COVID-19 VACCINATION FAQS

covid-19 vaccination in pregnancy: faqs and how midwives might answer them

As the trusted health providers for whānau during pregnancy, birth and postpartum, midwives are well placed to provide clear and accurate information about Covid-19 vaccination during pregnancy and the first few weeks with a new baby.

Covid-19 vaccination is strongly recommended during pregnancy, due to the increasing concern about the adverse outcomes in unvaccinated pregnant and early postpartum wāhine infected with the delta variant. College Midwifery Advisor Claire MacDonald teamed up with Covid Immunisation Education Facilitators Jennifer Andrews and Abbey Palmer from the Immunisation Advisory Centre (IMAC) to provide some answers to questions you may be asked when discussing the recommendation to be vaccinated while pregnant.

CLAIRE MACDONALD MIDWIFERY ADVISOR

HOW DO I KNOW THE VACCINE IS SAFE FOR MY BABY WHEN THERE ARE NO LONG-TERM TRIALS?

Comirnaty is safe for the infant; no parts of the vaccine can pass to the baby. Only antibodies from the mother cross the placenta. It’s similar to Boostrix (pertussis containing vaccine), except the Comirnaty vaccine is made by an mRNA technology (McLaurin-Jiang et al., 2021). The safety of the Covid-19 vaccination during pregnancy is understood in two ways. Firstly, there is a large amount of international data showing no increase in adverse pregnancy outcomes in those who are vaccinated in pregnancy compared with unvaccinated pregnancies. In contrast, there is good evidence that Covid-19 infection can be very serious and life-threatening in pregnancy. Secondly, we understand how the vaccine works, and that there is no known mechanism by which the vaccine could harm the baby from a biological and immunological perspective - this is known as ‘first principles’.

CAN THE VACCINE CAUSE MISCARRIAGE/STILLBIRTH/FETAL ANOMALIES/PLACENTAL ANOMALIES?

No. There is good evidence that the vaccine is not associated with any adverse pregnancy outcomes (Zauche et al., 2021a; Dagan et al., 2021).

Covid-19 infection is associated with more severe disease in those who are pregnant. Infection with the virus in pregnancy is also associated with pre-term birth and pathological changes to the vasculature of placenta, that can lead to poor fetal growth and pregnancy complications such as hypertension and preeclampsia, and a higher rate of caesarean section (Zauche et al., 2021b; Kharbanda et al., 2021). So it is far safer to be vaccinated against Covid-19 than to be infected with Covid-19 in

pregnancy.

I’VE HEARD THIS IS AN EXPERIMENTAL VACCINE BECAUSE TRIALS ARE NOT FINISHING UNTIL 2023 – SHOULD I WAIT UNTIL THEN?

Comirnaty is not an experimental vaccine there is lots of safety and effectiveness data after hundreds of millions of doses have been given worldwide (Butt et al., 2021). Clinical trials continue for years after any vaccine has been approved for use, and Medsafe will continue to receive all information from Pfizer as part of an ongoing process. Comirnaty is fully approved by FDA and EMA now. The trials follow long-term effectiveness and secondary endpoints that provide more information about how well the vaccine is performing over time and to help inform other vaccines that may be developed from this platform (Ministry of Health, 2021a). Placebo groups are now being offered the vaccine because it is unethical not to offer them an effective vaccine. Any rare safety concerns related to the vaccine would have been detected by now (and have, like myocarditis) (Ministry of Health, 2021a).

SHOULD I WAIT FOR A DIFFERENT VACCINE INSTEAD OF COMINARTY (PFIZER/BIONTECH)?

mRNA technology has been around for a while. Human trials of cancer vaccines using the same mRNA technology have been taking place since at least 2011. Comirnaty (Pfizer/BioNTech) is a messenger RNA (mRNA) vaccine. The vaccine provides the instructions to our cells to make a protein identical to the Coronavirus surface spike protein. This protein is seen by our immune system as foreign and it then responds, creating memory cells ready for the next time the virus enters our body - either after another dose of the vaccine, or due to infection with the virus (CDC, 2021). mRNA does not enter the nucleus of the cell (where our DNA is), therefore it does not alter DNA (CDC, 2021).

WHAT ABOUT THE PERTUSSIS VACCINATION DURING PREGNANCY? DO I HAVE TO WAIT BETWEEN THIS AND THE COVID-19 VACCINATION?

We are now much more familiar with the side effects of Covid-19 vaccine, therefore other vaccines can be given at the same time, or immediately before or after Covid-19 vaccination. There is no wait time between Covid-19 vaccine and other vaccines (except for Zostavax) (Ministry of Health, 2021b).

DO I EVEN NEED THE VACCINE IF I'M YOUNG AND HEALTHY?

Covid-19 infection when pregnant – or soon after pregnancy - substantially increases the risk of severe disease. When compared with non-pregnant people, Covid-19 in pregnancy increases the risk of admission to an intensive care unit by up to four times. Twice as many pregnant women of the same age with symptomatic Covid-19 die than those with Covid-19 who are not pregnant (Zambrano et al., 2021; Allotey et al., 2021). All those who are pregnant are strongly recommended to get the vaccine. The vaccine protects you and reduces the risk of being seriously ill from Covid-19. It also protects your baby, as there is evidence that babies can get antibodies through the placenta that help protect them from Covid-19 (Dagan et al., 2021). Furthermore, Covid-19 infection increases the risk of pre-term birth, which has long-term consequences for the baby. Being vaccinated reduces the chance of severe Covid-19 infection and therefore pre-term birth.

I PREFER TO USE RONGOĀ OR ALTERNATIVE MEDICINES

The best recommendation is that rongoā or alternative medicines be used alongside the vaccine, rather than in place of it. Rongoā has amazing benefits to overall hauoratanga, especially for wāhine hapū, but current rongoā and alternative medicines do not have the antibodies needed to fight Covid-19 (Te Rōpū Whakakaupapa Urutā, n.d.).

WHĀNGAI Ū (BREASTFEEDING): CAN I GET THE COVID-19 VACCINE?

As with all vaccines on the New Zealand Immunisation Schedule, there are no safety concerns about getting the mRNA Covid-19 vaccine while breastfeeding your baby. By being vaccinated, women can provide some protection against Covid-19 for their babies in their milk (McLaurin-Jiang et al., 2021).

Studies show there are no additional safety concerns or issues with continuing to breastfeed after vaccination (McLaurin-Jiang et al., 2021; Ministry of Health, 2021c).

DOES THE COVID-19 VACCINE AFFECT THE IMMUNE SYSTEM IN WĀHINE HAPŪ?

As we know, the immune system is suppressed in pregnancy to allow for the fetus to develop undisturbed. This puts pregnant people at much higher risk of severe infection if they develop Covid-19. What this also means is that the reactivity and immunogenicity is reduced in pregnancy, so the immune response to the vaccine is not as robust as for those who are not pregnant. However, protective antibodies are still produced at a rate that is high enough to significantly reduce the chances of experiencing moderate to severe disease, along with the highrisk tactics the immune system would deploy if it had not been prepared by the vaccine (Bookstein et al., 2021; Falsaperla et al., 2021).

CAN I GET COVID-19 FROM THE COMINARTY (PFIZER) VACCINE?

Comirnaty is an inactive vaccine. Inactivated vaccines do not contain live viruses or bacteria, and therefore cannot cause disease. You may feel unwell after having the vaccine, but this is a normal, expected response. This tells us your body is working to produce the antibodies to fight the actual disease (IMAC, 2021). square

References available on request.