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COVID-19 Vaccination in Pregnant and Breastfeeding Women and those planning pregnancy


Updated Wednesday 18 August 2021


The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the risk posed to the community, healthcare workers, and all patients, due to the COVID-19 pandemic. RANZCOG also recognises our responsibility to respond to this situation as a large organisation, and also as a medical college, and health leader.

The College respects the role of government, health departments and health administrators in coordinating a national response in Australia and New Zealand. The purpose of this communiqué is to provide updated advice on the issue of vaccination for pregnant and breastfeeding women, and those planning pregnancy in Australia, in line with updated advice from The Australian Technical Advisory Group on Immunisation (ATAGI).
 

Key points

 
  • Pregnant women are a priority group for COVID-19 vaccination, and should be routinely offered the Pfizer vaccine (Comirnaty) or Spikevax (Moderna) at any stage of pregnancy. 
  • Pfizer (Comirnaty) and Spikevax (Moderna) are mRNA vaccines
  • Women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination. 
  • There is no evidence of increased risk of miscarriage or teratogenic risk with mRNA or viral vector vaccines.
  • Global evidence has shown that the Pfizer and Moderna vaccines are safe for pregnant women. 
  • Pregnant women have a higher risk of severe illness from COVID-19. 
  • Their babies also have a higher risk of being born prematurely. 
  • COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (for pregnant women) or through breastmilk (for breastfeeding women).
  • All healthcare workers, including midwives and doctors, are encouraged to be vaccinated, to protect themselves, pregnant women, and their babies. The vaccine does not cause “shedding” and vaccinated people are far less likely to transmit COVID.


What are the current recommendations for COVID-19 vaccine in pregnant women? 


Pregnant women are a priority group for COVID-19 vaccination, and should be routinely offered Pfizer mRNA vaccine (Cominarty) or Spikevax (Moderna) at any stage of pregnancy

Pregnant women with COVID-19 have a higher risk of severe illness compared to non-pregnant women with COVID-19 of the same age. This includes an increased risk of:
-    hospitalisation
-    admission to an intensive care unit
-     invasive ventilation. 

COVID-19 during pregnancy also increases the risk of complications for the baby including a higher risk of stillbirth and of being born prematurely.

Vaccination is the best way to reduce these risks.


Women who are trying to become pregnant can receive either Pfizer, Moderna or AstraZeneca vaccines and do not need to delay vaccination or avoid becoming pregnant after vaccination.
 


When is the best time to have a COVID-19 vaccine if I am pregnant?


It is recommended to have a COVID-19 vaccine as soon as you are offered one. Pfizer or Moderna vaccines can be given at any stage of pregnancy. Two doses of Pfizer or Moderna vaccine provides good protection against COVID-19, including against the Delta strain. It is recommended to have 2 doses of the vaccine, 3-6 weeks apart.


Recommendations for women who have already received a dose of AstraZeneca Vaccine.


Pregnant women who have already received a first dose of AstraZeneca vaccine can receive either the Pfizer vaccine or Moderna or the AstraZeneca vaccine for their second dose.
 
  • Research has shown that mRNA vaccines (e.g Pfizer or Moderna) are safe for pregnant women.
  • There is less available data on the safety of viral vector vaccines (e.g Astra Zeneca) in pregnancy, hence the current advice for Pfizer or Moderna. This advice is likely to change as more data on AstraZeneca becomes available.


What are the recommendations for breastfeeding women? 


Vaccination is recommended for breastfeeding women. You do not need to stop breastfeeding before or after vaccination. Either Pfizer, Moderna or AstraZeneca vaccine is considered safe. The mRNA in Pfizer or Moderna is rapidly broken down in the body and does not appear to pass into breastmilk. The viral vector in AstraZeneca cannot cause infection.
 

Other treatments in pregnancy


Pregnant women should continue to receive pertussis and influenza vaccination during pregnancy, noting the advice to space vaccine injections by at least one week.
 
The administration of Anti-D should continue as per usual indications and timing is not affected by vaccination.
 

New Zealand Advice


Ministry of Health

Immunisation Advisory Centre


General Advice


RANZCOG advice aligns with that issued by ATAGI.

Patients can use the Australian Government Eligibility Checker to arrange an appointment.

Pregnant women are eligible for the vaccine, and can use the Australian Government Eligibility Checker to arrange an appointment.

Please note: When using the eligibility checker, pregnant women should tick ‘no’ to AstraZeneca and keep going to the end.

Pregnant women should get vaccinated and continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. Vaccination significantly reduces the risk of becoming infected with COVID. Vaccination also reduces your risk of transmitting the virus to others, including your baby. Everyone should continue with hand hygiene, masks where social-distancing cannot be maintained, testing when symptoms are present and isolation, when appropriate.

RANZCOG emphasises the importance of inclusion of pregnant and breastfeeding women in clinical trials of COVID-19 vaccines to develop evidence-based advice regarding safety and efficacy.

It is not routinely recommended to co-administer COVID-19 vaccine with other vaccines. The minimum recommended interval between COVID-19 vaccine and any other vaccine (including influenza vaccine and whooping cough vaccines) is 7 days.

All medical advice should be patient-centred and take into account each individual’s personal considerations and preferences. 

The circumstances of the COVID-19 pandemic are unprecedented and knowledge is rapidly evolving. RANZCOG will continue to monitor available data and issue updated advice as evidence emerges.

Further information can be found here

A National coronavirus Hotline (1800 020 080) is available to find relevant vaccination clinics. Eligibility for vaccination is determined by the Australian Government and the New Zealand Ministry of Health, and local jurisdictions, and is not within the authority of RANZCOG. 
 

MyAus COVID-19 app


RANZCOG recognises the importance of ensuring multicultural communities throughout Australia have the information they need about the COVID-19 vaccination program, and would recommend members encourage their patients use the Migration Council Australia’s MyAus COVID-19 app.
 
The Council developed MyAus COVID-19 - a multilingual app for Australia’s culturally and linguistically diverse communities about COVID-19, its impact and available support.

MyAus COVID-19 app supports access to information in a user-friendly format, including via short animations. The app is supported by the Australian Government and is currently available in 29 community languages. Available for iPhones and Android.
 

 

Disclaimer

Disclaimer

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is the lead body for women’s health in Australia and New Zealand and carries the responsibility for advice, dissemination of information and support of our members, our patients and the community during the Covid-19 pandemic.

The College respects the role of government, health departments and health administrators in coordinating a national response. Our public statements are made following consultation with officials, and medical experts, and with the understanding that the impacts of the pandemic are evolving, multifactorial and that action in one area will have intended, and unintended, effects on other areas.

RANZCOG will continue to provide information and advice that is the best available, to our knowledge. Given the recency of Covid-19 and the paucity of data, particularly in pregnancy, the accuracy of any advice may be rapidly superseded. We will endeavour to regularly update our communication as new information becomes available. Furthermore, RANZCOG will not comment on areas beyond our remit.

RANZCOG commentary on COVID-19 should be considered advisory, and not proscriptive, and all health workers, and the general public, should heed the advice of government and health authorities.
 

 

 

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