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Q&A: Answering questions on the Covid vaccine and pregnancy

covid vaccine pregnancy questions and answers

Nicola Sturgeon has urged pregnant women to get vaccinated against Covid-19.

More than 4,000 pregnant women in Scotland had already been vaccinated and the first minister said the evidence regarding safety was “overwhelming”.

She added that the jag will help protect the expecting mother and to the baby.

The Joint Committee on Vaccination and Immunisation (JCVI) says it should be available to every pregnant woman in the UK.

The Royal College of Obstetricians & Gynecologists (RCOG) reported that some women in their third trimester of pregnancy (over 28 weeks) are at a higher risk of becoming unwell if they contract Covid.

But the change in advice has raised a lot of questions and concerns among expectant mothers.

On the back of these questions and concerns,the RCOG has provided the following answers to the most pressing covid vaccine pregnancy questions weighing on people’s minds:

Q. Which pregnant women are being offered a Covid-19 vaccine?

The Joint Committee for Vaccination and Immunisation (JCVI) updated their advice on April 16, 2021, and are now advising that all pregnant women should be offered the Covid-19 vaccine at the same time as the rest of the population, in line with the age group rollout.

Previously, their advice was that pregnant women at high risk of exposure to the virus, or with high-risk medical conditions, should consider having a vaccine in pregnancy.

The following groups of pregnant women are being offered the vaccine:

  • High-risk medical conditions who have a greater risk of severe illness from Covid-19.
  • Health or social care workers – who are at very high risk of catching the virus.
  • Individuals considered at high risk of the virus because of health and personal factors that include age, ethnicity, BMI and underlying health conditions.
  • Women diagnosed with gestational diabetes in pregnancy or pregnant women with a BMI of more than 40.
  • The age bracket being offered vaccines in the general population.

The benefits and risks of the vaccine in pregnancy should be considered on an individual basis.

If you are eligible for and have been offered a Covid-19 vaccine, the decision of whether to have the vaccination in pregnancy is your choice.

You may want to discuss your options with a trusted source like your doctor or midwife.

Q. I am a pregnant healthcare worker and have been offered a Covid-19 vaccination, what should I do?

Since December 31, 2020, pregnant women who are frontline health or social care workers, including carers in a residential home, have been able to discuss the option of vaccination.

This is because the risk of exposure to COVID-19 may be higher, even if they have a low risk of experiencing complications if they are otherwise well.

If you are eligible for and have been offered a vaccine, the decision of whether to have the vaccination in pregnancy is your choice.

The risks and benefits of vaccination will need to be assessed on an individualised basis. This may include factors such as your ethnicity, whether you are overweight or obese, any underlying health conditions you may have as well as occupational exposure and ability to socially distance at work.

Public health advice says, until further data are available, those who are vaccinated should continue to observe all current guidance, such as social distancing and the wearing of personal protective equipment.

If you are a pregnant health or social care worker, having a vaccine will not change your occupational risk assessment.

This includes not working in high-risk areas if you are 28 weeks pregnant and beyond, or if you have an underlying health condition.

Q. What is the advice on going to work if I am pregnant and have been vaccinated?

According to the government’s advice for pregnant employees, employers must carry out a risk assessment for pregnant employees taking into consideration the RCOG/RCM Guidance on Coronavirus in pregnancy. Employers are still required to carry out a risk assessment whether an employee has been vaccinated or not.

Q. Is the vaccine safe and effective in pregnant women?

There is limited UK data on Covid-19 vaccination and pregnancy.

However, robust real-world data from the United States – where over 100,000 pregnant women have been vaccinated mainly with mRNA vaccines, such as Pfizer-BioNTech and Moderna – have not raised any safety concerns.

For this reason, the JCVI advises that it is preferable for the Pfizer-BioNTech or Moderna mRNA vaccines to be offered to pregnant women in the UK, where available.

The large clinical trials which showed that the vaccines are safe and effective did not include pregnant women.

As the Covid-19 vaccines were not tested in pregnant women, we cannot say for sure that they work as well in pregnant women as they do in other adults.

However, there is no reason to think that the vaccines will not protect pregnant women effectively against the virus. Also, there is no reason to think that the vaccine will have worse side effects in pregnant women.

Covid-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccine causes harm to the pregnancy or to fertility.

The Covid -19 vaccines that we are using in the UK are not “live” vaccines and so cannot cause Covid-19 infection in you or your baby.

Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough). Pregnant women are offered other non-live vaccines, such as those against flu.

Q. What are the side effects from Covid vaccines?

In non-pregnant individuals, the Covid vaccines are known to have mild and short-lasting side effects, such as a fever or muscle aches lasting a day or two. Reports of serious side effects, such as allergic reaction or clotting problems, have been very rare.

