COVID-19

COVID-19 and pregnancy

RANZCOG Update – 13/7/2022

Link: https://ranzcog.edu.au/news/covid-19-vaccination-when-pregnant-or-breastfeeding-and-for-those-planning-pregnancy/

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the risk posed to the community, healthcare workers, and all patients, due to the COVID-19 (coronavirus) pandemic. RANZCOG also recognises our responsibility to respond to this situation as a large organisation, and also as a medical college, and health leader.

The College respects the role of governments, health departments and health administrators in coordinating a national response in Australia and New Zealand, respectively. The purpose of this communiqué is to provide updated advice on the issue of vaccination for pregnant and breastfeeding women, and those planning pregnancy in Australia, in line with updated advice from The Australian Technical Advisory Group on Immunisation (ATAGI) and the Ministry of Health and Immunisation Advisory Centre in New Zealand.

RANZCOG advice aligns with that issued by ATAGI and the New Zealand Ministry of Health.

Key points

Pregnant women have a higher risk of severe illness from COVID-19. Their babies also have a higher risk of being born prematurely. 

COVID-19 vaccination significantly reduces the risk of becoming infected with COVID-19. Vaccination also reduces your risk of transmitting the virus to others, including to infants.

COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (for pregnant women) or through breastmilk (for breastfeeding women).

Pregnant women in Australia are a priority group for COVID-19 vaccination and should be routinely offered up to 3 doses of the Pfizer vaccine (Comirnaty) or Moderna (Spikevax) at any stage of pregnancy. 

Pregnant women in Aotearoa New Zealand are a priority group for COVID-19 vaccination and should be routinely offered up to 3 doses the Pfizer vaccine (Comirnaty) as this is the preferred vaccine for pregnant women in New Zealand. 

Pfizer (Comirnaty) and Moderna (Spikevax) are mRNA vaccines. Global evidence has shown that the Pfizer and Moderna vaccines are safe for pregnant women. 

Novavax COVID-19 vaccine, a protein-based vaccine, can also be used in pregnancy (but is not currently approved for use in third or fourth doses). While there are no immunogenicity or safety data, there are no theoretical safety concerns relating to its use in pregnancy, since the Novavax COVID-19 vaccine, like other COVID-19 vaccines, is not a live vaccine.

There is no evidence of increased risk of miscarriage or teratogenic risk with mRNA or viral vector vaccines (e.g. AstraZeneca (Vaxzevria).

Women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination. 

Third doses for pregnant women are recommended 3 months after the second dose and are vital for protection against the Omicron strains BA.1 and BA.2.

All healthcare workers, including midwives and doctors, are encouraged to be vaccinated, to protect themselves, pregnant women, and their babies.

What are the current recommendations for the COVID-19 vaccine in pregnant women? 

Pregnant women are a priority group for COVID-19 vaccination and should be routinely offered Pfizer mRNA vaccine (Cominarty) [or Moderna (Spikevax) in Australia] at any stage of pregnancy. 

Pregnant women with COVID-19 have a higher risk of severe illness compared to non-pregnant women with COVID-19 of the same age. This includes an increased risk of:

hospitalisation

admission to an intensive care unit

invasive ventilation

COVID-19 during pregnancy also increases the risk of complications for the baby including a higher risk of stillbirth and of being born prematurely.

Vaccination is the best way to reduce these risks.

Pregnant women should get vaccinated and continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. Vaccination significantly reduces the risk of becoming infected with COVID-19. Vaccination also reduces your risk of transmitting the virus to others, including your baby. Everyone should continue with hand hygiene, wearing masks where social distancing cannot be maintained, testing when symptoms are present and isolation, when appropriate.

When is the best time to have a COVID-19 vaccine if I am pregnant?

It is recommended to have a COVID-19 vaccine as soon as you are offered one.

Pfizer (Cominarty) and Moderna (Spikevax) are mRNA vaccines and can be given at any stage of pregnancy. Two doses of Pfizer mRNA [or Moderna mRNA vaccine in Australia], 3-6 weeks apart, provides good protection against COVID-19, including against the Delta strain.

With the advent of the Omicron strain it is recommended that a third dose is administered 3 months after the second dose of the vaccine. Current approved COVID-19 vaccines have been shown to be similarly effective against both Omicron BA.1 and BA.2 when a third dose has been administered.

With newer Omicron variants having emerged:

in Australia, a fourth dose of COVID-19 vaccination is now available to all people aged 30 years and over and recommended to all people aged 50 years and over, to be given three months after the third dose. This fourth dose is also recommended for people with certain conditions including immunocompromise, cancer, chronic inflammatory conditions, chronic lung disease, chronic kidney disease, chronic neurological disease, diabetes requiring treatment, people with disability with significant health needs, severe obesity (BMI > 40kg/m2), and severe underweight (BMI < 16.5 kg/m2). People with medical conditions should discuss vaccination with their care providers.

At this stage, pregnancy is not considered a specific indication for a fourth dose in healthy women under 50 years of age, who do not have additional risk factors. RANZCOG recommends that pregnant people discuss this with their maternity care provider, or doctor.

Covid-19 vaccines can be given at the same time as an influenza vaccine. The administration of other types of vaccines (whooping cough vaccine, etc.) with a COVID-19 vaccine is not recommended. The minimum interval time between a COVID-19 vaccine and any vaccine other than the influenza vaccine, is 7 days.

All medical advice should be patient-centred and take into account each individual’s personal considerations and preferences. 

