✓ Covid vaccination in pregnancy

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Recently the Ministry of Health said that Covid vaccination is not contraindicated in pregnancy, but it will not be mandatory either. The Ministry, in fact, has decided to leave freedom of choice to all pregnant women who do not intend to be vaccinated during gestation and has therefore established the creation of a provisional "green pass" which exempts them from vaccination. However, the most important national and international scientific societies insist on the importance of vaccinating future mothers against Covid.

Let's take stock of the situation with the help of the dr. Luca Savelli, Director of the Obstetrics and Gynecology Unit of the Morgagni-Pierantoni Hospital in Forlì.

Covid vaccination in pregnancy

The Istituto Superiore di Sanità (ISS), in the light of the data that emerged, recently published a new official document containing the indications for vaccination against Covid, "recommending the extension of the vaccination offer, with mRNA vaccines, to all pregnant women in the second and third trimesters who want to get vaccinated ". About a month ago the Ministry of Health had already made it known, in a circular, that the anti-Covid vaccination "is not contraindicated" in pregnant women because no important side effects have emerged.

"At the moment there is no scientific evidence of damage to the mother or the fetus" replies Dr. Savelli. "For the first few months we had no data available and pregnant women clearly could not be included in the trials, for this reason vaccination was initially not recommended. Then, however, an increasing number of women got the vaccine during pregnancy, either because they were part of the healthcare staff or because they were considered high-risk patients. The data relating to these women, several tens of miles, were entered in a register and it was immediately noticed that there were no adverse effects or complications neither for women nor for the fetus. For this reason, the scientific societies, first the American ones and then the Del Paesene ones, have decided to recommend vaccination to pregnant women through official documents ".

Read also: Anti-covid vaccination in pregnancy and breastfeeding: there is too much confusion

The American Centers for Disease Control and Prevention (CDC) recently updated their guidelines, arguing that Covid vaccination is recommended for all people 12 years of age and older, including pregnant, breastfeeding and breastfeeding women. trying to get pregnant now or in the future.

In Of the country, the Del Paesena Society of Gynecology and Obstetrics (SIGO), the Del Paeseni Hospital Obstetricians Association (AOGOI), the Del Paeseni University Gynecologists Association (AGUI), the Del Paesena Society of Perinatal Medicine (SIMP), the Society of Paesena di Pediatria (SIP), the Del Paesena Society of Neonatology (SIN), the European Society of Pediatric Resuscitation (ESPNIC) have launched an appeal to the Ministry of Health and national institutions so that vaccination against Covid during pregnancy is promoted and lactating. The mRna vaccines, ie Pfizer and Moderna, the joint document reads, "are absolutely safe for both pregnant women, both for women who are breastfeeding. There are therefore no contraindications to vaccination other than the rest of the population. Furthermore, the vaccine does not affect a woman's fertility, nor is there any reason to postpone a pregnancy ".

It was also shown, in a study published in the journal JAMA, that the Covid vaccine generates a good immune response in pregnant or breastfeeding women and this results in a transfer of protective antibodies from mother to newborn.

The indications of the National Institute of Health

The new document from the Istituto Superiore di Sanità on vaccination against Covid in pregnancy and breastfeeding is now available. Here are the indications of the ISS for pregnant women:

In consideration of the growing evidence on the safety of vaccination in pregnancy for both the fetus and the mother, the new evidence relating to the greater morbidity associated with the Delta variant, the increasing circulation of the same variant and the significant lowering of the median age at infection in Of the country, the ISS recommends the extension of the vaccination offer, with mRNA vaccines, to all pregnant women in the second and third trimester who wish to be vaccinated;
although vaccination can be considered at any stage of pregnancy, there is still little scientific evidence for vaccinations performed in the first trimester. Women who want to get vaccinated during this gestational period must evaluate the risks and benefits together with the healthcare staff;
women at increased risk of contracting SARS-CoV-2 infection and / or at increased risk of developing severe COVID-19 disease (women with risk factors such as age> 30 years, BMI> 30, comorbidities, nationality of Countries with high migratory pressure) remain the priority target for vaccination during pregnancy;
healthcare personnel are required to illustrate as clearly as possible the relationship between risks and benefits, so as to allow each woman to make the most appropriate decision for her case. Healthcare professionals should also recommend vaccination of cohabitants to further limit the risk of contagion of pregnant and breastfeeding women;
if a vaccinated woman discovers that she is pregnant after being vaccinated, there is no evidence in favor of termination of the pregnancy.
if a woman discovers that she is pregnant between the first and second doses of the vaccine she may consider delaying the second dose until the second trimester.

