An increasing number of patients are asking me about COVID vaccination in pregnancy. I strongly suggest you arrange to be vaccinated against COVID.
Safety of COVID vaccination in pregnancy
Some patients are saying they are worried about safety especially for their unborn baby as the vaccine is new and has not been adequately assessed.
In the USA there have been over 130,000 pregnant women who have been vaccinated mainly with mRNA vaccines, such as Pfizer-BioNTech and Moderna. There have not been any safety concerns for pregnant women, their unborn or newborn babies (1,2).
In Australia COVID vaccination is recommended in pregnancy. “RANZCOG and ATAGI recommend that pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy. This is because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.” (3)
In the UK the RCOG states: There are no reported concerns with the AstraZeneca vaccine in pregnancy, but there is less experience in pregnancy with this vaccine, than with the Pfizer and Moderna vaccines, which has led to the JCVI recommending a preference for Pfizer-BioNTech or Moderna (2).
I personally do not believe there any logical reason why you should defer being vaccinated because of safety concerns.
Risks of you getting COVID infection in pregnancy
In contrast to being vaccinated, becoming infected with COVID during your pregnancy is a real risk for you and your baby.
It is reported COVID infection in pregnancy causes increased risk for more severe COVID illness than for non-pregnant women. As well sadly a 38-year-old woman with no underlying health conditions has recently died from COVID infection (4). Additionally, pregnant women with COVID-19 are at increased risk for preterm birth and might have an increased risk of other adverse pregnancy outcomes. (1,2, 3, 5)
In the past it was recommended the pregnant women should not be vaccinated against COVID. That was not based on concern about vaccine safety but because the incidence of COVID in Australia was so low. As well there was no Delta variant at the time of this recommendation. There was not the high and increasing incidence of COVID in the community at the time of this recommendation. While Australia was hesitating, in countries with a higher incidence of COVID such as USA and UK, the vaccine was being rolled out to pregnant women.
Now the Australian Government and RAZCOG recommend pregnant women are vaccinated against COVID-19. Pregnant women are now in the Australian Government priority group for vaccination. (6)
It is logical you should be vaccinated. To be infected with COVID poses a risk for you and your unborn baby. As well, it will be a more unpleasant childbirth experience for you if you have a COVID infection. Staff will be in full COVID PPE, etc. which is much less personable. If you are booked for confinement at Norwest Private Hospital, you will be advised to go to Westmead Public Hospital for confinement. Your husband/partner will not be allowed to be with you. There is the possibly your new baby will be separated from you immediately after delivery.
As well if you do become infected with COVID you most likely will infect other people. This would be especially dangerous if you infected an elderly relative who does not have the same immune strength as you and possibly significant co-morbidities. This is happening now with the current outbreak. People have infected their close relatives who have died. Sadly, those deaths were unnecessary and most likely would not have happened if there had been COVID vaccination. Look what has happened in nursing homes because staff members decided not to be vaccinated, even though they could have been vaccinated in March. This current COVID crisis and all its health (physical and mental) and financial consequences was caused by one selfish ignorant airport driver who deliberately decided not to be vaccinated.
There are risks of adverse reactions to any medication and to any vaccination.
I had one patient who had a life-threatening adverse reaction to (Boostrix) whooping cough vaccine and another who was temporarily paralysed from the waist down after (MMR) rubella vaccine. Another patient had a life-threatening adverse reaction to a general anaesthetic reversal medication. All three patients made a full recovery.
Cases of immune thrombocytopenia have been reported after administration of various vaccines like influenza, measles-mumps-rubella, hepatitis B, and diphtheria-tetanus-pertussis and Pfizer COVID (7). Many people have allergic and potentially life threatening adverse reactions to many medications.
But these possible uncommon serious adverse reactions do not stop people taking medications or being vaccinated.
Which vaccine?
Pfizer is currently the only COVID vaccine approved for use by the Australian Technical Advisory Group on Immunisation (ATAGI) for pregnant and breastfeeding women (1,6).