Please note: Eligibility for vaccination is determined by the Australian Government and the New Zealand Ministry of Health, and local jurisdictions, and is not within the authority of RANZCOG. 

 

Australian advice:

Four (4) COVID-19 vaccines are approved in Australia: Pfizer (Comirnaty); Moderna (Spikevax); AstraZeneca (Vaxzevria) and Novavax (Nuvaxovid).

Pregnant women in Australia are a priority group for COVID-19 vaccination and should be routinely offered up to 3 doses of the Pfizer vaccine (Comirnaty) or Moderna (Spikevax) at any stage of pregnancy.

Everyone in Australia aged 5 years and over is eligible for a free COVID-19 vaccination. Use  the Australian Government Eligibility Checker to arrange an appointment. A national COVID-19 Hotline (1800 020 080) is available to find relevant vaccination clinics.

Please note: When using the eligibility checker, pregnant women should tick ‘no’ to AstraZeneca and progress to the end.

Recommendations for women who have already received a dose of AstraZeneca (Vaxzevria) vaccine.

Pregnant women who have already received a first dose of AstraZeneca vaccine can receive either the Pfizer vaccine or Moderna or the AstraZeneca vaccine for their second dose within the recommended time periods.

Research has shown that mRNA vaccines (e.g. Pfizer or Moderna) are safe for pregnant women.

There is less available data on the safety of viral vector vaccines (e.g. AstraZeneca (Vaxzevria)) in pregnancy, hence the current recommendation for pregnant women to receive mRNA vaccines (Pfizer (Comirnaty); Moderna (Spikevax)).

There is currently no immunogenicity or safety data for these groups with the Novavax (Nuvaxovid) vaccine.

Other treatments in pregnancy

Pregnant women should continue to receive pertussis and influenza vaccination during pregnancy, noting the advice to space these two vaccine injections by at least one week.

The administration of Anti-D should continue as per usual indications and timing is not affected by vaccination.

What are the recommendations for women planning pregnancy?

Women who are trying to become pregnant can receive COVID-19 vaccination (Pfizer, Moderna, AstraZeneca or Novavax), as approved within their country. They do not need to delay vaccination or avoid becoming pregnant after vaccination.

There is currently no immunogenicity or safety data for these groups with the Novavax (Nuvaxovid) vaccine.

What are the recommendations for breastfeeding women? 

Vaccination is recommended for breastfeeding women, as approved within their country. They do not need to stop breastfeeding before or after vaccination.

Either Pfizer (Comirnaty) and Moderna (Spikevax) or AstraZeneca (Vaxzevria) are considered safe for breastfeeding women.

There are substantial data on the safe use of the Pfizer (Comirnaty) and Moderna (Spikevax) vaccines in breastfeeding women. The mRNA in Pfizer or Moderna is rapidly broken down in the body and does not appear to pass into breastmilk. The viral vector in AstraZeneca (Vaxzevria) vaccines cannot cause infection.

There is currently no immunogenicity or safety data for these groups with the Novavax (Nuvaxovid) vaccine. 

Further information

Australian Government Department of Health: Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy, available at:

GO TO LINK

Australian Government Department of Health

ATAGI statement 7th July 2022, available at:

GO TO LINK

Australian Technical Advisory Group on Immunisation

ATAGI statement 25th May 2022, available at:

GO TO LINK

Australian Technical Advisory Group on Immunisation

RANZCOG will continue to monitor available data and issue updated advice as evidence emerges. 

 

Planning a Pregnancy

Nutrition

If you are trying to have a baby or are just thinking about it, it is not too early to start getting ready for pregnancy. A healthy, well balanced diet is strongly recommended before, during and after pregnancy.

Folate and Pregnancy

Folate and folic acid are important for pregnancy since they can help prevent birth defects known as neural tube defects, such as spina bifida. Folate is a B group vitamin needed for healthy growth and development.

During a Pregnancy

Food to Avoid During a Pregnancy

There are some foods to avoid or take care with when you’re pregnant as they might make you ill or harm your baby. 

Make sure you know the important facts about which foods you should avoid or take precautions with when you’re pregnant.

Common Issues in Pregnancy

During your pregnancy you may have a number of annoying problems that are not dangerous but may need some attention. These problems include cramps, urinary frequency and incontinence, heartburn and indigestion, varicose veins, backache, constipation, haemorrhoids and thrush.

Complications of Pregnancy

There are several conditions unique to pregnancy, such as gestational diabetes and pre-eclampsia.

Whooping Cough and Flu Vaccinations in Pregnancy

Whooping cough (pertussis) and influenza (flu) vaccines are very safe to be given during pregnancy and are recommended to protect both the mother and the baby during pregnancy and in the first few months after birth.

Birth

Signs of Labour

Giving birth will be different for every woman, but the main signs that you are starting labour will be strong, regular contractions, and a ‘show’.

Pain Relief in Labour

Labour is painful, so it’s important to learn about all the ways that you can relieve the pain. It’s also helpful for whoever is going to be with you during your labour to know about the different options, as well as how they can support you.

Cesarean Section

A Caesarean is an operation where an incision (a cut) is made through the abdomen and uterus to deliver the baby. Some Caesareans are elective which are planned during pregnancy, and others are done in an emergency

After Birth

Common Breastfeeding Problems

When you first start breastfeeding, you may worry that your baby isn’t getting enough milk. It can take a little while before you feel confident that your baby is getting what they need

Perineal Care

The perineum is the area of skin and muscle between your vagina and your anus. The perineum stretches and thins out over your baby’s head as he or she is born.