Thursday, June 1, 2023

Which Vaccine Is Safe To Give In Pregnancy

Possible Complications Of Covid

Ask a Doctor: Are COVID vaccines safe for pregnant and breastfeeding people?

Pregnant women are considered a vulnerable group for severe illness and complications from COVID-19 infection, which is why they are a priority group for COVID-19 vaccination.

Women who contract COVID-19 whilst pregnant have a higher risk of certain complications compared to non-pregnant women of the same age who contract COVID-19, including:

  • An increased risk of needing admission to hospital.
  • An increased risk of needing admission to an intensive care unit.
  • An increased risk of needing invasive ventilation .

COVID-19 during pregnancy also increases the risk of complications for the newborn, including:

  • A slightly increased risk of being born prematurely .
  • An increased risk of needing admission to a hospital newborn care unit.

Some pregnant women are more likely to have severe illness from COVID-19 compared to pregnant women without these conditions. The conditions are:

  • Being overweight or obese
  • Having pre-existing high blood pressure
  • Having pre-existing diabetes

A multinational study of 2,130 pregnant women in 18 countries found there was a consistent association between having COVID-19 while pregnant and higher rates of adverse outcomes such as maternal death, preeclampsia and pre-term birth compared with pregnant women without COVID-19.

Pregnant women with COVID-19 have a higher risk of certain complications compared to non-pregnant women with COVID-19 of the same age, including:

What Are The Possible Adverse Effects From Covid Vaccines

The COVID vaccines are known to have mild and short-lasting side effects, such as a fever or muscle ache lasting a day or two in non-pregnant people. 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. Because this side effect is so rare, we can’t know the exact risk in pregnancy.

This information on the AstraZeneca vaccine may be less relevant for you now that the JCVI recommends that the Pfizer-BioNTech or Moderna vaccines are offered in pregnancy, where available.

The government has also advised that individuals under the age of 40 should be offered an alternative vaccine to the AstraZeneca vaccine, based on the risk/benefit ratio for that age group.

Vaccine Trials In Pregnant Participants Paradigm

COVID-19s threat during pregnancy is what led vaccine manufacturers to begin trials in pregnant women, says Sandra Hurtado, an obstetrician/gynecologist with McGovern Medical School at UTHealth in Houston, and the principal investigator for the Pfizer/BioNTech clinical trial site there.

Pfizer is recruiting people between 24 and 34 weeks of pregnancy for the international phase two and three placebo-controlled trial that will enroll 351 participants for phase two and 3,660 participants for phase three. The trial focuses on safety and testing antibody levels in participants, in their newborns at birth, and in the infants at six months old. Johnson & Johnson has plans for a trial in pregnant women, but Moderna has not announced plans.

The Pfizer/BioNTech trial includes 83 locations in the U.S., but the trial only started in February. Since the vaccine has been available to pregnant people for several weeks or longer, recruitment is a challenge.

The women who want the vaccine are going to go ahead and get vaccinated, and the women who dont want the vaccine are waiting to be vaccinated later or wont be vaccinated at all, so its difficult to enroll patients, Hurtado says.

Since the trial is focused more on safety than on effectiveness, and since restricting people from getting a vaccine in a pandemic would be unethical, participants will be unblinded one month after delivery and offered the vaccine if they received the placebo, she says.

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Can The Vaccine Affect My Fetus During Pregnancy Or Reach My Baby Through Breastfeeding

The mRNA vaccines work by presenting your body with a small set of genetic instructions for producing the SARS-CoV-2 spike protein. Your body generates the protein and allows your immune system to learn what the protein looks like so it can recognize the protein if you should ever encounter the actual SARS-CoV-2 virus and prepare an immune response to keep you from getting sick. mRNA is extremely short-lived and easily degraded this is why the vaccine must be stored at such cold temperatures and used quickly after preparation. Once the vaccine has been injected into your arm, your body either uses the instructions to make those spike proteins or it rapidly breaks down the small amount of mRNA thats remaining. It is therefore extremely unlikely that any of the mRNA would be able to get into breast milk or into the fetus through the placenta. Additionally, because its so easily degraded, it cannot survive the acidic environment of your babys stomach, so the vaccine itself cannot affect your baby.

The vaccine is made up of mRNA, and contains no live virus. Therefore, it is impossible to contract COVID-19 from the vaccine, or spread the virus to others.

Recombinant Herpes Zoster Vaccine

H1N1 flu vaccines safe during pregnancy

This vaccine should be used with precaution in those who are pregnant , or breastfeeding . The safety and efficacy in individuals younger than 18 years of age has not been studied, and there are limited data on its use in immunocompromised individuals 50 years of age and older.

Refer to Herpes zoster vaccine in Part 4 for additional information.

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The Uk Vaccine In Pregnancy Surveillance Programme

All COVID-19 vaccines given inadvertently from the first day of last menstrual period to any time in pregnancy should be reported to the UK Vaccine in Pregnancy surveillance programme run by the Immunisation Department of UK Health Security Agency.

