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Corona vaccination during pregnancy and breastfeeding? What experts advise

Should I get vaccinated against coronavirus if I am pregnant or breastfeeding? Is the vaccination dangerous for my unborn or newborn baby? And am I actually allowed to be vaccinated? These and other questions are currently on the minds of many pregnant and breastfeeding women. Tikbow tries to answer some of them. To do so, we looked at the current state of research and talked to a virologist.

First of all, whether a pregnant or breastfeeding woman wants to be vaccinated against Corona is her own decision and, above all, a very personal one. Both rational factors, such as her health and life circumstances, are involved. And then there is also the good old gut feeling. Accordingly, there can be no blanket yes-or-no answer when it comes to pregnancy/breastfeeding and corona vaccination. But there are considerations that speak for or against and can perhaps help in the decision.

Pregnancy, breastfeeding and Corona vaccination – this is what the STIKO recommends.

The Standing Commission on Vaccination (STIKO) of the Robert Koch Institute (RKI) recently extended its recommendation on corona vaccination during pregnancy. In doing so, it has given more room to the free decision of the pregnant woman for a vaccination, according to the RKI. The STIKO still does not recommend general vaccination during pregnancy. At the same time, vaccination during pregnancy is "not an indication for abortion". 

The current recommendation of the STIKO is: "Pregnant women with previous illnesses and a resulting high risk of severe COVID-19 disease or with an increased risk of exposure due to their living conditions can be offered vaccination with an mRNA vaccine from the 2nd trimester onwards after a risk-benefit assessment and detailed information. In addition, the STIKO considers it very unlikely that the vaccination of the nursing mother poses a risk to the infant.

However, the STIKO does not want to issue a general vaccination recommendation for pregnant and breastfeeding women. In their opinion, there is still not enough data available, although there are now some studies, especially from the USA. According to the experts of the Robert Koch Institute, however, the results are "no findings from controlled studies on the use of Covid-19 vaccines in pregnancy". (As of 5/12/2021)

Gynecologists clearly in favor of vaccination

At the same time, the Standing Commission on Vaccination refers to a joint recommendation of the German Society for Perinatal Medicine (DGPM), the German Society for Gynecology and Obstetrics (DGGG) and the National Breastfeeding Commission (NSK). In the document, the experts clearly advocate corona vaccination during pregnancy and breastfeeding. The document states: “In informed participatory decision making and after exclusion of general contraindications, it is recommended to vaccinate pregnant women with mRNA-based vaccine against Covid-19 in a prioritized manner. Furthermore, the gynecologists recommend offering and enabling mRNA-based vaccination against Covid-19 to breastfeeding women;

Can the Corona vaccine harm the unborn baby? What the virologist says

In view of these different approaches on the part of German experts, Tikbow wanted to know more and asked the virologist Prof. Dr. Christian Jassoy, Academic Director of the Institute of Medical Microbiology and Virology at Leipzig University Hospital. He told Tikbow: “I know that there are studies that show a more severe course of (corona) disease in the pregnant woman and also illness in the child. However, I am guided by the vaccination recommendations of the STIKO."

With regard to a potential risk of the mRNA vaccine for the unborn child, Jassoy explains: "The vaccine can probably not be transmitted to the children via the placenta due to the way it is used and the mechanism of action." Furthermore, the mRNA vaccine is less likely to cause fever reactions. The STIKO is still weighing up the advantages of vaccination, vaccination reactions and complication risks. In any case, it is good if pregnant women protect themselves against a SARS CoV-2 infection by taking the usual protective measures,” the virologist advises.

For corona vaccination in pregnant women, mRNA vaccines are currently recommended as a priority, currently Moderna and Pfizer-BioNTech. According to the U.S."Centers for Disease and Control" (CNC), the mRNA vaccines do not contain the live virus that causes covid-19. Accordingly, the virus cannot be transmitted to a person through it. Furthermore, mRNA vaccines do not interact with a person’s DNA or cause genetic changes because the mRNA does not enter the cell nucleus, where our DNA is stored,” says CNC.

Current state of research

Corona vaccination in pregnancy

Several studies now provide better insight into the benefits, vaccination reactions and risks of Corona vaccination during pregnancy and breastfeeding. In parallel, new evidence continues to come to light showing how dangerous Corona can be for pregnant women and their unborn children. The joint position paper of the gynecologists summarizes many of these findings. Among them is that of the U.S. V-safe Pregnancy Registry. According to this, 100,599 registered women received an mRNA vaccine in pregnancy, and 4,711 pregnancies were analyzed (as of 04/26/2021).

The analysis showed, among other things, that Covid-19 vaccination with mRNA-based vaccines did not lead to an increase in pregnancy-specific complications. These include abortions, stillbirths, premature births, fetal growth restriction, malformations and neonatal deaths. Furthermore, there is no detectable risk of increased morbidity or mortality for the pregnant woman or the fetuses. At the same time, the results showed that the maternal antibodies could also potentially protect the newborn from infection. The antibody titers are significantly higher than after an infection,” the paper states. And further: "Müternal IgG antibörpers could be detected with a high ¨titer ratio in the newborn."

Corona in pregnancy

In addition to vaccination and efficacy, Corona itself plays a role in the decision of whether to vaccinate. SARS-CoV-2 infection/Covid-19 disease in pregnancy can lead to severe adverse events (…)," the paper states. According to the paper, the risk of needing intensive care is six times higher than for non-pregnant women. Ventilation is even 23 times more likely to be necessary. If the pregnant woman is over 35, this is a risk factor, as are pre-existing conditions such as hypertension and diabetes mellitus. If there is already a high-risk pregnancy, the risk is further increased by a corona infection. Pregnant women are 26 times more likely to die than their non-pregnant peers. Here, the comparative figures are 141 to five deaths per 100,000 women.

Complications are particularly frequent in pregnant women infected with Corona. There is an 80 percent higher risk of premature birth after infection. If the infection is severe, the risk is more than four times higher, and the rate of stillbirths is also increased. But even those who do not experience any symptoms have an 80 percent higher risk of developing preclampsia. Again, the risk is four times higher if the condition is severe. Similarly, the risk of thromboembolic events increases and neonates are three times more likely to require treatment in a neonatal intensive care unit.

"According to the German CRONOS registry, in which 1,905 SARS-CoV-2-positive pregnancies have already been documented as of April 2021, intensive medical treatment was required in 1 out of 25 pregnant women", the gynecologists write. Of those, 1 in 5 patients required respiratory support and 1 in 10 required ECMO therapy. One in 2,000 pregnant women died, "which was consistent with internationally published data of approximately 50 per 100,000 women". "Maternal mortality in Germany in 2016 was 2.9 per 100,000 women", it added.

Corona vaccination during breastfeeding

There is also evidence for corona vaccination with mRNA vaccines in breastfeeding women, according to the gynecologists’ paper. They show about "equivalent antigen formation and a "similarly low side effect profile" as pregnant and non-pregnant women. In addition, vaccination during breastfeeding can cause so-called "nest immunity". This means that the antibodies may be transferred to the newborn baby via the mother’s milk. The mRNA itself has not been detected in breast milk, only the antibodies.

Where can women get Corona vaccine during pregnancy and breastfeeding?

Some countries now recommend and facilitate Corona vaccination of pregnant women. These include Belgium, the USA, Israel, Great Britain and Germany’s neighbor Austria. In Germany, it is not always easy for pregnant women to get vaccinated. Pregnant women who would like to be vaccinated should definitely consult their gynecologist and discuss their personal risk profile. He or she may also already be able to vaccinate. Otherwise, it is advisable to contact the family doctor or a vaccination center.