New Zealand and Australia will now routinely offer the Pfizer coronavirus vaccine to women at any stage of pregnancy, according to an update of vaccination advice. The risk of severe outcomes from infection is significantly higher in pregnant women as compared to the general population and that’s the reason why this research has been conducted.
At the same time, no safety concerns associated with Covid-19 vaccines have been found in the data from pregnant women who have already been vaccinated around the world. This is similar to influenza and whooping cough vaccines given during pregnancy.
The research found that there are no safety concerns for breastfeeding women who received a Covid-19 vaccine, and women trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination.
Prioritising pregnant women
When the vaccine rollout was announced by the New Zealand government in the month of March, pregnant women were designated as a priority in the third group which includes around 1.7 million people who are at higher risk if they catch Covid-19.
As compared to the rest of the population the pregnant women with COVID-19 were more likely to be hospitalized and admitted to intensive care unit and this decision showed the available information at the time from international research. However, the risk of hospitalization is higher to the other priority populations, including people aged between 65 and over, and those with underlying comorbidities or disabilities and people in these groups are also more likely to get very sick if they get Covid-19.
Acknowledging research that places pregnant women in a high-risk group if they were to be infected and hence, New Zealand’s decision was part of a principled strategy that aims to provide fair and equitable care based on scientific evidence.
Changing advice to pregnant women
The Immunisation Advisory Centre initially advised that women at any time of their pregnancy could receive the vaccine, but for those at low risk of exposure are recommended to be delaying vaccination until after birth.
Similar advice has been published earlier by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) that stated women could choose to have the vaccine at any stage of pregnancy, particularly if they were in a high-risk population. But they did not recommend routine universal vaccination if levels of community transmission were low.
So what is has changed since March?
The early advice as local vaccination centres became urgent to be reviewed, as the centres have started vaccinating people in the third group of the rollout. Also, travel bubbles with Australia and the Cook Islands meant people were possibly more exposed to transmission. Other countries such as Canada also started delivering advices on this along with countries like New Zealand and Australia. However, more research is being conducted that is soon to be coming out about the risks of Covid-19 infection in pregnancy, while international experience with mRNA-based vaccines (such as Pfizer-BioNTech) in pregnant women is growing.
Pregnant women were not included in the original clinical trials to test Covid-19 vaccines for safety reasons. But there is no evidence that is found to show any harm associated with the vaccine during pregnancy.
Pregnant women have been actively being involved in the vaccine trials in the US. We can expect research results by the end of this year.
In the meantime, we can be reassured by registries, which are studies that track women who have had the vaccine during pregnancy and have given consent to have information collected about them and their babies. Researchers in the US found women who received the vaccine during pregnancy had outcomes similar to background rates for the mother (regarding rates of miscarriage, diabetes, high blood pressure) and the baby.
However, side effects may be reported in pregnant women and non-pregnant women after receiving the vaccine and it is safe to take paracetamol as needed to manage these.
Other countries, including the UK, have published decision aids to help with this important decision
Research supports routinely offering the vaccine to pregnant women, and it is up to individuals to decide whether to receive it or not, as part of a shared decision-making process with their midwife or doctor.