Covid Immunisation whilst Pregnant or Breastfeeding
Many of my patients are planning pregnancy, currently pregnant or breastfeeding, and they have been asking me about the safety of Covid 19 vaccination in their situation.
The advice about Covid immunisation in pregnancy changed recently; even prior to the current outbreak in Australia. This was based on the large amount of International data we now have on Covid infection and immunisation in pregnancy and during breastfeeding.
Immunisation during pregnancy
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Technical Advisory Group on Immunisation (ATAGI) recently released a joint statement recommending that all pregnant women be offered immunisation against Covid 19 with the Pfizer vaccine.
Prior to this change, the previous advice was to consider each pregnant woman’s individual risk/ benefit for vaccinating- it was offered to pregnant women who had a medical condition or occupation that put them at increased risk of Covid 19 infection, and for other women it was considered reasonable to delay until after pregnancy.
This advice has now changed, in line with recommendations Internationally including in the UK, US and in Canada. This is because we now know that:
1. Pregnant women are at increased risk, compared to non- pregnant women of the same age, of
a. Getting infected by Covid 19
b. Experiencing severe Covid 19 infection, including the need for ICU admission and
c. Delivering their baby prematurely due to complications of Covid 19 infection and its’ treatment
This is because of pregnancy- related changes to a woman’s respiratory system and immune system.
2. There is NO evidence of harm from the Covid 19 vaccination to a pregnant women or her foetus. It is important to know that:
The actual vaccine components are broken down almost immediately after a woman is immunised, and as such they would not be passed on to the foetus through the placenta. There has been NO evidence of teratogenicity (ie harm caused to the foetus) from the vaccine itself
However, when a woman makes antibodies (immunity) against Covid 19 following vaccination, these ARE passed through the placenta and as a result the foetus receives passive immunity against Covid 19 and is protected if they are later exposed
The main risk or harm that can come from the immunisation during pregnancy is relating to the side effects for the mother, which is usually mild and self- limited. Side effects include fever, tiredness, feeling generally achey and unwell and a local reaction at the vaccination site. Typically Panadol, fluid and rest are all that are required.
When considering the risks vs benefit of immunisation during pregnancy, it is clear why the advice has changed and that all pregnant women should be offered immunisation. This is even more so during the current outbreak in Australia, in which there is a higher risk of being exposed to Covid 19 in the community.
Immunisation during breastfeeding
From extensive international data we can see that there is NO evidence of harm to a woman’s breastfed baby if she receives a Covid 19 vaccination whilst breastfeeding.
As with vaccination during pregnancy, the main risk or harm is relating to common vaccine- related side effects that might make a breastfeeding mother feel unwell and/ or may result in a temporary reduction in breastmilk supply. There is some evidence that the reduction in supply is more prominent in the breast which is on the same side as the arm that the vaccine was given. As a result, some women have requested to have the vaccination given in their leg instead.
We do know that when a breastfeeding mother receives the covid 19 vaccination that antibodies against Covid 19 are found in her breastmilk. It is unclear whether the baby absorbs these through their gastrointestinal tract- the specific sub-type of antibodies that are made in response to Covid 19 might be broken down in the infant’s gut before they are absorbed into the body.
Which immunisation should you receive?
The current recommendation is for pregnant and breastfeeding women to receive the Pfizer vaccination. This is in line with the preference for all women of childbearing age to have the Pfizer vaccination. If a breastfeeding woman would like to consider receiving the AstraZeneca (AZ) vaccination in order to be immunised sooner, she can discuss this with her GP. There is insufficient data available to offer AZ during pregnancy, but this may change in time.
Currently in Australia, the Therapeutic Goods Administration (TGA) recommends that people receive the same vaccination for both doses (ie should not have one of each)- international Data suggests that receiving two different vaccinations is safe and possibly MORE effective, but this is not currently TGA approved in Australia. The recommended interval between the 2 doses of the Pfizer immunisation is 3 weeks.
Please don’t hesitate to book an appointment to see me should you require further support and discussion about your Covid19 vaccination decision.
