infected with the British strain of the virus were at a higher risk than those infected with the strain that was more common in the last two waves. As Sharon Elrai-Price from the Ministry of Health said in an interview with Reshet B -

"We are seeing a significant increase in pregnant women in a difficult and critical condition. It can be said that in all the pregnant women that we sequenced genetically, there is actually a suspicion of the appearance of the English variant. ... We have not seen such numbers before."[9]

In general, it seems that the British variety is spreading rapidly in Israel[10]. Seventy percent of the new infections are of the British strain, which means it is much more contagious than the previous strain. If that's not enough, there is preliminary evidence that it is 30 percent more lethal than the 'normal' strains [11]. The good news? Both the Moderna and Pfizer vaccines are effective against the British strain[12]. But, of course, this is only on the condition that you are ready to get vaccinated.

And what about the South African, Brazilian and Californian variety? There don't seem to be any studies regarding their level of risk to pregnant women. If they are similar to the British variety and the Ministry of Health is correct in its assessment of the level of risk for pregnancy, then they will probably be more dangerous as well. But as mentioned - there are no studies.

Does the vaccine protect pregnant women?

The answer to that is almost certainly positive. Pregnant women are still human beings with a functioning immune system, and there is no reason why they will not respond well to the vaccine and develop resistance against the virus. Not only that, but between the second and third trimester, antibodies pass from the mother's bloodstream to the fetus. When the baby is born, the antibodies should continue to protect him for 6-12 months, until his immune system matures. Antibodies can also be passed to the baby during breastfeeding[13].

But here is an important caveat: we still do not know whether the antibodies from the vaccine against the corona virus reach the fetus during pregnancy. There is no reason to think not, and if this is indeed the case - then the vaccine provides protection for both women and young babies against the corona virus.

Is the vaccine safe for use in pregnant women?

Let's start by saying that vaccines, in general, are safe for pregnant women. As the American College of Obstetricians and Gynecologists stated in 2018 –

"There is no evidence of adverse effects on the fetus from vaccinating pregnant women with inactivated viruses, bacterial or toxoid vaccines, and a growing body of data demonstrates their safety. Women who are pregnant or will be pregnant during flu season, should receive an annual flu vaccine."[14]

And what about the vaccine against the corona virus? Here the evidence is murkier. A government committee in Great Britain determined at the end of 2020 that

"There is no known risk associated with giving non-live vaccines during pregnancy. These vaccines cannot multiply, and therefore cannot cause the woman or the fetus to become infected."[15]

It is commonly claimed that the Pfizer clinical study did not include pregnant women, but the truth is more complex. A small part of the women in the study - about ten - who received the vaccine, became pregnant during the experiment. None of them reported complications, but this is such a small sample that it is not customary to rely on it. And yet - there is no reason to think that the vaccine will harm the fetus or the person receiving it. As Dr. Paul Offitt, one of the greatest experts on vaccines today (or at least the most vocal among them) and a member of the advisory panel to the FDA said -

"There is no real or even theoretical risk to pregnancy or the fetus," due to the way Pfizer's vaccine is created[16].

And despite all these statements, the conclusion is clear: there is still no evidence that the vaccine is safe for use in pregnant women... just as there is no evidence that it is dangerous for pregnant women. But there is more than enough evidence that the vaccine is not dangerous to humans in general, and since pregnant women are still mostly part of the human race, there is no real reason to think that we should come to any other conclusions about the dangers of the vaccine for them. And yet, biology is a strange science, and the hidden more than the visible.

Is the vaccine approved for pregnant women?

And here we come to the last line, and the one that differentiates the guidelines in the United States from those in Israel.

Let's start with the recommendations of the CDC in the United States. The organization begins by stating that pregnant women are at a higher risk of developing a serious illness following infection with the virus. There is nothing surprising here - we have already gone over the evidence for this. From there, the CDC continues to detail the safety of the vaccine, noting that no reasons for concern were discovered in the rats that received Moderna's vaccines before and during pregnancy, but the studies with the Pfizer vaccine are still ongoing these days. He adds that

"Experts believe it is unlikely [that mRNA vaccines] are specifically dangerous for pregnant women. However, the actual risks of mRNA vaccines to pregnant women and their fetuses are unknown because the vaccines have not been tested in pregnant women."[17]

And yet, the CDC seems confident enough to recommend that pregnant women who are in a high-risk group - especially medical personnel whose chances of contracting the virus are higher than the average person on the street - get the vaccine. The second relevant group in line to receive the vaccine includes people with underlying illnesses and essential workers[18].

For me, this is important evidence regarding the experts' confidence in the safety of the vaccine, because in practice they recommend that pregnant women get vaccinated if there is a high chance that they will be infected with the virus. In any case, they do not require it - no body requires pregnant women to be vaccinated.

And what is happening in Israel?

the truth? Exactly the same as in the United States. The Ministry of Health recommends that pregnant women consult with their attending physician, who will explain to them what we know about the vaccine and what we don't. After that, the woman will decide what to do.

The only recommendation of the Ministry of Health regarding the administration of the vaccine is also parallel to the United States. The ministry recommends that pregnant women who have a high chance of contracting the virus (such as the medical staff) or who have underlying diseases, get vaccinated as soon as possible to prevent morbidity with a higher probability of complications from the corona virus. The office adds that -

According to experts, there is no biological mechanism that explains the possibility of harm to the mother or the fetus. Shadow of women who were vaccinated without being aware that they were pregnant, no more abnormal phenomena were observed during pregnancy than in a corresponding population that was not vaccinated."

That's it.

Summary

It was a long entry, but I tried to cover all the knowledge we have today - and also clarify what we don't know yet. As I wrote at the beginning - I do not provide recommendations in the record. Every pregnancy is different, and every woman has to decide for herself what to do - but only after being exposed to the information from her attending physician, and perhaps also to the information I have provided here.

Now you decide what to do, and only health.

Dr.Roey Tsezana is a futurist, lecturer and author of the books "The Guide to the Future" and "Those Who Control the Future"

[1] https://pubmed.ncbi.nlm.nih.gov/18021145/

[2] https://www.bmj.com/content/370/bmj.m3320

[3] https://www.who.int/news/item/01-09-2020-new-research-helps-to-increase-understanding-of-the-impact-of-covid-19-for-pregnant-women-and-their-babies

[4] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext

[5] https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763787

[6] https://jamanetwork.com/journals/jamapediatrics/fullarticle/2771636

[7] https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html

[8] https://pubmed.ncbi.nlm.nih.gov/32180426/

[9] https://www.mako.co.il/news-lifestyle/2021_q1/Article-d2d916fcfe32771026.htm

[10] https://news.walla.co.il/item/3413790