PREGNANCY, BREASTFEEDING AND COVID-19 VACCINE

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If 2020 was the year of the “Rona”, 2021 definitely is the year of the COVID-19 Vaccine and the year of hope.

The news of the possible release of a new vaccine came out already during the Christmas season and by the end of the year, the U.S. and the U.K. launched their vaccination campaign, followed by the other countries at the beginning of 2021. They started vaccinating certain recommended groups based on the risk of contracting the infections like healthcare workers and vulnerable people (aged 70 and over, who are extremely clinically vulnerable, and people who live in care homes) (1)

Countries have then developed a campaign with the aim to offer the vaccination to everybody that desire to be vaccinated.

We all know that from almost 200 COVID-19 vaccine candidates developed, only 69 reached clinical trials. In January 2021, only 9 vaccines have been authorized by at least one national regulatory authority for public use. The ones we have heard more and have been offered, especially in US and Europe are Pfizer-BioNTech, Moderna and Oxford-AstraZeneca (2)

As soon as they were released, lots of rumours both positive and negative came out. People asking questions like: Are they safe? Are they going to let us be more vulnerable to get the infection? What are their side effects? How much is their efficacy? Are there any contraindications?

Many of these questions are partially answered and talked on one of our Instagram videos (3), but one thing that has been talked since the arrival of the coronavirus and now with the vaccine, is rather if pregnant women and women breastfeeding could get the vaccine.

Amongst the vulnerable group we could actually put pregnant women, considering pregnancy a very delicate period for the mother and the future baby. The same, breastfeeding is a period where the new-born gets not only nutrition but develops his or her immunization system and the mother have the possibility to transmit the disease if she’s infected. So, there is no surprise that pregnancy and breastfeeding are partially considered contraindication conditions, for now.

Why?

Because of the lack of information and study results we have at the moment. For obvious ethical reasons in the clinical trials made for studying the COVID-19 disease and the vaccines, pregnant women were not involved. The few data that we have are from women that contracted the virus while they were already pregnant and breastfeeding and that have been monitored by clinicians during their hospitalization. Some of the fundings were:

Venous thromboembolism and preeclampsia episodes were higher among women giving birth with COVID compared to women giving birth without COVID, as having preterm birth, tromboembothic event and death (although there were absolute risk difference, absolute death rates and adverse events were very small) (4).
Pregnant women having COVID-19 symptoms were more likely to need intensive care, ventilator, hearth-lung bypass machine and have higher death cases. It is important to know that the overall risk of these complications were low (5).
Risk of foetal malformations has not been documented in pregnant women affected with COVID-19, according to the CDC (6).
There were a limited number of cases available reporting the possibility of passing the virus on foetus or new-born, but the risk appears to be very low (7,8,9, 10).

Considering Breastfeeding and COVID 19:

there are extremely limited evidence that the virus may be present in breast milk.

current evidence suggests that breast milk is not likely to spread the virus to babies.

These and other observational data demonstrate that, while the chances to get these severe health effects are low, pregnant people with COVID-19 have anyway an increased risk to develop severe illness, including illness that results in ICU admission, mechanical ventilation, and death compared with non-pregnant women of reproductive age. Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth.

So, it’s important for pregnant people, and those who live with them, to protect themselves and reduce the risk of getting infected. And it is normal for women to consider critically the possibility to get the vaccination if they are pregnant or are planning to have children during this period. Not because of the nature of the vaccine ( we will continue to stress the fact that mRNa vaccines do not contain the live virus that causes COVID-19 and, therefore, cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with a person’s DNA ) but of the limited information that we have. A conversation between pregnant patients and their clinicians may help them decide whether to get vaccinated or not.

Pros and cons of getting the vaccination should be discussed between women and their healthcare provider. And key considerations should be:

The likelihood of exposure to SARS-CoV-2.
Risks of COVID-19 to them and potential risks to their foetuses.
What is known about the vaccine: how well it works to develop protection in the body, known side effects of the vaccine, etc.
History of the mum of known allergies to treatments and vaccines.

Until additional findings will be available from clinical trials and studies, some limited data on the safety of COVID-19 vaccines administered during pregnancy and breastfeeding are (11):

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data from animal developmental and reproductive toxicity studies : No safety concerns were demonstrated in rats that received Moderna COVID-19 vaccine before or during pregnancy; studies of the Pfizer-BioNTech vaccine are ongoing.
data from monitor reports of the CDC and the Food and Drug Administration (FDA), that will continue collecting any side effect reported from the population.
data on side effects occurring specially after the second dose: these side effects are not expected to be any different for pregnant people than for non-pregnant people.
data on the safety of COVID-19 vaccines in lactating women or on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion: mRNA vaccines are not thought to be a risk to the breastfeeding infant.

The virus is still novel, it develops and changes. But scientist all around the world are getting many good results and are following the disease developments. We know that this article won’t answer all the questions and doubts about this aspect, but we hope it could help you to get an idea what is happening at the moment, what do we know and what do we still have to discover. Despite this uncertainty, there are few key points that we all agree on:

Keep wearing mask
Keep social distancing
Trying to avoid crowding places
Remember to wash your hands specially when you breastfeeding: you should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don’t have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
If you have COVID-19 and choose to breastfeed, wash your hands before breastfeeding and wear a mask while breastfeeding and whenever you are within 6 feet of your baby
If you have COVID-19 and choose to express breast milk use your own breast pump, wear a mask during expression, wash your hands before touching any pump or bottle parts and before expressing breast milk and clean all parts of the pump that come into contact with breast milk.
Consider having a healthy caregiver who does not have COVID-19, is not at increased risk of getting COVID-19 and living in the same home. Any caregiver feeding the baby should wear a mask when caring for the baby

If you are pregnant during the pandemic:

Keep up with all of your healthcare appointments during and after pregnancy: Visit your healthcare provider for all recommended appointments. If you’re concerned about going to your appointments because of COVID-19, ask your healthcare provider what risk assessment procedure is taken to separate healthy patients from those who might be sick.

Get recommended vaccines.

Call your healthcare provider if you have any concerns about your pregnancy or if you get sick

Do not delay getting emergency care because of COVID-19. Emergency departments have steps in place to protect you from getting COVID-19 if you need care.

And most importantly, ensure you give attention or care for your own social, emotional, and mental health:

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Call your healthcare provider if you think you are experiencing depression after pregnancy.
Learn about ways to cope with stress and tips for caring for yourself during the COVID-19 pandemic

Always remember you are not alone and ask for help!

!!!Disclaimer: The information in this article are from research studies and experiences from health professionals working with COVID-19 patients and not our own words. This article is not funded by any individuals or organizations.

PREGNANCY, BREASTFEEDING AND COVID-19 VACCINE

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