Regarding serious blood clots, the JCVI has stated that “there are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine”.

This means that someone is not necessarily at higher risk of this serious side effect just because they have a higher risk of other blood clots, for example, because they are pregnant.

However, because this side effect is so rare and has not been reported in any pregnant women, we can’t know the exact risk in pregnancy.

Q. What are the benefits of vaccination in pregnancy?

Vaccination is effective in preventing Covid-19 infection.

More than half of women who test positive for Covid in pregnancy have no symptoms at all but some pregnant women can get life-threatening illness from the virus, particularly if they have underlying health conditions.

In the later stages of pregnancy, women are at increased risk of becoming seriously unwell with Covid.

Contracting the virus can also affect the pregnancy. A recent UK study found that pregnant women who tested positive in England at the time of birth had higher rates of stillbirth or a preterm birth; however, the actual increases remain low.

We have known for some time that women with Covid in late pregnancy are two to three times more likely to give birth prematurely, which can affect their baby’s long term health.

The benefits of vaccination include:

  • reduction in severe disease for the pregnant woman
  • reduction in the risk of stillbirth and prematurity for the baby
  • potentially reducing transmission to vulnerable household members.

Q. When in pregnancy can I have the vaccine?

The vaccine should work at whatever stage of pregnancy you are in.

The JCVI advises that individuals do not need a pregnancy test before vaccination, and that women planning a pregnancy do not need to delay pregnancy after vaccination.

However, some women may choose to delay their vaccine until after the first 12 weeks (which are most important for the baby’s development) and plan to have the first dose at any time from 13 weeks onwards.

With a higher risk of babies being born prematurely if Covid-19 is caught in the third trimester (after 28 weeks), women may wish to have the vaccine before their third trimester.

Q. Does it matter which vaccine I have?

The JCVI’s advice published on April 16, 2021, advises that it is preferable for pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna mRNA vaccines, where available.

If you have been offered the vaccine, you may wish to discuss the benefits and risks with a healthcare professional, including a discussion of potential side effects.

For pregnant women, those who have recently had a baby or those about to start – or who have started – fertility treatment, this discussion should cover the different types of vaccine available, and possible side effects.

This includes the extremely rare side effect of blood clots.

The JCVI statement said: ‘There are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine.’

“The advice to offer an alternative vaccine for those under 40 years old is based on the relative benefits and risks of the vaccine in each age group, as represented in the joint briefing slides.”

Q. I have already had one dose of the AstraZeneca vaccine prior to or earlier in my pregnancy.
I am now pregnant and due my second dose. What should I do?

If you have received a first dose of AstraZeneca vaccine, and subsequently become pregnant, you should be given the opportunity to discuss with your obstetrician, midwife or GP, your decision on whether to have your second dose.

On April 7, 2021, the JCVI said there are “no reports of the extremely rare” blood clots of those who had their second dose of the AstraZeneca vaccine.

All those who have received a first dose of the AstraZeneca vaccine should continue to be offered a second dose, irrespective of age and including pregnant women.

The safety of mixing different vaccines is being investigated in an ongoing trial (the ComCov trial), which does not include pregnant women.

Q. Can I participate in a vaccine trial or vaccine study while I am pregnant?

One trial of the vaccines in pregnant women in the UK has launched and two others are planned.

A clinical trial by the vaccine manufacturer Pfizer has launched across several National Institute for Health Research (NIHR) sites in the UK.

Women who participate in this study will be randomly assigned to receive either the vaccine or a placebo. Those who received the placebo will then be offered the vaccine once they give birth, so that all the women participating will have received the vaccine either in pregnancy or shortly after giving birth.

The role of this study is to provide more robust information on the vaccine immune response in pregnancy, as well as safety reporting and the potential transfer of maternal antibodies to infants.

Another study is planned by the vaccine manufacturer Janssen, and is called HORIZON1.

In that study, all the women who participate in the trial will receive the vaccine (no one will get a placebo).

This study aims to recruit 400 women worldwide (including about 50 in the UK). The HORIZON1 study is currently paused while reports of rare blood clots with this vaccine are investigated.

Q. Can I have a COVID-19 vaccine if I am breastfeeding?

The JCVI advice says there is no known risk in giving available vaccines to breastfeeding women.

Breastfeeding women will now be offered vaccination at the time when they become eligible.

Although there is lack of safety data for these specific vaccines in breastfeeding, there is no plausible mechanism by which any vaccine ingredient could pass to your baby through breast milk. You should therefore not stop breastfeeding in order to be vaccinated against Covid-19.

Q. Should I have the vaccine if I plan to become pregnant?

The most recent JCVI advice says that women who are trying to become pregnant do not need to avoid pregnancy after vaccination.

