Corona virus infection and COVID-19 vaccine during pregnancy
Since the beginning of August 2020, pregnant women in Switzerland are considered to be at risk of coronavirus infection and should be protected. No increased risk of infection has been observed in pregnant women, but there is a slightly increased risk of severe complications.
Pregnant women and women who have recently given birth show fewer symptoms such as fever or pain in the limbs, but there are more severe courses, an increased rate of premature births, and an increased rate of pregnancy complications in infections in the 3rd trimester. Pregnant women with pre-existing conditions such as hypertension, diabetes mellitus, obesity and women over 35 are particularly affected.
Vertical transmission (transmission of the virus from the mother to the unborn child) has been described in some case reports, but this is still under discussion. No data are known so far for infection of the foetus or malformations. However, infections in newborns are a rarity, at birth or during breastfeeding.
The protective measures (hygiene measures, hand disinfection, distance rules) should be strictly observed and performed by pregnant women and their partners. And, most recently, regular testing. In the case of a coronavirus infection, there is no contraindication to vaginal birth or breastfeeding, but special protective measures should be taken.
After the BAG initially excluded pregnant women from the SARS-CoV-2 vaccination, and then only allowed pregnant women with the highest risk, all pregnant women will now be given the opportunity to be vaccinated against COVID-19 from 28.05.2021.
In particular, pregnant women with pre-existing conditions or a high risk of exposure to SARS-CoV-2 infection can be offered the vaccination.
Two mRNA COVID-19 vaccines are currently licensed in Europe and are available in the 2nd or 3rd trimester after detailed consultation with the gynaecologist.
There are no data available yet regarding the safety in pregnancy of vector DNA vaccines.
The immune protection after vaccination is comparable to that in non-pregnant women and the side effect profile is comparable between pregnant and non-pregnant women. There are no specific known contraindications (other than the general ones) for vaccination in pregnancy or lactation.
Maternal antibodies formed by vaccine immunisation provide potential protection against infection for the infant, which is transmitted to the newborn through the placenta during pregnancy and through breast milk during breastfeeding.
For women of childbearing potential, it is important to note that there is no evidence to date that mRNA vaccines affect fertility. Immunisation before pregnancy can minimise the risk of infection during pregnancy and the associated risks. Pregnancy prevention after vaccination is not required.
For couples undergoing fertility treatment, vaccination before treatment should be discussed, especially if there are risk factors that could predict a complicated pregnancy. It is recommended that infertility treatment be started a few days after the second dose of vaccine.
If vaccination is given in early pregnancy because the pregnancy is still unknown, it is not necessary to terminate the pregnancy.
A pregnancy test before vaccination is not generally recommended.
Due to the clearly predominant benefits of a Covid-19 vaccination, it is recommended by several medical societies during pregnancy, the breastfeeding period and when planning a pregnancy. Worldwide research in this field is supported.
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Sources: SGGG, DGGG, DGPM, ISUOG, WHO