Vaccine history offers guidance on COVID-19 inhibition in pregnant women

Pregnant women, who are at increased risk of premature birth or loss of pregnancy if they develop a severe case of COVID-19, need the best guidance on whether they should receive the COVID-19 vaccine, according to an article and two obstetricians UT Southwestern. published today in JAMA. These guidelines can take lessons from what is already known about other vaccines given during pregnancy.

In the Viewpoint article, Emily H. Adhikari, MD, and Catherine Y. Spong, MD, describe the availability of safety and efficacy data, basic science of mRNA vaccines, and a long history of provides alternative vaccines in pregnant women worldwide. background for obstetricians to realize the potential benefits of COVID-19 inhibition with their patients.

Vaccines against diseases such as flu and whooping cough have been shown to save lives for new women and babies when given to pregnant women. The pertussis vaccine reduced whooping cough, a potentially fatal respiratory illness in infants, by 85 percent compared with waiting until after pregnancy. Flu vaccination during pregnancy reduced both maternal and infant flu disease by 20 and 30 percent, respectively. While it is not known what level of infant protection may be provided against COVID-19 by maternal vaccination, Adhikari states that there is a protective potential.

In the article, Adhikari and Spong describe how pregnant or lactating women were excluded from clinical trials during the development of COVID-19 vaccines due to vulnerability concerns. As a result, guidance provided by professional bodies on the subject has been limited, leaving physicians with responsibility to discuss the pros and cons with patients based on the benefits of other vaccines. used during pregnancy, evidence from COVID-19 vaccine trials in infertile patients, and basic vaccine science suggest safety for the fetus.

“We still need granular data about safety in pregnancy and data that do not show adverse pregnancy outcomes,” says Adhikari, assistant professor of obstetrics and gynecology at UT Southwestern.

“But without that data, we still have to care for our patients. It’s not something we can wait for,” said Spong, UTSW professor of obstetrics and gynecology, who talks about issue in JAMA’s meaningful panel discussion today at 2pm EST. astern Standard Time.

Both the American College of Dentists and Gynecologists and the Maternal-Feetal Medicine Association have advocated for the administration of COVID-19 vaccines to pregnant or lactating women. The World Health Organization recommended on January 26 not to vaccinate pregnant women with the use of the Moderna vaccine except in select conditions, but three days later they revised the report. to a more permissible language, supporting offering the vaccine to pregnant women at high risk of exposure or comorbidities in consultation with their health care provider. However, the change in language caused great concern despite the fact that no disturbing data were available.

“I am very supportive of any woman who decides to be vaccinated,” Adhikari says. “I fully support that woman ‘s choice. I understand if a woman decides she is not ready for the vaccine, but I also think it is an opportunity for education about vaccines in general. “

Adhikari previously published a study of 3,374 pregnant women, including 252 who had contracted COVID-19 during pregnancy and 3,122 who tested negative. They found no increase in overall adverse fertility outcomes. But among the 5 percent of pregnant women who were hospitalized for COVID-19 respiratory disease, preterm birth increased.

The Viewpoint article reviews the main risks of maternal respiratory illness from COVID-19, and states that prevention is essential.

“Pregnant women, who have severe respiratory distress, who need high oxygen support – some of which have been ingested for months – are the greatest risk for pregnancy,” says Spong, who has Gillette Professor of Obstetrics and Gynecology.

For a broader context, the piece revisits how the RNA vaccines have proven a safe and effective messenger in preventing COVID-19, and that the same technology has been proven in trials for the prevention or treatment of diseases other.

“We are carrying out ongoing data collection to show what we have expected but not shown – that this vaccine is safe in pregnant women, does not cause harm, and will not intermittent any difference in pregnancy outcomes, ”Adhikari says.“ It is important for us to examine that. This will help establish an evidence base that allows the public and clinicians to feel more comfortable with the vaccine. “