The COVID-19 vaccine is being rolled out around the world as we continue to fight the spread of the coronavirus, but hasn’t always been entirely clear whether pregnant and breastfeeding women can have the vaccine. Here’s what we know so far…
Despite the recent news that confirmed pregnant women in the UK can now have the COVID-19 Vaccine, there has still been confusion and concerns over offering the jab – following suggestions that people under 40 were advised not to have the AstraZeneca jab. However, the NHS and the UK government have now confirmed the coronavirus booking system will be amended to allow pregnant women to book a specific vaccine.
This comes as ta number of organisations had flagged the seemingly conflicting information being shared and feelings of being passed from ‘pilar to post’ when pregnant women tried to book their vaccine appointments.
According to The Guardian, Pregnant Then Screwed founder and campaigner Joeli Brearley said pregnant women had faced ‘insurmountable challenges’ when trying to access the vaccine, and often faced ‘inaccurate information’ from medical professionals.
“Pregnant women are telling us that this is affecting their mental health,” she added. :The government has had a baby blind spot throughout this pandemic.”
Last month, pregnant women were advised by the UK’s Joint Committee on Vaccination and Immunisation (JCVI) to opt for the Pfizer/BioNTech or Moderna vaccines, however the booking system was not changed to enable people to heed this advice. There will now be a dedicated system in place to allow pregnant women to book a specific vaccine.
Can pregnant women have the COVID-19 vaccine?
This comes as a recent change in guidelines from vaccination advisers suggested Pregnant women in the UK should now be offered the COVID-19 vaccine.
After previous guidelines not to vaccinate pregnant women unless they were at a substantially high risk, the Join Committee on Vaccination and Immunisation has now said pregnant women should all be offered the jab a the same time as other people of the same age.
The JCVI has also stated that the Pfizer and Moderna vaccines would be preferable as data from the US for 90,000 pregnant women administered with those vaccines has not raised any safety concerns.
According to The BBC, pregnant women are encouraged to ‘discuss the risks and benefits of the vaccines with their doctor before making the appointment,’ although this is not an official requirement.
Professor Wei Shen Lim, Covid-19 chair for the JCVI, said: “We encourage pregnant women to discuss the risks and benefits with their clinician – those at increased risk of severe outcomes from Covid-19 are encouraged to promptly take up the offer of vaccination when offered.”
Additionally, Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, states: “Vaccination offers pregnant women the best protection from Covid-19, which can be serious in some women.
“We believe it should be a woman’s choice whether to have the vaccine or not after considering the benefits and risks, and would encourage pregnant women to discuss with a trusted source like their GP, obstetrician or midwife, or a healthcare professional in a vaccination centre.”
Can breastfeeding women have the COVID-19 Vaccine?
As it stands, breastfeeding women can be vaccinated with any vaccine, depending on their age and clinical risk group.
In a recent update, the Joint Committee on Vaccination and Immunisation announced breastfeeding women could have the vaccine, if they are otherwise eligible. Meanwhile, pregnant women are advised not to take it, unless they have been deemed ‘clinically extremely vulnerable.
What about the vaccine and fertility?
In short, the COVID-19 vaccine does not affect fertility, however, a combination of confusing language, misinformation and initial un-founded fears that the antibodies could attack the placenta have lead to concerns swirling about fertility and the vaccine.
According to a public document, released by the government for healthcare professionals concerning the Pfizer/BioNTech vaccine, it claimed that it was ‘unknown’ the COVID-19 vaccine had an affect on fertility.
This guidance has since been updated and now states: “There is limited experience with use of the COVID-19 mRNA Vaccine BNT162b2in pregnant women,” the government explains in the document. It also adds that initial ‘animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity’.
In an attempt to debunk this somewhat confusing language, Dr Victoria Male, a lecturer in reproductive immunology at Imperial College London, told The I that full fertility studies are not generally done on new vaccines or medications before they are rolled out.
She went on to explain that based on the Pfizer efficacy and safety trials and the science behind the vaccine, there is no need for concern: “No one who is serious about vaccines or immunology is worried about this.”
Dr Male also adds that if the claims that the small stretch of amino acids in the spike protein – the part of the virus in the Pfizer vaccine that tells our bodies to attack – was going to attack the placenta, we would have seen this happening when women contracted the vaccine originally.
“We have evidence this doesn’t happen, because we are now seeing people becoming pregnant having had COVID-19 in the spring,’ she confirmed to The I.
Why couldn’t pregnant women have the COVID-19 vaccine in the UK at first?
In an early statement, the Medicines and Healthcare products Regulatory Agency (MHRA) explained, “The clinical trials for the Pfizer/BioNTech Covid-19 vaccine did not include pregnant or breastfeeding women,” resulting in a lack of data surrounding pregnancy, breastfeeding and the vaccine.
With this in mind, the issue is not that the vaccine was deemed unsuitable for pregnant and breastfeeding women, but that there simply wasn’t enough data to prove otherwise.
The statement continued: “Therefore, as a precautionary measure our recommendation is that the vaccine should not be given to pregnant or breastfeeding women until more data is available.
“These judgements reflect the absence of data at the present time and do not reflect a specific finding of concern. Further studies on this are planned, the results of which will be provided when available, and the guidance will be changed accordingly – if appropriate.”
What about breastfeeding women? Why are they grouped with pregnant women?
When it comes to clinical trials, new medicines and vaccinations, breastfeeding and lactating women are usually grouped together with pregnant women. This also the case with the COIVD-19 vaccine.
In updated guidelines published on 30th December 2020, the JCVI also now advises that there is no known risk in giving these vaccines to breastfeeding women.
“Breastfeeding women should therefore be offered vaccination if they are otherwise eligible, for example if they are a frontline health or social care worker, including a carer in a residential home,” the RCOG website claims.
The JCVI does stipulate that women should be advised that there is lack of safety data for these specific vaccinations in breastfeeding.
However, there is some concern that in placing breastfeeding women in the same category as pregnant women when it comes to clinical trials and government guidelines, the advice is too broad. Additionally, in doing so, some medical professionals fear women will thus be under undue pressure to either stop breastfeeding or put themselves at a higher risk of COVID-19 by abstaining from the vaccine.
Speaking to WIRED, Joeli Brearley, founder of Pregnant Then Screwed, a group that campaigning against pregnancy and maternity discrimination, explained: “We’ve been talking to breastfeeding doctors who are really concerned that they feel under pressure to either stop breastfeeding or put themselves at risk of COVID-19.”
What about in America? Reports say pregnant women in the US can have the vaccine.
In excluding pregnant and lactating women from clinical trials, Pfizer/BioNTech and other providers are acting in accordance with US regulators such as Food and Drug Administration (FDA) and the Centres for Disease Control (CDC) as standard with any new medicine or vaccination. However, in the US the decision has been made to recognise these are not normal times.
Instead, regulators in the US have approved the use of the vaccine on pregnant women who are deemed particularly risk, and where the benefits of the vaccine far outweigh the risks to the mother or the foetus.
“The experts came to a consensus view that scientific plausibility of harm just wasn’t there,” Dr Ruth Faden, a bioethicist at Johns Hopkins University told the BBC. Dr Faden went on to stipulate, however that this “doesn’t mean zero”.