In a recent study published in the journal Vaccinations, researchers looked at whether the risks of coronavirus disease 2019 (COVID-19) in pregnant women outweighed the uncommon but significant hazards associated with the delivery of COVID-19 vaccines to pregnant people.
Background
For decades, pregnant women have been vaccinated against diseases such as tetanus, yellow fever, pertussis, and influenza in order to minimise the frequency of these infections and the accompanying illness and mortality. However, the recently produced COVID-19 vaccines are not yet available to pregnant women since they must be assessed for both mother and foetus safety. Data on the safety of COVID-19 vaccinations is currently being gathered.
New vaccinations, on the other hand, are not tested in pregnant women, who are generally excluded from such studies. COVID-19 may have a more severe presentation in pregnancy and may harm the baby, according to preliminary data in the current pandemic. Most of the currently available COVID-19 vaccine guidlines have not had this factor taken into account while developing or conducting clinical trials.
Despite the lack of proof, numerous expert groups have recommended that these vaccinations be given to pregnant and breastfeeding women. As a result, some individuals have been included in a few vaccination studies late.
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Arguments for vaccination during pregnancy
Young women’s normally low-risk COVID-19 profile is altered during pregnancy, putting them in a category with a higher risk of COVID-19 problems. This is because changes in respiratory physiology make a pregnant woman more susceptible to more severe illness after a lung infection.
COVID-19 is associated with an increased risk of hospitalisation, admission to the intensive care unit (ICU), and treatment with invasive or non-invasive ventilation, as well as a greater death rate in pregnancy. Despite the low overall prevalence of severe COVID-19 in women of reproductive age, ICU hospitalizations were necessary in 10.5 out of 1,000 pregnant women and four out of 1,000 non-pregnant women, respectively.
In pregnancy, the chance of invasive ventilation was nearly quadrupled, while the risk of mortality was 70 percent greater, at 1.5 per 1,000. A multicenter research (the Inter covid Multinational Cohort Study) on almost 2,000 women in 18 countries, including roughly 750 pregnant women, confirmed these findings.
In fact, this study found a 22-fold increased risk of death in pregnant women who were exposed to COVID-19, with a mortality rate of 1.6 percent – an order of magnitude higher than in previous research. ICU admissions were five times greater during pregnancy, and ICU stays were nearly four days longer.
Pregnancy complications
Because of the substantial variability across the studies conducted early in the pandemic, none of them suggested a higher risk of foetal mortality or miscarriage. The women in the study were at various stages of pregnancy, had varying risk factors, and received varying degrees of care.
Preterm delivery and stillbirth are the most prevalent problems, followed by pre-eclampsia. According to one meta-analysis, the rates of these problems rose by 82 percent, 200 percent, and 33 percent, respectively. Other researchers claim that the rise is substantially greater, with preterm births accounting for up to 37% of all births and a five-fold higher stillbirth rate in COVID-19-positive pregnancies than in the general population.
The risk of pre-eclampsia was raised fourfold. Cesarean sections have also become more common. Women with a temperature and shortness of breath, which indicate a more serious illness, were more than twice as likely to have a difficult course.
COVID-19-positive moms’ babies were 11 times more likely to require newborn care, 1.5 times more likely to develop jaundice, and 2.5 times more likely to die.
Mechanisms of COVID-19 pregnancy problems
The causes of COVID-19 pregnancy problems are unknown, although they are most likely connected to the illness’s impact on the heart and vascular system, as well as the clotting cascade. These side effects might result in reduced foetal growth and development due to inadequate foetal perfusion and placental malfunction.
Because some indicators, such as placental alterations, are missing in COVID-19 instances, the pre-eclampsia seen during pregnancy differs slightly from that found in non-COVID-19 patients.
While some research have suggested that the virus causes placental inflammation, poor foetal perfusion, and a lack of adequate placental perfusion, most of these investigations have been conducted in the third trimester. As a consequence, it’s unclear if the virus is to blame for the damage or whether it’s due to COVID-19’s vascular harm.
The replication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been proven to directly infect placental cells. Because placental cells have low amounts of the angiotensin converting enzyme 2 (ACE2) receptor, which is required for cell entrance, it’s unlikely that the virus causes foetal problems directly. More investigation is required.
Vertical transmission is improbable, according to virtually all research conducted thus far. Breast milk isn’t regarded a transmission channel, and caesarean birth isn’t considered any safer than vaginal delivery in this regard.
COVID-19 prevention during pregnancy
According to available research, the current COVID-19 vaccines elicit a robust humoral and cellular immune response in pregnant and lactating women that is equivalent to that seen in other women. The reaction is stronger than that elicited by a normal infection.
As a result, infants born to vaccinated mothers have breast milk antibody titers that are 15 times or greater than babies born to unvaccinated mothers – despite the fact that the binding antibody titers in these babies’ serum samples were half those in the mother’s blood.
What is the end result?
The conclusion appears to be unavoidable: COVID-19 puts pregnant women, as well as their unborn children and newborn babies, at risk of serious disease. The messenger ribonucleic acid (mRNA) vaccines now in use are both safe and immunogenic in pregnancy, according to published evidence.
