Obstetricians are alarmed by the number of pregnant women still not vaccinated against Covid-19, and say they are concerned misinformation is wrongly leading them to believe the vaccine is not safe during pregnancy.
The clinical director of women’s and children’s health at St George hospital in Sydney, Prof Michael Chapman, said six weeks ago he surveyed the 22 women in the hospital’s postnatal ward who had just given birth. Just three were fully vaccinated, while 14 women had received one dose.
He then surveyed 60 women who came through the hospital’s antenatal clinic over the course of a morning on 21 September, and found 38% had not started the vaccination process. A similar number of women – 30% – were completely unvaccinated when he repeated the survey in the clinic last week. The percentage of fully vaccinated pregnant women was “well below” vaccination rates in the general population, he said, with 88% of those in NSW age 16 and over now fully vaccinated.
Australia’s independent expert advisory group on immunisation, Atagi, and the Royal Australasian College of Obstetricians and Gynaecologists, advise that women should be vaccinated against Covid with the Pfizer or Moderna vaccines at any stage of their pregnancy.
This is because the risk of severe outcomes from Covid-19 is significantly higher for pregnant women and their unborn baby. Global surveillance data from large numbers of pregnant women have not identified any significant safety concerns with mRNA Covid-19 vaccines given at any stage of pregnancy.
“Furthermore, there is also evidence of antibody in cord blood and breastmilk, which may offer protection to infants through passive immunity,” a statement from Atagi says.
Chapman said there were a number of reasons pregnant women were delaying or not getting the vaccination.
“I think the early negative media that there were potential side-effects was one factor, and secondly, the messages they’ve been getting from some general practitioners has not been positive,” Chapman said. “Some general practitioners still have a hesitancy themselves to do anything in pregnancy that might cause a problem and they don’t want to be held responsible, despite all of the reassurances of science.”
Chapman also runs an IVF clinic, where he said “at least twice a week” he has a patient check with him whether they should receive the vaccine, because their GP had told them they were unsure of the best advice to give.
“Unfortunately there are still women saying they won’t get it, or that they want to wait until after they have had the baby.”
A large study published in the Journal of the American Medical Association followed 18,715 women with Covid-19 in the US who gave birth across 499 medical centres between March 2020 and February 2021. The study found women with Covid-19 had a higher death rate, need for intubation and ventilation, and intensive care unit admission than pregnant women without the virus.
Dr Stefan Kane, a maternal foetal medicine specialist and acting director of maternity services at the Royal Women’s hospital in Melbourne, has been treating pregnant women with Covid.
“None of the vaccinated pregnant women with Covid we have seen has required hospitalisation for Covid, and they have very mild symptoms or no symptoms at all,” he said.
“It speaks to the value of vaccination. By contrast, we’ve seen extremely unwell unvaccinated women at six weeks of pregnancy, at 12 weeks, at 18 weeks, at 24 weeks, at 36 weeks and at 40 weeks … they get very sick at any gestation. We’ve had very unwell women with Covid who have needed to be admitted to hospital and who needed to have medications and therapies for which we don’t have a huge amount of data in pregnancy, and there were a significant number who needed intensive care admission and intensive care support.”
There was a major risk to babies as well, he said, mainly through premature birth. There is also a risk of stillbirth.
“We may have to deliver the baby early to help the mother get over the Covid infection,” Kane said. “Some of the women who get very sick from Covid have preexisting medical concerns, while others are otherwise completely healthy and their only risk factor was being pregnant.”
He said vaccination is also safe and recommended for women attempting to conceive, and those who are breastfeeding. Vaccine hesitancy among the pregnant and breastfeeding population was a concern among many of the health workers at the Royal Women’s hospital, Kane said.
“Early on in the vaccine rollout, it was natural for people to be concerned about the vaccine and it was very important for us to be able to get better information about the safety of the vaccine including the importance of vaccinating during pregnancy,” Kane said. But the safety profile of the Pfizer and Moderna vaccines for pregnant women was now well established, he said.
“I think there has been quite a shift in the last few months where we now have a majority of our patients who are either already fully vaccinated or getting vaccinated, but there’s still a small minority who are not willing to get vaccinated and obviously we have ongoing conversations with them around the potential risks and concerns around that. We are always willing to have that conversation.”