Following the recommendations of the health authorities, the government announced the extension of the 2nd booster dose for pregnant women. Update on the vaccination of future mothers against Covid-19.
Covid and pregnancy: should you take a 4th dose of vaccine when you are pregnant?
In accordance with the latest health recommendations (High Health Authority and Vaccine Strategy Guidance Council), the government has announced to extend the administration of the second booster dose of the vaccine against Covid-19 to pregnant women, as well as people under the age of 60 who are at risk, including people living in the entourage of the most vulnerable. A decision taken in an “epidemiological context which remains worrying, with very contagious variants”, specified the Ministry of Health on July 20.
This July 13, the High Authority of Health had indeed issued new recommendations concerning the vaccination of pregnant women. “While an additional booster dose is already recommended for people aged 60 and over, the HAS recommends extending the administration an additional booster dose (2nd booster or 4th dose most often) adults under the age of 60 identified as being at risk of a severe form of Covid-19, pregnant women (from the first trimester of pregnancy) and to people living in the environment or in regular contact with immunocompromised or vulnerable people”. The HAS also specifies that the deadlines to be observed for future mothers between two booster doses is 6 months and “if a SARS-CoV-2 infection has occurred after the last dose, an additional booster dose is still recommended, respecting a minimum period of 3 months after infection“.
Messenger RNA: “No increased risk of complications during pregnancy”
This January 18, the European Medicines Agency (EMA) had announced that the two vaccines Pfizer and Modernamanufactured using the technology messenger RNA, did not present an increased risk of complications for future mothers and their babies. To make this conclusion, the EMA based itself on the examination of a dozen studies on the subject involving 65,000 women. “The exam (studies) did not identify no signs of an increased risk of pregnancy complications, miscarriages, premature births, or adverse effects in unborn babies after vaccination with the mRNA Covid vaccine“, specified the EMA in a press release.This review (…) suggests that the benefits of mRNA Covid vaccines during pregnancy outweigh any possible risks to pregnant women and unborn babies“, added the EMA.
Pregnant, should I get vaccinated against Covid-19?
In a press release published on July 12, 2021, the National College of French Gynecologists and Obstetricians (GNGOF) and the Research Group on Infections during Pregnancy (GRIG) already insisted on the importance of getting vaccinated as soon as possible when you are pregnant. Ditto for the couples in desire of child. And for good reason, “Covid is a potentially very serious illness during pregnancy”.
At the end of December, the Minister of Health Olivier Véran had once again called on pregnant women to be vaccinated. “We have a subject with pregnant women, who sometimes do not get vaccinated because they are afraid for their little ones, or sometimes they are badly advised, badly guided. Let me pass on the message again: the teams in Paris or elsewhere who have pregnant women who have had serious Covid, sometimes with consequences for the fetus, for the infant and for the mother, these are absolutely terrible life situations for caregivers, even the most experienced, and especially for the families concerned, so really: do not hesitate to get vaccinated if you are pregnant, it is more than possible, it is recommended“, declared Olivier Véran on December 27. On December 14, the Minister of Health also sounded the alarm at the National Assembly: “pregnant women who hesitate to get vaccinated put themselves at risk. I was yesterday at the Cochin hospital at the AP-HP and out of 8 patients in an intensive care unit that I visited, 7 were not vaccinated and there were 2 pregnant women” had testified Olivier Véran. Remember that the health authorities recommend the vaccination for future mothers from the start of pregnancy. In addition, a study conducted in France by the hospitals of Paris (APHP) and published at the end of November in the journal PLOS makes the link between the risk of premature births and Covid during pregnancy. “We have observed links between a diagnosis of Covid-19 and several maternal morbidities (including) premature births, pre-eclampsia (raised blood pressure associated with increased protein in the urine, editor’s note), hemorrhages at the time of childbirth and caesarean births“says the study.
At what month of pregnancy should you be vaccinated against Covid?
Pregnant, it is possible to be vaccinated against Covid-19 from the first trimester of pregnancy.
Which Covid vaccines for pregnant women?
- The currently recommended vaccines are mRNA vaccines (Comirnaty or Moderna). On March 8, the National College of French Gynecologists and Obstetricians (CNGOF) and the Research Group on Infections during Pregnancy (GRIG), which called for vaccination of all pregnant women, had also made recommendations regarding the type of vaccine to be used. “mRNA vaccines (Comirnaty® or Moderna®) should be preferred. The DNA vaccine (VaccineAstraZeneca®) is not contraindicated but it is more frequently the cause of a reaction fever without specific risk that can be treated with paracetamol. There is to date no argument to suggest that the vaccines mentioned can induce a deleterious effect on the fetus, but an injection during the first trimester of pregnancy should be avoided in principle“, specified the experts.
- The Vaxzevria vaccine, as well as the Janssen vaccine, is not recommended to date in France in pregnant women.
Can you get vaccinated while breastfeeding?
Regarding young nursing mothers, the CNGOF and GRIG assure us: “vaccination does not interfere with breastfeeding and breastfeeding does not prevent vaccination”. A breastfeeding mother can therefore be vaccinated during breastfeeding without risk to her or her baby. The ANSM nevertheless specifies that there is no study on the passage of vaccines in milk. “However, in view of the rate of degradation of vaccine RNA by the body and the biological mechanisms of management of RNA vaccines, no vaccine-related effects are expected in infants and children breastfed with a vaccinated woman. The agency recommends seeking advice from your GP, midwife or gynecologist before deciding to get vaccinated if breastfeeding, “especially if there are risk factors for a serious form for the mother. “
Covid and risks of premature births?
During a press briefing by the Belgian vaccination taskforce, Dr Frédéric Debiève, head of the obstetrics department at Cliniques Universitaires Saint-Luc, specified that “pregnancy increases the possibility of being treated in intensive care for Sars-CoV-2. Due to the physiology of a pregnant woman, mechanical and invasive ventilation is often necessary.”. Studies conducted in the United Kingdom and the United States with 4,000 pregnant women who have been infected with Covid-19 show that they have “60% increased risk of giving birth prematurely” said the doctor. Vaccination prevents severe forms of Covid-19, premature deliveries as well as maternal and perinatal mortality. In addition, antibodies are transmitted during pregnancy and lactation, which protects the baby.”
Vaccination of pregnant women: what contraindications?
According to the Minister of Health, only three situations on the advice of the National Medicines Safety Agency (ANSM), the committee on Alain Fischer’s vaccine strategy and the scientific council “which potentially concern a few hundred French people”, can give rise to a vaccine contraindication. Thus, only the “PIMS syndrome”, or pediatric multi-system inflammatory syndrome or even “reactions such as myocarditis, pericarditis and severe hepatitis requiring hospitalization and following a first injection of mRNA vaccine”, are concerned, he said on July 20. As well as people allergic to one of the components of the vaccine, this “who must concern about ten cases in our country”, reassures Olivier Véran. In these three cases, only “medical certificates in good and due form can be recognized as contraindications”. The Minister of Health adds that there is “no contraindications to messenger RNA vaccine including first trimester pregnancy”.