If you are in one of the groups offered the vaccine, getting vaccinated before pregnancy will help prevent Covid-19 infection and its serious consequences. In some cases, women will need to make a decision about whether to delay pregnancy until after the vaccine becomes available to them.

The JCVI advice around vaccines in younger age groups should be followed for those who are planning to get pregnant.

Q: I am currently trying to get pregnant. I have had the first dose of Covid-19 vaccination, should I delay pregnancy until after the second dose?

One dose of the vaccine gives you good protection against infection, but it is thought that this is not long-lasting​ and may not protect you for the whole of pregnancy. If possible, we recommend that you complete the course of vaccination before you become pregnant.

If you find out you are pregnant after you have had one dose of the vaccine (between doses), it is your choice to either have the second dose after the recommended interval, to wait until after 12 weeks of pregnancy (which are the most crucial weeks for the baby’s development) or defer until after pregnancy.

Q. Can I have the vaccine during IVF treatment?

Yes, you can have the COVID vaccine during IVF treatment.

The British Fertility Society recommends considering the timing of your vaccine and to separate the date of vaccination by a few days from some treatment procedures (for example egg collection and embryo transfer in IVF).

This is so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure.

Q. Is the Covid vaccine safe if undergoing immune therapy during IVF?

A minority of women going through IVF receive immune suppressant therapy. None of the vaccines used in the UK are ‘live’ vaccines, and so cannot cause COVID-19 infection, even in women taking immune-suppressing treatments.

However, the vaccine may provide less protection as these treatments may reduce the level of anti-Covid antibodies produced by the body in response to the vaccine.

It might be preferable, therefore, to delay having the vaccine until the effects of any immune therapy have worn off; or delay your IVF treatment until a few weeks after you’ve had your vaccine.

You should discuss the pros and cons of these approaches with your fertility specialist.

Q. Does the COVID-19 vaccine affect fertility?

There is no evidence to suggest that Covid-19 vaccines will affect fertility.

There is​ ​no biologically plausible mechanism by which current vaccines would cause any impact on women’s fertility.

Animal studies of the Pfizer and Moderna vaccines showed that administering these vaccines in rats had no effect on fertility. Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.

Likewise, the theory that immunity to the spike protein could lead to fertility problems is not supported by evidence. Most people who contract the virus will develop antibody to the spike and there is no evidence of fertility problems in people who have already had the virus.

Q. What if I find out I am pregnant after I have had the vaccine?

If you receive a dose of the vaccine before finding out you are pregnant, or unintentionally while you are pregnant, you should be reassured that it will not affect the vaccine’s success and the risk of harm to your baby is very low.

If you find out you are pregnant after you have had one dose of the vaccine (between doses), it is your choice to either have the second dose after the recommended interval, to wait until after 12 weeks of pregnancy (which are the most crucial for the baby’s development) or defer until after pregnancy.

Q. Are vaccines normally used in pregnancy?

Pregnant women and women who are breastfeeding are already routinely and safely offered vaccines in pregnancy, for example, to protect against influenza and whooping cough.

Many of these vaccines also protect their babies from infection. These vaccines, like the Covid-19 vaccines, are non-‘live’ vaccines, which are generally considered safe in pregnancy. However, specific evidence regarding the safety of the COVID-19 vaccination in pregnancy is not yet available.

The RCOG and RCM, with leading academics across the UK, are calling on the UK Government to fund research studies to establish the suitability of approved COVID-19 vaccines in pregnant and breastfeeding women.

Q. What should I do if I develop a reaction to the vaccine?

Like all medicines, vaccines can cause side effects. These are usually mild and do not last long.

Very common side effects in the first day or two after your vaccine include: pain or tenderness in your arm where you had your injection, feeling tired and headaches, aches and chills.

You may also have flu-like symptoms and experience episodes of shivering or shaking for a day or two. If you develop a fever (temperature 38C or above) you can rest and take paracetamol, which is safe in pregnancy.

You can report any suspected side effects through the Yellow Card scheme, which allows the MHRA to monitor side effects and ensure vaccines are safe.

If you are concerned about your symptoms, contact your GP or maternity team for further advice.

There have been reports of an extremely rare clotting problem associated with people receiving the Oxford/AstraZeneca vaccine. If you experience any of the following from around four days to four weeks after vaccination you should seek medical advice urgently:

  • a new, severe headache which is not helped by usual painkillers or is getting worse
  • an unusual headache which seems worse when lying down or bending over or may be accompanied by: blurred vision, nausea and vomiting, difficulty with your speech, weakness, drowsiness or seizures
  • new, unexplained pinprick bruising or bleeding
  • shortness of breath, chest pain, leg swelling or persistent abdominal pain

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