We recently reached out to our families to share any concerns or questions they had regarding the Covid-19 vaccination during pregnancy and whilst breastfeeding. As well as any concerns about your children having the vaccine. Shauna Leven, CEO of Twins Trust was joined on an Instagram Live by Dr Surabhi Nanda, a consultant obstetrician / maternal fetal medicine at Guy’s & St Thomas’, and Dr Geraint Lee, a consultant neonatologist at Evelina London Children's Hospital to answer your questions. You can view the recording on Instagram here or read their responses below. 

Covid Vaccination Questions during pregnancy and breastfeeding – Dr Surabhi Nanda

From data of over 100, 000 women vaccinated all over the world (and counting), there is no suggestion that the vaccine affects fertility. In fact the British Fertility Society has released a statement suggesting that it does not affect any stage of IVF cycle or interacts with any IVF medications either. Sometimes due to common side effects of the vaccine, like fever or body ache, the IVF doctors may defer IVF procedures for a day or two, but otherwise there is no suggestion that you should alter having an IVF due to the vaccine.

Studies from USA, and in UK / Europe have compared chance of miscarriage with vaccinated and unvaccinated group and have found no difference in miscarriage rates. Therefore, it can be accepted that the COVID vaccine does not increase the chance of miscarriage. 

Depending on the kind of vaccine you may have upto 85-90% immunity with two doses, but with passing of time the immune response that the body has generated to the vaccine goes down. It is difficult to quantify “how much” are you protected six months post vaccination. Therefore booster doses should be opted for as recommended nationally. Booster vaccines can be given 3 months (91 days) after your 2nd dose. We strongly encourage all pregnant women to have the COVID-19 booster vaccination as it provides the best protection against the virus for you and your baby.

Research from 13 studies in five countries, involving more than 100,000 people vaccinated in pregnancy, shows having the vaccine does not increase the risk of miscarriage, preterm birth or stillbirth, or increase the chance of having a small-for-gestational age baby, or the chance of congenital anomalies in the baby.

The vaccines that are unsafe in pregnancy are live vaccines. The usual vaccines given in pregnancy are Pfizer and Moderna vaccines. These are m-RNA vaccines (not live vaccines) and quickly broken down in the body within a few days of injection. As these are new vaccines, there are no studies yet on the long-term effects on babies born to women who had a COVID-19 vaccine in pregnancy. But as COVID-19 vaccines are not ‘live’ vaccines they cannot cause infection, and other non-live vaccines have been given to women in pregnancy for many years without any safety concerns – these include the flu vaccine and also the whooping cough jab.

The vaccines provide “passive immunity” to the baby – which means that the protective antibodies developed from vaccination can transfer from mother to baby across the placenta, and after birth through breast milk, helping with the baby’s immunity to COVID-19. The degree of protection this provides to the baby is unknown at present and more research is needed.

Current evidence from the UK suggests that pregnant women are no more likely to get COVID-19 than other healthy adults, but if they are unvaccinated or not fully vaccinated, they are at increased risk of becoming severely unwell if they catch COVID-19, which can lead to admission to intensive care and premature birth of the baby.

 

From UK (UKOSS) and international registry data, we know that mothers who are at high risk of pregnancy complications ie – those with additional risk factors are at a higher risk of the complications of COVID in pregnancy. These include women aged over 35,  with BMI over 30 or higher, with preexisting medical problems such as raised blood pressure (hypertension), asthma or diabetes and women of non-white ethnicity. A UK based study on admissions with COVID, nearly 98% of women who were admitted in intensive care were unvaccinated and nearly 80% of those admitted with symptoms of COVID were in third trimester.

In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity.  Several international studies have also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

There are no separate data on women with twins and triplets and risks of COVID. However many mothers with twins and triplet pregnancies have risk factors (as above) that puts them at a higher risk of complications due to COVID in pregnancy. In addition, the chance of premature labour is higher in twins and triplet / higher order multiple pregnancy. It can therefore be extrapolated that mothers with twins or triplet pregnancies who become unwell with COVID would have a higher chance of preterm delivery and its subsequent complications.

It is however worth mentioning that roughly two-thirds of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms.

