Updated vaccine recommendations for pregnant women
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Pregnant women have a slightly increased risk of a severe COVID-19 disease course, and there is more knowledge about vaccinating pregnant women. The Norwegian Institute of Public Health now recommends that all pregnant women are vaccinated against COVID-19. Vaccination during pregnancy will also protect the baby after birth.
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The risk of a severe disease course among pregnant women who become infected with coronavirus is low. However, international studies show that pregnant women are somewhat more likely to have a severe COVID-19 disease course than non-pregnant women, and that the risk is highest in the later stages of pregnancy. This may be because pregnant women have a greater strain on the heart and lungs as the foetus grows, and are therefore more prone to a severe disease course if they are infected.
“The risk for the pregnant woman increases throughout pregnancy. We therefore recommend pregnant women who are in the 2nd and 3rd trimester to be vaccinated with an mRNA vaccine against coronavirus. Pregnant women who belong to a risk group for COVID-19 can also be vaccinated from the first trimester,” says Margrethe Greve-Isdahl, Senior Physician at the Norwegian Institute of Public Health.
As a precautionary principle, pregnant women are not usually recommended to be vaccinated in early pregnancy. Pregnant women who belong to the risk groups for COVID-19 disease can still be vaccinated in the 1st trimester, because the risk of a severe disease course will also be higher in the 1st trimester for those with underlying diseases.
“Data from countries where pregnant women have been vaccinated show that coronavirus vaccination does not have an adverse effect on the course of pregnancy for either the mother or the foetus. The World Health Organization (WHO) recommends that pregnant women are given priority for coronavirus vaccines, and more and more countries have begun to vaccinate pregnant women. Coronavirus vaccination is already recommended for pregnant women in Denmark and Sweden,” says Greve-Isdahl.
Coronavirus vaccines can also be given to women who are planning to conceive and to women who are undergoing fertility assessment and follow-up (IVF treatment).
Maternal vaccine during pregnancy can also protect newborn babies
There is a low risk that infants in their first year of life will have a severe COVID-19 disease course. Nevertheless, children at this age are admitted to hospital more often than older children if they first become ill. This is because there is a lower threshold to admit infants when they are ill, and because they may be more affected by both fever and respiratory tract symptoms than older children.
“Women who are vaccinated during pregnancy will produce antibodies against coronavirus which are then transmitted to the child - especially in the last stage of pregnancy. Therefore, vaccination of pregnant women can help protect the baby in the first months after birth. Vaccination during pregnancy can protect both mother and child from becoming ill with COVID-19,” explains Greve-Isdahl.
Recommend full vaccination with mRNA vaccine in pregnancy
Knowledge about vaccination of pregnant women against COVID-19 disease comes mainly from countries that have vaccinated pregnant women for many months already. Pregnant women will be offered two doses at 3-8 week intervals with one of the two mRNA vaccines available in Norway. The mRNA vaccines from BioNTech / Pfizer (Comirnaty) and Moderna (Spikevax) are considered equivalent in terms of efficacy and safety for pregnant women.
“A flexible interval is important so that those who have come further in pregnancy can be fully vaccinated before birth, while for those who start vaccination earlier in pregnancy, a longer interval may be allowed. The best protection is obtained after the second vaccine dose. If vaccination is not completed during pregnancy, dose two may be given after the birth. Breastfeeding women can also be vaccinated,” says Greve-Isdahl.
No other post-vaccination adverse effects are observed in pregnant women compared to non-pregnant women of the same age.
“In follow-up studies of vaccinated pregnant women, it is reported that they can have the same, common side effects as other women of the same age. This means that they may experience pain in the arm, lethargy, body aches and fever. The side effects are short-lived and pass within one to two days,” says Greve-Isdahl.
Pregnant women are also recommended influenza vaccine
Before the upcoming influenza season, pregnant women are also encouraged to accept offers of the influenza vaccine.
“We expect that this year's season will be tougher than normal because we have had less influenza in the last two or three seasons, and the immunity in the population will be lower than usual. Both pregnant women and newborns are at risk of a severe influenza disease course, and pregnant women are encouraged as before to accept offers of influenza vaccine,” says Greve-Isdahl.
Greve-Isdahl understands that some people may be worried about several vaccinations during pregnancy, but emphasises that there is good experience that several vaccines during pregnancy do not negatively affect the course of the pregnancy or the foetus. In fact, the vaccines protect both the mother and the newborn baby.
It is not recommended that coronavirus vaccine and influenza vaccine are given at the same time because there is currently limited experience with the new coronavirus vaccines, but the vaccines can be given with a minimum of one week interval.