The objectives of the UK vaccine in pregnancy surveillance are to compile additional information on women who are immunised with specified vaccines whilst pregnant to monitor the safety of such exposures. This data will be used to help better inform pregnant women who are immunised, their families and health professionals who are responsible for their care.

This surveillance is being undertaken in collaboration with the MHRA, the UK teratology information service and with Public Health Scotland, Public Health Wales and Public Health Agency in Northern Ireland.

Increased Risk For Severe Illness From Covid

Although the overall risks are low, people who are pregnant or recently pregnant are at an increased risk for severe illness from COVID-19 compared with people who are not pregnant. Severe illness includes illness that requires hospitalization, intensive care, need for a ventilator or special equipment to breathe, or illness that results in death. Additionally, people who have COVID-19 during pregnancy are at increased risk of preterm birth and stillbirth and might be at increased risk of other pregnancy complications.

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People Who Are Breastfeeding

COVID-19 vaccination is recommended for people who are breastfeeding. In addition, everyone who is ages 18 and older, including those who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future, should get a booster shot. Clinical trials for the COVID-19 vaccines currently used in the United States did not include people who are breastfeeding. Therefore, there are limited data available on the:

  • Safety of COVID-19 vaccines in people who are breastfeeding
  • Effects of vaccination on the breastfed baby
  • Effects on milk production or excretion

COVID-19 vaccines cannot cause COVID-19 infection in anyone, including the mother or the baby, and vaccines are effective at preventing COVID-19 in people who are breastfeeding. Recent reports have shown that breastfeeding people who have received mRNA COVID-19 vaccines have antibodies in their breastmilk, which could help protect their babies. More data are needed to determine what level of protection these antibodies may provide to the baby.6-9

Pfizer And Moderna Vaccines Safe For Pregnant People Major Study Confirms

Ask Dr. Walensky: How do we know the COVID-19 vaccines are safe during pregnancy?

The report strengthens the CDCs recommendation that anyone pregnant be offered the vaccine and sets the stage for more paradigm-changing vaccine trials during pregnancy.

As each of the FDA-authorized COVID-19 vaccines became available, the Centers for Disease Control and Prevention consistently asserted that they should not be withheld from people who are pregnant and want the vaccine. But since all the clinical trials excluded people who were pregnant, no safety data was available for those who had to make that choice.

Now, since tens of thousands of people have chosen to get vaccinated while pregnant, the largest retrospective study yet provides strong evidence of the mRNA vaccines safety during pregnancy. The findings come soon after research confirmed the seriousness of COVID-19 during pregnancy, including an increased risk of preterm birth and stillbirth. Two otherstudies have also shown that vaccinated mothers pass more protective SARS-CoV-2 antibodies on to their newborns than mothers who had COVID-19 while pregnant.

As such, CDC recommends that pregnant people receive the COVID-19 vaccine, Walensky said. We know that this is a deeply personal decision, and I encourage people to talk to their doctors or primary care providers to determine what is best for them and for their baby.

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What Vaccines Should You Get Before Pregnancy

Certain preventable infections can be harmful during pregnancy. That’s why you should ask for a blood test during a pre-pregnancy checkup to find out if you’re immune to these diseases. If you’re not, you should get vaccinated before becoming pregnant. Just be sure to postpone pregnancy for one month because these shots are made from live viruses that can harm your baby.

Why It Is Important For Pregnant Individuals To Get Vaccinated

Data strongly indicate that the benefits of getting a COVID-19 vaccine far outweigh risks for individuals who are pregnant or might become pregnant in the future.

The CDC recently released data showing the highest number of COVID-19-related deaths in pregnant people in a single month was in August 2021. Data also indicate that 97% of pregnant people hospitalized, either for illness or labor and delivery, with confirmed SARS-CoV-2 infection were unvaccinated.

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What Vaccinations Are Recommended Before Pregnancy

If youre thinking about getting pregnant, get a preconception checkup. This is a medical checkup you get before pregnancy to help make sure youre healthy when you get pregnant. At your checkup, ask your provider if you need any vaccinations and how long to wait after getting them to try to get pregnant.

If you have a copy of your vaccination record, share it with your provider. If you dont have a copy, your provider can do blood tests in most cases to find out what vaccinations you need.

Your provider may recommend these vaccinations before you get pregnant:

Principles For Developing Pregnancy Recommendations

H1N1 flu vaccines safe during pregnancy

Formulating policy to guide vaccination of women during pregnancy and breastfeeding is challenging because the evidence-base to guide decisions is extremely limited. In 2008, CDC published Guiding Principles for Developing ACIP Recommendations for Vaccination During Pregnancy and Breastfeeding to provide guidance to help standardize both the process of policy formulation and the format and language of recommendations for pregnant and breastfeeding women to CDC workgroups or subject matter experts developing vaccine statements subsequent to that date.

