COVID-19 and pregnancy

Opinion piece by Dr Michael Gannon

Pregnant women are at higher risk of complications from COVID-19 disease than non-pregnant women of a similar age. This is true in terms of higher rates of admission to hospital, admission to an Intensive Care Unit and need for ventilation. There is also an increased stillbirth rate, an increased risk of preterm birth and an increased risk of babies being admitted to special care nurseries.

UK surveillance data from February to September 2021 showed 1714 pregnant women were admitted to hospital with COVID-19. Unvaccinated women accounted for 98.1 per cent of cases. Another 1.5 per cent of women had received a single dose of vaccine. Unvaccinated women accounted for 98.7 per cent of women admitted to ICU. 1.3 per cent of women had received a single dose. No ‘double-vaccinees’ were admitted to ICU, proving the effectiveness of the vaccines.

mRNA vaccines such as Comirnaty (Pfizer) and Spikevax (Moderna) have been shown to be safe in pregnant women. Women who are trying to fall pregnant do not need to delay vaccination or avoid becoming pregnant for any length of time after receiving vaccination.

There is no evidence to show an increased risk of miscarriage or birth defects. There is no need to delay vaccination until after the first trimester. There is no evidence to support the myth of any negative impact on fertility.

COVID-19 vaccination is likely to provide protection to newborn babies by transfer of antibodies across the placenta or into the breast milk. Pregnant women are a priority group for COVID-19 vaccination and should all be offered either the Comirnaty (Pfizer) or the Spikevax (Moderna) vaccine.

Other measures such as social distancing, hand hygiene and mask wearing are all important measures to protect against SARS-CoV-2 infection. However, vaccination is the key to prevention of severe disease.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian College of Midwives (ACM) have both urged Fellows and Members to heed the advice issued by the Australian Technical Advisory Group on Immunisation (ATAGI) in recommending that pregnant women are routinely offered mRNA vaccination in pregnancy.

Pregnant women should also be offered mRNA booster shots in line with the national recommendations.

On WA Health’s COVID-19 Maternity Clinical Working Group, we are developing policies and procedures to protect mothers, babies, health care workers and the wider community. At the heart of the various preventive measures are high rates of vaccination to protect the individual patient and the rest of the community more broadly.

Dr Gannon is a Member of the WA COVID-19 Maternity Clinical Working Group, Obstetrics and Gynaecology Head of Department at St John of God Subiaco Hospital and MDA National President.