COVID vaccine and pregnancy: evidence is growing that it is “safe” and avoids serious complications in infected women

Should I get vaccinated against the coronavirus? Doubts for some have been there throughout the pandemic. And when that vaccine not only affects you like this, but also the being that you are gestating inside yourself, the dilemma for many increases. From the first moment, gynecologists have recommended the COVID-19 vaccine for pregnant women. But now scientific evidence grows even more.

The mRNA vaccines, Pfizer and Moderna, “do not cause complications” during pregnancy, neither for the women themselves nor for their babies. This is confirmed by the European Medicines Agency (EMA) after reviewing multiple studies that have involved 65,000 pregnant women at different stages of pregnancy.

Which yes, it is still alarming is the risk of developing serious COVID-19 if a contagion occurs during pregnancy and EMA experts insist that vaccinations during pregnancy “are as effective in reducing the risk of hospitalization and death” as they are in non-pregnant women, with side effects similar to those common in the general population (pain in the injection site, tiredness, headache, redness and swelling at the vaccination site, muscle pain and chills, “mild or moderate” reactions that improve within a few days of vaccination).

And they reassure by emphasizing that have not found any signs of an increased risk of pregnancy complications, spontaneous abortions, premature births or side effects in the fetuses after vaccination.

In the same line, the pulmonologist Olga Mediano warns that pregnant women are “more at risk of serious illness” and “of ending up on mechanical ventilation.” “The pregnant woman has to be fully vaccinated and immunized before the end of the second trimester, which is when these complications occur,” she adds.

And it is that María del Mar Gil, doctor in Obstetrics and co-founder of the iMaterna Foundation, gives one of the keys to vaccination in pregnant women: its immune system. “Pregnant women have a slightly depressed immune system, since there is a foreign body growing in their body. Therefore, their immune system reacts less to other threats,” he explains.

Óscar Martínez Pérez, specialist in Obstetrics and Gynecology of the Puerta de Hierro Hospital in Madrid, also insists that pregnant women are experiencing a ‘perfect storm’ to suffer from the virus with particular severity. “There is a third of pregnant women who have symptoms that present pneumonia, and that is severe,” he says. In these women, “the lung is compressed”, so they need more breathing capacity. Something that with COVID is aggravated.

To these factors the expert adds the thrombus risk: “as in pregnancy there is a state where coagulation is highly activated, COVID induces hypercoagulation and there is a greater risk of thrombosis, another serious thing”.

And there are real risks to the fetus as well, to the point that it increases its chance of dying within the mother’s own womb. “There is an increased risk of intrauterine fetal death. We estimate that in a woman with COVID this is 0.7, but in a woman without it it is below 0.2,” he says.

Advantages of vaccination for the fetus

Estanislao Nistal, virologist and professor of Microbiology at CEU San Pablo University, explains that “although cases of infection in fetal tissue have been described in mothers with COVID and there are cases described in which the infection of the fetus is associated with organ failure in abortions of mothers with COVID, the main risk to the fetus may be the mother’s greatest risk of developing the disease. That is, heThe mother is at higher risk than other non-pregnant people of the same age.

Thus, the virologist joins the evidence that vaccination of pregnant mothers reduces the risk of severe COVID and death, in addition to giving birth prematurely. And he highlights another advantage of vaccination: “it is known that the antibodies produced by the mother against SARS-CoV-2 are capable of passing to the fetus and protect him after he is born.” “There is also evidence of the transmission of antibodies against SARS-CoV-2 in breast milk that can help protect the newborn,” he adds.

However, there are pregnant women who decide not to be vaccinated. We spoke with Maria (not her real name). He is 36 years old and is 29 weeks pregnant. It is one of those has refused the injection. She explains that she is not against vaccinations and that in fact, her other three-year-old daughter has received all the ones recommended by pediatricians. We hear her in the background, her daughter is at home because they have confined her classroom (another of the dramas of this pandemic).

Maria justifies how she made the decision: “Whenever there is a negative doubt I do not do it, one thing is for me to vaccinate myself and another for my baby to be vaccinated. I don’t know what can happen to her.” And she tells us that she read all kinds of information and that although her gynecologist’s recommendation to get vaccinated was clear, she finally decided that she would not do it. The doctors who accompany her in the process they have respected. “The pressure to get vaccinated has existed”, recognizes by referring to relatives and acquaintances.

The Justina’s case is different. He is 36 years old and is in the 25th week of gestation. From the very beginning, before I was pregnant, chose to get vaccinated. The second dose came just in the first days of pregnancy. She confesses that she was afraid, “in case it affected the implantation of the ovum” but the words of her gynecologist were reassuring. Immunization for her and her baby manifested only with a side effect: he had “a little fever”.

Later passed the COVID-19 in the 22nd week of pregnancy. Everything was still fine, but he did have more symptoms. High fever, vomiting, muscle pain, and severe headache. He tells us that he did not lose his sense of smell or taste because of what he believes was affected by the Omicron variant, although he does not have medical confirmation. Recognize that He has not yet given the third dose but he will do it as soon as his doctor prescribes it.

What happens with the third dose?

The fifth wave, also known as ‘the wave of pregnant women’, highlighted the need to prioritize the immunization of this group. It was learned the hard way. In ICUs, the presence of pregnant women with respiratory complications and premature births began to be common.

Since May, the Health strategy includes the recommendation to immunize pregnant women with mRNA vaccines (Pfizer and Moderna) and, as it maintains, “there is no contraindication” to be vaccinated in any trimester. Now with the arrival of the third dose, the recommendation is repeated. The EMA calls for following the same steps as with the other doses because there is no evidence of an increased risk.

The Spanish Society of Gynecology and Obstetrics (SEGO) recommends pregnant women a booster dose from six months after full vaccination with messenger RNA vaccines and from three months with AstraZeneca or Janssen. In the event that the first doses of the vaccine were with AstraZeneca or Janssen, the use of messenger RNA vaccines (Pfizer or Moderna) is recommended for the booster dose.