COVID-19 VACCINES IN THE PREGNANT
The Latin American Federation of Obstetrics and Gynecology Societies (FLASOG), a scientific institution affiliated to FIGO, the World Federation of Gynecology and Obstetrics based in London, and made up of gynecological-obstetrician physicians from all Latin American and Caribbean countries , which ensures the health of women, in relation to the use of vaccines in pregnant women states the following:
That the impact of the global health crisis due to the COVID 19 pandemic has been very detrimental to sexual and reproductive health, and its most obvious expression is maternal mortality.
That, at present, not only has the decline in maternal deaths in Latin America and the Caribbean stopped, but an increase in cases is reported in several countries of the region, deepening social inequalities (1) ; In some countries, even cases of maternal death have increased by 47%, being the main cause, indirectly, COVID-19 (2) .
That, to date, there are numerous studies that show that there is a greater risk of maternal and fetal complications in pregnant women with COVID-19 (3) , and compared with the non-obstetric population, they are three times more likely to require admission to an intensive care unit, 2.9 times more likely to require mechanical ventilation and 70% higher risk of mortality (4) .
That preventive measures such as hand washing, use of masks and social distancing, although they significantly reduce the risk of contagion with COVID-19, are not enough (5) and in the absence of an efficient and effective treatment, efforts have been made focused on the development of vaccines (6) , messenger RNA, adenovirus vector and inactivated virus, which to date have demonstrated their efficacy and should not be associated with maternal or fetal risk (7) .
According to the first reports of vaccination in pregnant women (8-10) , it is indicated in the surveillance of the messenger RNA vaccine, (BioTech-Pfizer and Moderna), which includes almost 36,000 vaccinated pregnant women in the United States, that the incidence of adverse reactions is the same as that of the general population (pain in the puncture site, fatigue, headache and myalgia), that in relation to fetal complications, the incidence of spontaneous abortion and fetal death in vaccinated pregnant women was found within of the expected percentage in the general population; Likewise, neonatal complications (premature birth, small for gestational age, abortions, stillbirth) were found in a similar percentage to the general obstetric population (8) .
That, in addition, in pregnant women who were vaccinated, several cases of transfer of antibodies against SARS-CoV2 through the placenta and breast milk have been reported (11-13) , which could potentially protect the newborn from COVID-19.
In this sense, taking into consideration the increase in maternal-fetal morbidity and mortality secondary to COVID-19, the Latin American Federation of Obstetrics and Gynecology Societies (FLASOG) considers that vaccination against COVID-19 should be included in the pregnant women or those who are breastfeeding; likewise, it makes the following recommendations (14-15) :
- Give priority to pregnant or lactating women in access to vaccination.
- Encourage pregnant women to get vaccinated, voluntarily against COVID-19.
- Provide adequate advice to the pregnant woman for informed decision making, including the level of activity of the virus in her community, risk and potential severity of maternal disease due to COVID-19, the efficacy of the vaccine, safety in pregnancy , expected side effects of vaccination.
- Do not limit vaccination to a specific gestation trimester.
- Give a separation time of at least 14 days with the triple vaccine (Tdap) and Influenza.
- Monitor the vaccination against COVID 19 in pregnant women by the respective health professional.
- Do not delay or terminate pregnancy due to vaccination.
- Do not suspend breastfeeding due to vaccination against COVID 19.
- Not doing a pregnancy test as a requirement for vaccination against COVID 19.
- Carry out follow-up studies on vaccinated pregnant women and their children, on behalf of the Gynecology and Obstetrics Societies.
- In the event that pregnant women decline to receive the vaccine against COVID 19, they will be given information about the risks that this implies and the other prevention measures will be emphasized.
FLASOG recommends the priority of vaccinating pregnant women, on a voluntary and informed basis, based on the concept of risk-benefit, and to help prevent maternal morbidity and mortality in Latin America and the Caribbean.
EXECUTIVE COMMITTEE FLASOG
(1) Strategic Interagency Consensus for the Reduction of Maternal Morbidity and Mortality: Strategic Orientations for the 2020-2030 decade. Regional Working Group for the Reduction of Maternal Mortality (GTR), 2021.
(2) National Center for Epidemiology, Prevention and Control of Diseases. Ministry of Health of Peru. Maternal Mortality 2020 https://www.dge.gob.pe/epipublic/uploads/boletin/boletin_202053.pdf
(3) Villar J, Ariff S, Gunier RB, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women with and without COVID-19 Infection: The INTERCOVID Multinational Chort Study. JAMA Pediatr. Published online April 22, 2021.doi: 10.1001 / jamapediatrics.2021.1050
(4) Zambrano L, Ellington S, Strid P et al. Update: Characteristics of Symmptomatic Women of Reproductive Age with Laboratory-Confirmed SARS CoV-2 Infection by Pregnancy Status-Unitade States, Jan 22- Oct 3, 2020. Weekly, Nov 6, 2020/69;1641-1647 MMWR
(5) Lerner AM, Folkers GK, Fauci AS.Ppreventing the Spread of SARS-CoV-2 with masks and other “Low-tech” Interventions. Jama. 2020; 324 (19): 1935-1936.doi:10.1001/jama2020.21946
(6) Lyu WW, Wehby GL. Community Use of Face Masks and COVID-19: Evidence from a Natural Experimento f State Mandates in the U.S. Health affairs (Project Hope).2020;39(8). https://doi.org/10.1377/hlthaff.2020.00818
(7) Kalafat E, O´Brien P, Health PT, et al. Benefits and potential harms of COVID-19 vaccination during pregnancy evidence summary for patient counseling. Ultrasound Obstet Gynecol.2021 May;57 (5):681-686.doi:10.1002/uog.23631.PMID:33734524
(8) Shimabukuru T, Kim S et al. Prelimary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. NEJM Abril 21,20021.doi:10.1056/MEJMoa2104983
(9) Collier AY, McMahan K, Yu J, et al. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. Publicado online May 13, 2021.doi:10,1001/jama.2021.7563
(10) Male V, Are COVID-19 vaccines safe in pregnancy? Nat Rev Immunolo 21. 200-201 (2021). https://doi.org/10.1038/s41577-021-00525-y
(11) Perl SU-Y, Klainer A, Asiskovich H, et al. SARS-CoV-2-Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women JAMA.2021;325 (19)
(12) Mithal LB, Otero S, Shanes ED, et al. Cord blood antibodies following maternal coronavirus disease 2019 vaccination during pregnancy. Am J Obstet Gynecol.2021 Apr 1:S0002-9378(21)00215-5.doi:10.1006/j.ajog.2021.03.035.Epub ahead of print.PMID:33812808:PMC8012273
(13) Gray KB, Bordt EA, Atyeo, C et al. COVID-19 vaccine response in pregnant and lactating women : a cohort study. MedRxiv 2021 03.07.21253094; doi:https://doi.org/10.1101/ 2021.03.07.2153094
(14) FIGO. Vaccination against COVID-19 for pregnant and lactating women / FIGO 2021 https://www.figo.org/es/vacunacion-contra-la-covid-19-para-mujeres-embarazadas-y-lactantes
(15) ACOG. Vaccinating Pregnant and Lactating Patients Against COVID-19 April 28,2021.