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What Should I Do If I Develop A Reaction To The Vaccine

Like all medicines, vaccines can cause adverse 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 experiences episodes of shivering or shaking for a day or two. If you develop a fever 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 Medicines and Healthcare Regulatory Agency to monitor side effects and ensure vaccines are safe.

If you are concerned about your symptoms, you can 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 4 days to 4 weeks after any 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
  • new, unexplained pinprick bruising or bleeding
  • shortness of breath, chest pain, leg swelling or persistent abdominal pain

Measles Vaccine During Pregnancy

Measles is the other vaccine-preventable disease on the minds of moms across the country. With measles outbreaks popping up around Canada, many new mothers are facing real concerns about their newborn infants being exposed, says Poliquin. But, babies normally arent vaccinated until theyre about 12 months. In this case, having antibodies already on board is key. Unfortunately theres a catch: the MMR vaccine is live, so if youre already expecting, dont expect your practitioner to offer you a booster.

In general, live virus vaccines are not administered during pregnancy because there is a theoretical risk of infection to the fetus, says Sarah Tranquilli-Doherty, family physician who provides obstetrical care at St. Pauls Hospital in Vancouver. Other live vaccines like the herpes zoster for shingles and oral typhoid are also contra-indicated during pregnancy.

My advice is to see your primary care provider if getting pregnant is even a possibility and talk to them about whether you are immune , says Poliquin. Theres a good chance you received one or two doses of the vaccine in childhood If you got the vaccine, youre probably still protected. If youre not sure if you were immunized, your practitioner may suggest a blood test to see if you have sufficient antibodies. If youre not immune, but already expecting, youll have to wait until after baby arrives to get the vaccine and baby wont get any protection until their 1-year shots.

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Travel Vaccines During Pregnancy

If youre a mom-to-be with wanderlust, you may be wondering about travel vaccines, too. The shot for yellow fever, which is recommended if youre heading to Argentina or Brazil, for example, is one thats not considered safe while youre expecting . But, hepatitis A and B vaccines, which are frequently recommended for vacationers headed to any developing countries, are both OK to receive during pregnancy. I encourage pregnant women to speak with their primary care provider or travel medicine specialist to tailor the discussion to their specific travel needs, says Poliquin. Youll need to address these at least four to six weeks before you travel, to give the vaccines time to take effect.

Some vaccines, like the Bacillus Calmette-Guerin shot for tuberculosis and vaccine for yellow fever, can be passed through breastmilk and as a result are not recommended as long as you are nursing, since they are not considered safe for babies. A small amount of antibody from the flu shot, on the other hand, can be passed through breastmilk to babys benefit since it will safely bolster their immunity to influenza. Smith says shell get the flu shot this fall too, as she always does, since she knows itll give her newborn that extra protection. Were just doing everything we can to prevent having a sick baby, she says.

*name has been changed

Which Vaccines Should Pregnant Women Avoid

Are COVID-19 vaccines safe for pregnant women?

The following vaccines can potentially be transmitted to the unborn child and may result in miscarriage, premature birth or birth defects.

  • Hepatitis A: The safety of this vaccine hasn’t been determined, but it can be given if the benefits outweigh the risks. Women at high risk for exposure to this virus should discuss the risks and benefits with their doctors.
  • Measles, Mumps, Rubella : Women should wait at least one month to become pregnant after receiving these live-virus vaccines. If the initial rubella test shows that you are not immune to rubella, then you will be given the vaccine after delivery.
  • Varicella: This vaccine, used to prevent chicken pox, should be given at least one month before pregnancy.
  • Pneumococcal: Because the safety of this vaccine is unknown, it should be avoided in pregnancy, except for women who are at high risk or have a chronic illness.
  • Oral Polio Vaccine and Inactivated Polio Vaccine : Neither the live-virus nor the inactivated-virus version of this vaccine is recommended for pregnant women.
  • HPV Vaccine: To prevent the human papillomavirus virus .

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Immunization Of Breastfed Infants

Infants who are breastfed should receive all recommended vaccines according to the routine immunization schedule. There is no evidence that the transfer of antibodies in human milk affects the efficacy of live attenuated vaccines in breastfed infants if these are given at the appropriate age.

Infants of breastfeeding women initiating monoclonal antibody treatment after delivery should be immunized according to routinely recommended schedules. Transfer of monoclonal antibodies through breast milk is limited, and the minimal quantities that are ingested are likely to be broken down in the infant’s gastrointestinal tract.

For information on the immunization of infants exposed to immunosuppressive therapy in the womb, whether breastfeeding or not, refer to Immunization of immunocompromised persons in Part 3.

Table 1: Summary of Recommendations for Immunization in Pregnancy and Breastfeeding – Inactivated vaccinesRefer to in Part 4 for additional information.


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