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COVID-19 Vaccination in Pregnant and Breastfeeding Women
 

Updated Monday 22 February 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 College has already issued general advice for healthcare workers and pregnant patients. The purpose of this communiqué is to address the issue of vaccination for pregnant and breastfeeding women. 

Several respected bodies, including Royal College of Obstetricians and Gynaecologists (RCOG), The Society of Obstetricians and Gynaecologists of Canada (SOGC) and Centers for Disease Control and Prevention (CDC) have issued advice on this subject. The experience of the pandemic in other countries has been significantly different. The following advice takes into consideration the low level of community transmission in Australia and New Zealand.

It is expected that the large majority of pregnant women infected with COVID-19 will experience only mild or moderate cold/flu like symptoms. However, pregnant women are potentially at increased risk of complications from any respiratory disease due to the physiological changes that occur in pregnancy. These include reduced lung function, increased oxygen consumption and changed immunity. In particular, pregnant women with co-morbidities are at higher risk of hospital admission, ventilation and severe illness.
 
Currently there is no evidence of an increased risk of miscarriage or teratogenicity. There is a possibility of vertical transmission of the COVID-19 virus and an increased incidence of third trimester premature birth, probably as a result of medical intervention for maternal illness.

Different technologies have been adopted to develop the six major vaccines that have undergone clinical trials. These include the use of novel mRNA vaccines, viral vectors and inactivated viral particles. They do not contain live virus and they cannot transmit COVID-19. They all aim to evoke an immune response against coronavirus. Australia and New Zealand have secured stocks of different vaccines for COVID-19. The following advice is general, recognising differences in regimens and efficacy. It is uncertain as to the extent to which COVID-19 vaccines protect against acquiring the disease, or limit transmission, but initial data has demonstrated reduction in the length and severity of disease if a person were to become infected.

Based on known data from other similar vaccines, it is unlikely that COVID-19 vaccines pose a risk to a pregnant woman or her fetus. However, as pregnant and breastfeeding women have not been included in initial trials, data are very limited and our current knowledge is based on inadvertently exposed patients and the impact of the disease in an unvaccinated population.

Although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy.

However, if a pregnant woman meets the definition of being particularly vulnerable, then she should discuss the option of COVID-19 vaccination with her obstetrician, GP and/or midwife. This is based on the observation that people with certain underlying medical conditions are at very high risk of experiencing serious complications of COVID-19.

The most likely relevant groups of pregnant women include:
 
  • Significant pre-existing medical conditions e.g. diabetes
  • Solid organ transplant recipients
  • Those with chronic respiratory conditions including cystic fibrosis and severe asthma
  • Those who have homozygous sickle cell disease
  • Those receiving immunosuppression therapies sufficient to significantly increase risk of infection
  • Those receiving dialysis or with advanced chronic kidney disease
  • Those with significant congenital or acquired heart disease

  

Pregnant Workforce

RANZCOG recommends that, in settings of high community transmission, health care workers with direct patient contact, and other workers in areas of significantly increased risk of exposure to COVID-19, be allocated to lower risk duties that have reduced risk of exposure to patients with, or suspected to have, COVID-19 infection, working from home or leave of absence. RANZCOG recognises that pregnant women are, appropriately, often anxious about their own health and protective of their unborn baby. Where this is not possible to avoid exposure, pregnant workers who are in an at-risk work environment should be offered vaccination.

All personnel should observe strict hygiene protocols and have full access to adequate Personal Protective Equipment (PPE).
 

Breastfeeding

There are no data on the safety of COVID-19 vaccines in lactating women or on the effects of inactivated vector-based vaccines or mRNA vaccines on the breastfed infant or on milk production/excretion. These vaccines are not thought to be a risk to the breastfeeding infant.
 

Preconception

There is no evidence that women who become pregnant after receiving the vaccine are at increased risk of teratogenicity, miscarriage or maternal illness. Pregnancy need not be delayed after receiving the vaccine.
 

General Advice

All patients who decide to get vaccinated should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. This includes 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.

All pregnant women should continue to be offered immunisation for influenza and pertussis, as per current protocols.

In the setting of high community-prevalence, or high risk of exposure, pregnant women and pregnant healthcare workers should consider isolation to reduce the risk of acquiring the disease. Universal isolation for pregnant women is not recommended at this time.

All medical advice should be patient-centred and take into account each individual’s personal considerations and preferences. In the absence of evidence on the safety or efficacy of the COVID-19 vaccines in pregnant women, the decision to receive vaccination rests solely with the pregnant woman following informed consultation with her midwife and/or doctor.

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.
 

New Zealand

Read New Zealand's Ministry of Health Immunisation Handbook 2020 which includes information on COVID-19 and the COVID-19 vaccines.

 

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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