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwifery have developed a decision aid to empower women to make an informed choice for COVID vaccination and pregnancy. The health care professionals should have an unbiased opinion and give you contemporaneous guidance on vaccination in pregnancy. It is within your right to ask questions about information that is not in sync with the available guidance. You can defer to the available resources (see below), and ask to have a chat with your Obstetricians , lead midwife, or local vaccination centre.

https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19-vaccines-pregnancy-and-breastfeeding/

https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1024223/UKHSA_12073_COVID-19_pregnancy_poster.pdf

Pregnant women are offered Pfizer and Moderna vaccines as the data on safety in pregnancy and breastfeeding is the largest for these groups. Both have good effectiveness in protecting against COVID. The vaccine that is no given in pregnancy is Astra Zeneca, and this is because of the reports small increase in the chance of clots forming in the blood vessels with this vaccine, as the risk of clots in blood vessels is increased in pregnancy as such.    

Breastfeeding has exceptional benefits for the health, wellbeing, and immunity for the baby as well as aids psychological wellbeing and bonding in the mother. The protective antibodies developed from vaccination can transfer from mother to baby through breast milk, helping with the baby’s immunity to COVID-19. The degree of protection this provides to the baby is unknown at present and more research is needed. COVID-19 vaccines are strongly recommended to breastfeeding women. There is no plausible mechanism by which any vaccine ingredient could pass to your baby through breast milk. You should therefore not stop breastfeeding in order to be vaccinated against COVID-19.

 

Covid Vaccination Questions for 5-12 and 12-17 year olds – Dr Geraint Lee

Whilst we can never say that any medical intervention or treatment is safe, we do know the benefits of vaccination outweigh the risks even in this age group. There is lots of data now from around the world (eg Israel and the US) as many countries started to offer to children a lot earlier than the UK.

  • Acute covid is unpleasant even mild cases and in children and young people, but also runs the risk of missing school with the adverse effects on social, academic, physical and mental wellbeing. It will also impact upon parents needing to stay home.
  • Rare possibilities of long covid and PIMS-TS (Paediatric inflammatory multisystem syndrome temporally associated with SARS CV19) – unpredictable, but potentially avoidable with vaccine
  • Impact on vulnerable family and friends. They can become seriously unwell and die even if vaccinated
  • Even if the vaccine doesn’t prevent transmission of the vaccine completely, it has been shown to reduce the viral load and reduce a person’s risk of spreading Covid19
  • Teenagers, as with all of us, can experience the usual vaccine side effects. This can include local tenderness, tiredness, headache, general aches
  • Myocarditis has been reported in association with the vaccine, but data shows the risk is still very low. For example, in Denmark they showed that there were 269 cases in almost 5 million people who have received the vaccine
  • Not having the vaccine may impact upon future social restrictions or ability to travel in Europe and beyond
  • The reason the vaccine was able to be produced so quickly relative to others was because never before has so much time, effort, energy and money been invested into the development process. The timeline for peer reviewed research has shortened, but is just as rigorous.

Fortunately very few young people have ended up in intensive care with either respiratory covid or myocarditis. Many more (although still small numbers) have had PIMS-TS. Most people have recovered following myocarditis following rest and simple treatments. In the Danish study above the risk of myocarditis for those receiving the Pfizer vaccine was ~1:72000

My wife and I have three children, the eldest of whom is 13 and has received the first dose of the vaccine. She is keen herself to receive the booster as soon as possible, because she really doesn’t want to miss more school, socialising and sport. As she is not in a high risk group, she will wait until 3 months from her first vaccine.

Young people between 12 & 17 have been offered two doses of vaccine 12 weeks apart. The JCVI (Joint Committee on Vaccination and Immunisation) have recommended this based upon the best available evidence. They have chosen 12 weeks to reduce even further the risk of myocarditis, based upon evidence from overseas where the vaccination programmes for CYP started before the UK. Only those in high risk groups or who are household contacts of immunosuppressed individuals may be offered a booster at least 3 months after completion of their primary course.

We do not yet know whether the JCVI will add younger children who are not at high risk to their recommendations and therefore do not know the answer to the second part of the question.

Even before the pandemic we knew that children who are born prematurely are more likely than the general population to need treatment for asthma and other respiratory infections. From a respiratory perspective only those with poorly controlled asthma or those needed repeated hospital admission were defined as high risk for covid infection. Other ex-preterm infants may have cerebral palsy or neurodisability which may also put them in a higher risk group.

As above, I would wait for the JCVI to decide whether they recommend vaccination in the 5-12 age group. They have access to vast amounts of data around the world and will be taking into consideration the effect on the individual child, families and society, including the effect on physical & mental health as well as the impact on schooling etc.