✓ Yes to the anti-covid vaccine in pregnancy

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The U.S. Centers for Disease Control and Prevention have updated guidelines on anti-covid vaccines in pregnancy, now officially recommended. All pregnant women would be offered the Pfizer or Moderna vaccine based on their age and clinical risk group after data from the United States showed that around 90.000 pregnant women had been vaccinated with no safety concerns. Pregnant women, who were previously advised not to take the vaccine due to a lack of data on the impact, will be able to have it at any time. Green light to anti-covid vaccines in pregnancy then in the USA and UK.

Anti-covid vaccine in pregnancy: the green light in the US and UK

The new guide says that women who are trying to get pregnant, have recently had a baby or are breastfeeding can be vaccinated with any injection, depending on their age and clinical risk group.

JCVI Prof Wei Shen Lim said women should discuss the risks and benefits with their doctor and those at greatest risk should accept the vaccination offer promptly.

"There have been no specific safety concerns from any brand of Covid-19 vaccine in relation to pregnancy," she said. "There is more real-world safety data from the United States regarding Pfizer / BioNTech and Moderna vaccines in pregnant women, so we recommend preferring these to be offered to pregnant women."

Dr Mary Ramsay, head of immunization at Public Health England (PHE), said the data provided "confidence that [mRNA vaccines] can be safely offered to pregnant women." Dr Edward Morris, president of the Royal College of Obstetricians and Gynecologists (RCOG), said vaccination offered pregnant women the best protection from Covid.

"We believe it should be a woman's choice whether to have the vaccine or not after considering the benefits and risks," she said. "This move will allow all pregnant women in the UK to make the right decision for them, at the same time that the non-pregnant population in their age group will receive protection from Covid-19."

Anti-covid vaccine in pregnancy: few differences

The preliminary study, published in the New England Journal of Medicine, is based on data from over 35.000 pregnant women who received one of two mRNA vaccines. The reports were entered from December 14, 2022 to February 28, 2022 in three different federal databases where it was possible to report any reactions to vaccines and enter information on one's health status.

Vaccinated pregnant women reported injection site pain more frequently than non-pregnant women, but fewer symptoms such as headache, chills, muscle pain or fever. Pregnant women did not report intense reactions more often than the other vaccinated: the only symptom that appeared slightly more frequently was nausea, especially in the days following the second dose.

The lack of evidence was largely due to the fact that pregnant women are often excluded from clinical trials, although some women became pregnant after receiving the vaccine. Several investigations are underway to specifically examine the use of the vaccine in pregnant women.

The risk of thrombosis

On 7 April, following concerns over a rare blood clotting syndrome that had been identified in some recipients of Covid vaccines, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) released new advice regarding the Oxford vaccine / AstraZeneca, including a note for pregnant women. "Pregnancy predisposes to thrombosis, so women should discuss with their doctor whether the benefits of having the vaccine outweigh the risks to them," the MHRA said. The JCVI has also recommended that all healthy children under 30 in the UK be offered an alternative to the AstraZeneca vaccine.

Anti-covid vaccine in pregnancy: in Del Paese

As for the country, however, the information provided by the Del Paesen Obstetric Surveillance System (ItOSS) of the Istituto Superiore di Sanità (ISS) as of January 31, 2022 are as follows:

pregnant and lactating women were not included in the Pfizer-BioNtech mRNA (Comirnaty), Moderna and AstraZeneca vaccine evaluation trials so we do not have safety and efficacy data for these people;
the studies conducted so far have not shown or suggested biological mechanisms that can associate mRNA vaccines with adverse effects in pregnancy and laboratory evidence on animals suggests the absence of vaccination risk;
currently pregnant and breastfeeding women are not a priority target of the COVID-19 vaccination offer which, to date, is not routinely recommended for these people;
from the data of the ItOSS study - relating to the first pandemic wave in the country - it emerges that pregnant women have a low risk of serious maternal and perinatal outcomes and that previous comorbidities (hypertension, obesity) and non-Del Paesena citizenship are significantly associated an increased risk of serious complications from COVID-19;
vaccination should be considered for pregnant women who are at high risk for serious complications from COVID19. Women in these conditions must evaluate, with the healthcare professionals who assist them, the potential benefits and risks and the choice must be made on a case-by-case basis;
if a vaccinated woman discovers that she is pregnant soon after vaccination, 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 can postpone the second dose after the termination of pregnancy, except for those at high risk.

Article sources: cdc.gov, gov.uk, salute.gov

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