Vaccination in lactation

Breastfeeding women can get vaccinated without any need to stop breastfeeding;
the nursing woman must be informed that vaccination does not expose the infant to risks and allows him to take antibodies against Covid-19 through milk;
the infant suckled by a vaccinated mother follows his vaccination schedule without any changes.

Covid-19 in pregnancy: is it really more aggressive?

In the joint document SIGO, AOGOI, AGUI, AGITE, SIMP, SIN, SIP and ESPNIC, the scientific societies invite the Ministry of Health to try to speed up the anti-Covid vaccination for pregnant women, especially for counteract possible serious risks for this fragile category and for their children. "The most recent scientific evidence shows us that pregnant women have a increased risk of developing severe pneumonia and that the virus, if contracted during pregnancy, can cause damage to the placenta, thus increasing the risk of growth retardation and preterm birth, "said Savelli.

According to a study, published in the journal JAMA Pediatrics, there is even a risk of death 20 times greater in infected pregnant women than in uninfected women, as well as a higher chance of having to be hospitalized in intensive care, preterm delivery and gestational complications, such as preeclampsia.

Although now for pregnant women there is the possibility of apply for exemption for the Covid vaccine, as we will see shortly, the advice of the most important scientific societies remains that of not postponing vaccination and of doing it even during pregnancy.

Read also: Yes to the anti Covid vaccine in pregnancy

Covid vaccination in pregnancy: when can it be done?

"The vaccination could be done at any time, but to be safer it would be better to wait until the second quarter of pregnancy "explains Dr. Savelli. Why? Because about 10-15% of the population develops a fever after the second dose and in the first trimester the fever could cause adverse effects (increased risk of miscarriage)." The pregnant woman can therefore choose to be vaccinated starting from the fifteenth week of pregnancy, while if she was vaccinated before pregnancy, then it is advisable to wait until the second trimester for the second dose "Savelli specifies.

who is looking for a child, on the other hand, there are no problems, quite the contrary! "It is good for women who want a child to program the vaccine given the adverse effects of the virus on the development and function of the placenta."

Vaccination, remember, is highly recommended for pregnant women with potential risk factors such as diabetes, obesity, over 35 years of age.

Read also: Vaccines against Covid-19 in pregnancy, breastfeeding and children

The temporary exemption for pregnant women

The Ministry of Health, in the note of 4 August, specified that in women in nursing o pregnancy vaccination it is not contraindicated. In the second case, however, it is possible to opt for the postponement of the administration after a medical evaluation and at that point "a certificate of temporary exemption from vaccination can be issued".

Covid-19 vaccination exemption certifications will be dispensed in order to allow access to services and activities to subjects who due to a medical condition (including pregnant women) cannot receive or complete the vaccination to obtain a green Covid-19 certification.

The circular also specifies that: "People who obtain an exemption from the anti-SARS-CoV-2 vaccination must be adequately inform about the need to continue to maintain preventive measures such as: using masks, distancing oneself from non-cohabiting people, washing hands, avoiding gatherings especially in closed rooms, respecting the conditions envisaged for workplaces and for means of transport ".

Please note that, up to 30 September 2022, except for further provisions, the certifications may be issued in paper format directly by the vaccination doctors of the vaccination services of the companies and bodies of the regional health services or by general practitioners or paediatricians of free choice. After September 30, 2022on the other hand, the certificate certifying that one is exempt from the vaccine can also be obtained via a computer or smartphone, since the national system for the digital issuance of certifications should be launched.

Read also: Green pass in pregnancy, how to do it?

Sources used: Dr. Luca Savelli, Director of the Obstetrics and Gynecology Unit of the Morgagni-Pierantoni Hospital in Forlì; position papaer SIGO, AOGOI, AGUI, AGITE; information material from the World Health Organization

- Updated on 25.09.2022

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