Research finds no association between COVID vaccines and miscarriage

‘It’s really reassuring.’
 
That is Dr Wendy Burton, Chair of RACGP Specific Interests Antenatal and Postnatal Care, commenting on new research conducted in the United States on COVID-19 vaccination and miscarriage.
 
Published in JAMA, researchers looked at 105,446 pregnancies, including 13,160 miscarriages and 92,286 pregnancies that were ongoing by the end of the study.
 
Overall, 7.8% of women received one or two doses of Pfizer, 6% received one or more doses of Moderna, and 0.5% received a dose of Janssen in the month prior and before 20 weeks’ gestation, and found no association between vaccination and miscarriage.
 
‘Spontaneous abortions did not have an increased odds of exposure to a COVID-19 vaccination in the prior 28 days compared with ongoing pregnancies,’ the authors wrote.
 
Dr Burton said the findings provide further evidence for GPs to reassure both pregnant women, as well as those planning to conceive, of the benefits of vaccination.
 
‘It’s been a really widespread myth online, which has unfortunately made its way into our maternity services, that there is a problem with fertility associated with the vaccine,’ she told newsGP.
 
‘So it’s really important that doctors are able to confidently rebut that and say, “It’s been looked at and it’s just not happening. There’s no link between the vaccines and fertility, and no link between the vaccines and adverse pregnancy outcomes”.
 
‘We are as confident as we can be that these vaccines are safe to use during pregnancy and while breastfeeding, and we encourage pregnant women to get on and have the vaccines done.’
 
In June the Australian Technical Advisory Group on Immunisations (ATAGI) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) first recommended that pregnant women be routinely offered Pfizer ‘at any stage of pregnancy’.
 
They noted that global surveillance data from large numbers of pregnant women ‘have not identified any significant safety concerns with mRNA COVID-19 vaccines’, and that women who are trying to become pregnant ‘do not need to delay vaccination or avoid becoming pregnant after vaccination’.
 
Meanwhile, there is also evidence of antibody in cord blood and breastmilk, which ‘may offer protection to infants’ through passive immunity.
 
‘We want to reassure pregnant women that COVID vaccines are safe and effective,’ RANZCOG President Dr Vijay Roach said.
 
‘The risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby. It’s critical that pregnant women, their midwives and doctors, are aware of this clear advice, and that pregnant women have access to a vaccine.’
 
Research published in JAMA Pediatrics in April looking at the impacts of COVID infection on pregnant women in 18 countries found they were at a higher risk of preeclampsia/eclampsia, severe infections, ICU admission, preterm birth, maternal mortality, severe neonatal morbidity, and severe perinatal morbidity and mortality.
 
Dr Burton says these very real concerns add an additional layer of anxiety for patients.
 
‘When we add the additional concerns for the baby it cuts both ways in terms of women recognising that protecting themselves from getting COVID helps to protect their baby from complications that might arise if mum’s sick,’ she said.
 
‘It’s also that additional [thought process that] “it’s not just my body that we’re talking about; it’s a baby as well and what does this mean?”.’
 
To further assist GPs in their consultations, Dr Burton suggested a series of resources developed by the Australian College of Midwives, including a free e-learning course.
 
‘It’s for midwives, but it would also be quite suitable if GPs and practice nurses wanted to have a look,’ she said. ‘It just walks through the issues particularly as they pertain to pregnant women.’
 
The GP–patient relationship, Dr Burton says, is ‘of course critical’ in helping women to weigh up the risks and benefits of vaccination, and a pre-existing relationship prior to pregnancy is ideal.
 
‘It means that hopefully we’ve developed that trusting relationship where we can have a conversation that is more than just a generic one,’ she said. ‘I can individualise it for this woman and her family and social context, knowing her medical history.’
 
While many GPs are being proactive in opportunistically asking all patients about their COVID vaccination status, Dr Burton says ‘the timing is right’ to prioritise pregnant women as the allocation of Pfizer doses is expected to increase across general practice over the coming weeks.
 
‘By the time pregnancy was an eligibility criteria, appointments were all booked,’ she said.
 
‘But by the end of the month, we’re seeing a doubling in the number of Pfizer vaccines we’ll have available, [so] we’ll be emailing the 159 pregnant women our database has identified with an offer of Pfizer.’
 
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