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Friday, March 5, 2021

Coronavirus and pregnancy: 12 questions and answers about Covid-19 vaccine

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Women who are expecting a baby or trying to have a baby through assisted reproduction are concerned about the safety of the SARS-CoV-2 coronavirus vaccine.

The key recommendation by scientists from the European Center for Disease Prevention and Control (ECDC), the American Society for Reproductive Medicine (ASRM), the European Society for Human Reproduction and Embryology (ESHRE) and the Greek National Vaccination Committee is that women should not be vaccinated. with the COVID-19 vaccine during their pregnancy.

However, there are many parameters around this major issue that concerns many women in our country, and Dr. Vassilios G. Koufomichael, Obstetrician - Gynecological Surgeon Msc. University of Athens and specialist in Assisted Reproduction clarifies the landscape, answering key questions.

Is the COVID-19 vaccine safe in pregnancy?
The protection of the pregnant woman from infectious diseases is the main concern of gynecologists and for this reason it is treated with special care and sensitivity. After all, there is many years of experience from the flu vaccine. The vaccine against the new coronavirus as a molecule and as a mode of action, seems unlikely to have any burden on either the pregnant woman or the fetus.
The most competent bodies, such as the European Center for Disease Prevention and Control and the National Vaccination Committee of Greece, recommend that the coronavirus vaccine should not be given during pregnancy, not because it is dangerous or because it increases the likelihood of causing pregnancy disorders and the fetus, but because clinical safety and efficacy studies did not involve groups of pregnant or lactating women.

What do scientific studies show about vaccinating pregnant women against COVID-19?
Clinical studies on the efficacy and safety of the two vaccines that have received the required marketing authorization to date (Pfizer / BioNTech and Moderna) did not include groups of pregnant women. Both pregnant and lactating women were excluded from the initial phase III trials of these two vaccines, so no specific safety data are yet available.

I am one of the first to be vaccinated in Greece with the first dose of the vaccine but now I think I am pregnant. What should I do until newer data is safe?
If the vaccine has been given, termination of pregnancy is not recommended under any circumstances. If the first dose has been given, the second is reserved after the end of the pregnancy.

I have been vaccinated against coronavirus and I want to plan my pregnancy. Should I wait?
The original recommendation was that a woman can start the two-dose vaccination program now, but avoid becoming pregnant for at least two months after the second dose. This recommendation was revised a few days ago and after the vaccination can be planned at any time for a pregnancy.
However, because infertility treatment data are limited in relation to coronavirus, it is recommended to postpone the start of the procedure, ie sperm collection, ovarian stimulation and embryo transfer for at least a few days after the completion of the second dose. , mainly so that there is no strong stimulation of the immune system.

How do vaccines work against coronavirus?
The mRNA-based COVID-19 vaccines are not made up of live virus, so they are not believed to pose an increased risk of infertility, miscarriage or congenital anomalies.
MRNA vaccines instruct the body's cells to produce structural parts of the coronavirus, such as the spikes on its surface. Certain cells of our immune system recognize this foreign body and the process of immune response begins, as is the case with natural COVID-19 infection.
However, so far no studies have been performed on the effects of these vaccines in pregnant or lactating women.

How is the COVID-19 vaccine given?
The COVID-19 vaccine is given by arm injection in 2 doses, at least 21 days apart (3 weeks). The vaccine does not contain animal products or eggs and is effective a few weeks after the 2nd dose. Once both doses of the vaccine are given, in most cases there will be protection against the coronavirus. According to the data so far, the effectiveness of the vaccine is 90-95%.

Are there any side effects from the COVID-19 vaccine?
Most side effects are mild and last for up to a week. These are usually:

  • Mild pain at the injection site
  • Feeling tired
  • Headache and myalgias in various parts of the body.
    If necessary, contact your doctor for an analgesic.

I am allergic and now during pregnancy I am more sensitive to allergens. Am I at risk of a severe allergic reaction if I get vaccinated?
All vaccines pose a risk of allergic reactions and rash.
Although the number of vaccinated patients who developed anaphylaxis was small, most had a history of severe allergic reactions and developed symptoms of anaphylaxis within 15 minutes of vaccination.
That is why all the competent health bodies worldwide recommend to the vaccinated people to stay for monitoring in the vaccination center for 15 minutes after the vaccination and 30 minutes for those who have a history of allergic reaction.
In case of pregnancy, your personal doctor will inform you responsibly.

I am in the 1st trimester of pregnancy. What should I do if I develop a fever after vaccination?
One of the rare side effects of COVID-19 vaccination is the onset of fever, which should not be a concern for either the vaccinator or the doctor.
While fever during pregnancy - especially during the first trimester - has been associated with an increased risk of neural tube defects, a recent study showed that this association is not significant if a pregnant woman is taking folic acid, which most women around the world follow. during their pregnancy.
The pregnant woman should contact her doctor for any antipyretic medication.

I am pregnant and due to the nature of my work, I am constantly exposed to the virus. Should I get vaccinated for coronavirus or not?
The risks of coronavirus infection itself for the pregnant woman, but also for the fetus should be weighed. So in this case, the scales will close in favor of vaccinating the pregnant woman.

I am pregnant and I have an underlying disease. Should I get the coronavirus vaccine or not?
Many women who are pregnant or planning to become pregnant through assisted reproduction or IVF have additional risk factors such as obesity, hypertension or diabetes, conditions that increase the risk of serious COVID-19 disease. In this case, too, the benefits of vaccination outweigh the benefits.

Does COVID-19 vaccination affect breastfeeding?
MRNA-based COVID-19 vaccines do not affect the pregnant woman, the fetus, or the baby when breastfeeding. Therefore, no baby or woman needs to be deprived of breastfeeding.

We are at the beginning of the end for this difficult period that all humanity is experiencing, thanks to the vaccines that have been developed, says Mr. Koufomichael. But until the coronavirus becomes a manageable virus, like the flu viruses, we must meticulously adhere to the protective measures of using a mask, washing our hands frequently, and avoiding social contact as much as possible. Expectant mothers in particular should be very careful and follow the instructions and advice of their doctor.

Nina Komninou

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