Concerns for under-vaccinated pregnant population

Morgan Liotta

15/02/2022 3:14:50 PM

Pregnant women remain cautious when it comes to the COVID-19 vaccine, but growing safety evidence should boost uptake.

Pregnant woman getting vaccine
It is estimated that only around a third of pregnant women in Australia are fully vaccinated against COVID-19.

Contracting COVID-19 is a relatively recent addition to the variety of potential risks that can arise during pregnancy.
Despite pregnant women being more at risk of complications from the virus and the widely known benefits of vaccination, experts are concerned that immunisation rates among pregnant women in Australia are still falling behind.
While no official data is available, it is estimated that only around a third of pregnant women are fully vaccinated and a third have had no doses.
Safety concerns are reported as among the top reasons to decline COVID-19 vaccination during pregnancy.
‘Although we don’t have any official numbers on this, my colleagues and I have the sense that pregnant women are an under-vaccinated group, who have been more hesitant than their aged-matched cohorts,’ GP and Chair of RACGP Specific Interests Antenatal and Postnatal Care Dr Wendy Burton told newsGP.
‘This is particularly concerning because unfortunately COVID has an increased risk to both the mothers as individuals but also to their child.
‘Pregnant women are a cautious group when it comes to using medications and immunisations. It’s not surprising, but I do think that we need to be very clear about the fact the recommendation is just getting stronger and stronger.’
The Pfizer vaccine was approved for pregnant women last year with RANZCOG and ATAGI recommending that it be routinely offered at any stage of pregnancy, outlining that the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby. 
RANZCOG released a statement in December 2021 to further promote the safety of the Pfizer vaccine and its role in maximising protection for both mother and baby, stating that there is no evidence of negative impact on fertility, increased risk of miscarriage, stillbirth, preterm birth or other adverse pregnancy outcomes, including during breastfeeding.
The importance of healthcare providers in addressing vaccine hesitancy among pregnant women and promoting the benefits of the vaccine was raised by RANZCOG obstetricians following their own experiences during pregnancy.
Dr Alexandra German spent 12 days in ICU after contracting COVID-19 in December 2021 while 31 weeks pregnant.

She was due to receive her third vaccination on the day she tested positive.
‘I deteriorated and was admitted to ICU,’ Dr German said.
‘It was definitely isolating; my partner could not visit me. You are pretty much locked in a room by yourself. After hospital, I had constant anxiety. I lost significant weight.

‘I was taking all the precautions; I didn’t think it would happen to me.’
While Dr German recovered, the infection slowed her baby’s growth and she is now due to deliver a few weeks early.
Meanwhile, new research has examined the impact SARS-CoV-2 infection can have on the placenta and the role this can play in stillbirth and neonatal death following COVID-19 infection.
The international study, which encompassed 12 countries, examined placental and autopsy pathology findings from 64 stillborn births and four neonatal deaths with placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19.
It identified associations with increased risk of severe disease, hospitalisation, admission to intensive care, prematurity and stillbirth, and revealed that all 68 placentas had conditions constituting SARS-CoV-2 placentitis.
These include increased fibrin deposition, villous trophoblast necrosis and chronic histiocytic intervillositis. In addition, 63 placentas had massive perivillous fibrin deposition, and severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement.
‘To the best of our knowledge all mothers in this cohort were unvaccinated,’ the authors wrote, concluding that pathology abnormalities composing SARS-CoV-2 placentitis cause ‘widespread and severe placental destruction resulting in placental malperfusion and insufficiency’.
Dr Burton said this research further highlights the broad impacts the virus can have, notably in the unvaccinated.
‘We’re seeing more of this now … essentially showing the effect of COVID on the placenta,’ she said.
‘As a multi-system disease, it definitely affects the cardiovascular system, so it’s perhaps not surprising that the placenta could be affected.’
In contrast, there is continually mounting evidence regarding the safety of COVID vaccines in relation to pregnant women and unborn children.
Most recently, a study comparing the outcomes of 16,697 newborn babies born to women who had received the Pfizer COVID-19 vaccine and 7591 whose mother was unvaccinated found no evident differences between the two groups.
The vaccine had no effect on rates of preterm birth, neonatal hospitalisations, post-neonatal hospitalisations, birth defects, or deaths, validating existing evidence of the safety of the vaccine for babies in utero and after birth.
But while there are fears pregnancy vaccination rates trail those of the general population, Dr Burton says her recent experience has been positive, with more pregnant women aware of the risks of infection as well as the safety of the vaccine.
‘My GP colleagues and I have found the conversations [around vaccination] are easiest this year than last year,’ she said.
‘And I suspect that that reflects the increasing prevalence due to Omicron, as it’s no longer a theoretical construct outside Victoria and NSW – it’s real and in your face, and everyone now knows someone on the eastern seaboard who’s had COVID. The danger is proximal.
‘[We also] have a growing evidence base, published peer reviews, showing that the vaccines themselves are safe in pregnancy.’
Dr Burton’s advice for GPs providing care to pregnant women is simple.
Encourage them to please have the vaccine at any stage of pregnancy, planning a pregnancy or in breastfeeding after birth,’ she said.
‘If you’re due have it, if you’re due for your booster have it, do your best to have it, don’t wait.’
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