The third COVID-19 vaccine – also known as a ‘booster’ – is currently being rolled out across the UK as we continue to fight the spread of the Omicrom variant of the Coronavirus. Now, pregnant and breastfeeding women are being prioritised in the queue to have their vaccines. Here’s what we know so far…
With the news that pregnant women have now been put on the UK’s priority Covid-19 vaccine list, we outline all you need to know about being pregnant and getting the vaccine.
On December 16th 2021, the JCVI – the Joint Committee on Vaccination and Immunisation – announced that all pregnant women were being made a priority group for vaccination. Cathy Tabner, in-house midwife at My Expert Midwife, who has cared for pregnant women throughout the pandemic with Covid-19, has given her expert advice.
“Hospital figures have been analysed and it seems that whilst for most pregnant women, a Covid-19 infection causes a flu-like illness, a third of cases in pregnancy caused severe illness,” says Cathy.
“Covid in the later stages of pregnancy puts women and their babies at increased risk and the latest evidence-based advice is to get vaccinated at any stage of pregnancy to protect you and your baby.
“Between May and October 2021 there were 1,436 women admitted to hospital with Covid in pregnancy and 19% of those gave birth prematurely, and sadly deaths in pregnant women with Covid-19 have been recorded.
“Having the vaccine is now known to be safe from research done during the pandemic on the Pfizer and Moderna vaccines in pregnancy, so any vaccine hesitancy is misplaced, though totally understandable.
“The booster is the same dose of the same vaccine which tops up our protection. Boosters are required after 12 weeks to trigger more antibodies to be made. Antibodies protect us from infection and we need them in high numbers – everyone is different, but most of us will have a diminishing number of antibodies in our bloodstream after three months so no one should delay this vital part of vaccination defence.”
Can pregnant women have the COVID-19 vaccine?
All pregnant women can and should receive the vaccine which comes in two doses given eight weeks apart and a booster given 12 weeks after the second dose, according to Cathy.
“After previous guidelines not to vaccinate pregnant women unless they were at a substantially high risk, the Joint Committee on Vaccination and Immunisation has now said pregnant women should all be offered the jab,” she adds.
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?
“Breastfeeding women can and should be vaccinated too,” says Cathy. “You can even breastfeed your baby whilst having your injection – no vaccine enters your milk supply, only the antibodies you make enter your milk and in so doing protect your baby from infection at every feed.”
As it stands, breastfeeding women can be vaccinated with any vaccine, depending on their age and clinical risk group.
What about the vaccine and fertility?
Cathy says: “The vaccine will not affect fertility and hundreds of thousands of inadvertent, unplanned pregnancies have helped research this fact.
“Anyone trying to conceive or undergoing fertility treatment is advised to get the vaccine without delay as treatment is not affected.”
“There is limited experience with use of the COVID-19 mRNA Vaccine BNT162b2in pregnant women,” the government explains. 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 2020 the novel virus that was identified had to undergo rigorous research and no clinical trials included pregnant people,” says Cathy.
“The situation is totally different now as we approach 2022. We do now have data on pregnant women from a worldwide collaboration with multiple simultaneous trials and no adverse outcomes have been associated with the vaccine you will be offered.”
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.
What about breastfeeding women? Why are they grouped with pregnant women?
“Pregnant and breastfeeding women are often classed as one group,” explains Cathy. “Pregnancy and lactation follow on and after giving birth our bodies take around 3 months to revert to their non-pregnant state.”
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 COVID-19 vaccine.
In updated guidelines published on 30th December 2020, the JCVI 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.”