The reservation with Astra Zeneca (AZ) vaccine has to do with it having been administered to fewer pregnant women than Pfizer (AZ vaccine as it is not available in USA) and with a rare adverse reaction called thrombosis with thrombocytopenia syndrome (TTS). The Australian Government considers the risk TTS, is 3.1 per 100,000 people in your age group (8). Pregnancy has not been found to increase the risk.
In Australia, the total number of cases of thrombosis with TTS is 87 from 6.1 million doses of AZ vaccine administered to date. Only five deaths from TTS have been reported out of 6.1 million doses of vaccine (9). That is less than one TTS death in a million AZ shots.
To put the AZ TTS risk in perspective, the risk of a serious life-threatening complication with childbirth is far greater than the risk of TTS with AZ vaccine. The risk of having a DVT with the oral contraceptive pill or with a long-haul flight is far greater. The risk of dying with some sports or in a car accident is far greater than the risk of dying from TTS with AZ vaccine (10). The risk of death from COVID infection is far greater than the risk of death from TTS after the AZ vaccination.
In other countries there has not been the same the political and media adverse hype about AZ and so overseas communities do not have the same concerns as in Australia. AZ is very popular in many countries and in some countries is the only option. A patient from Ireland told me her 35-year-old sister had AZ, her mother had Pfizer and another family member had Moderna.
The changing political messages and media hype and deliberate media scare campaign and bias reporting about AZ vaccine has given the anti-vaxxers fodder for their anti-vaccination social media campaign and their lies. It has resulted in a fear in the community not supported by medical science. Some members of the community are putting their lives and the lives of their loved ones at risk because they have decided not to have AZ COVID vaccination, even though there is not enough Pfizer available currently. This irrational fear in the community has resulted in increased hospitalisation and even in avoidable deaths because of COVID infection. Remember no one who is fully vaccinated is in hospital with COVID.
As I am fully vaccinated.
I had the AZ vaccine. My wife is having her second AZ vaccine shot at the start of August. My secretary Julie is fully vaccinated, and my secretary Kylee will soon have her second vaccine shot.
Being fully vaccinated means there is only a minor chance I will not get COVID. If I did it would most likely be a very mild infection that would not cause me to be sick or need hospitalisation. I have had a blood test after vaccination which showed I have a high COVID antibody level.
What should you do next?
- Contact your GP for a COVID vaccination appointment. Tell your GP you are pregnant. You will be given priority over many other people in the community (7).
- Ignore the anti-vaxxers posts with their lies on social media. These often-anonymous mischievous people will post fallacious reports with conviction because they are desperate to get normal but fearful people to believe their crazy ideas and erroneous beliefs. There has been an occasional religious leader with credibility in their community making false statements about vaccination. Ignore them. An anti-vaxxer scientist has been using his title and past research which is of dubious relevance to the mRNA vaccines available to try to stop people getting vaccinated. Ignore him. It is tragic as some people will believe these crackpots, not get vaccinated and die or infect someone who dies.
- Ignore incorrect information you may hear from family, friends, work colleagues and acquaintances. Remember it is you, your health, your baby, and your baby’s health at stake.
- Encourage everyone you know – family, friends, work colleagues and acquaintances to be vaccinated. Encourage AZ vaccination for those people where AZ is the preferred option.
- https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafepregnancyregistry.html
- https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19-vaccines-pregnancy-and-breastfeeding/
- https://www.health.gov.au/news/joint-statement-between-ranzcog-and-atagi-about-COVID-19-vaccination-for-pregnant-women
- https://www.smh.com.au/national/adriana-is-not-a-number-sydney-accounting-student-38-the-latest-nsw-coronavirus-death-20210725-p58csi.html
- https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19/what-cdc-is-doing.html
- https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine
- https://link.springer.com/article/10.1007/s11845-021-02614-2
- https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/about-the-astrazeneca-covid-19-vaccine
- https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-22-07-2021
- https://www.news.com.au/world/coronavirus/australia/risk-of-dying-from-astrazeneca-vaccine-blood-clots-exposed/news-story/3b4ed97f89a283df45a1d51c6facf304
