Victoria Goldman examines the latest Covid guidance for expectant mothers and parents and the role community pharmacy teams can play...
In April, the Joint Committee on Vaccination and Immunisation (JCVI) advised that pregnant women should be routinely offered Covid-19 vaccinations along with the rest of the population, based on their age and clinical risk group.1
About two-thirds of women who test positive for Covid-19 in pregnancy have no symptoms at all, but some pregnant women may be more prone to severe symptoms and hospitalisation.2 If this happens, their baby is three times more likely to be born prematurely, which can affect their long-term health.2
Previously, in December 2020, the JCVI had advised that only pregnant women at high risk of Covid-19 complications should be routinely offered the Covid-19 vaccination, due to lack of data rather than any evidence of adverse effects.3 But new research from the USA shows that around 90,000 pregnant women have been vaccinated with mRNA vaccines, including Pfizer-BioNTech and Moderna, without any safety concerns being raised.1
Based on the US data, the JCVI advises that it’s preferable for pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna vaccines where available.1 There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed.1
On 8 April the JCVI advised that, as a precaution, it is preferable for people under the age of 30 with no underlying health conditions to be offered an alternative to the AstraZeneca vaccine where possible.4 This follows reports of extremely rare blood clots in a small number of people.4
Pregnant women should discuss the risks and benefits of vaccination with their doctor or midwife, including the latest evidence on safety and which vaccine they should receive.1
Women who are planning pregnancy, have just had a baby or are breastfeeding can be vaccinated with any vaccine, depending on their age and clinical risk group.1 Breastfeeding women shouldn’t stop breastfeeding when they are vaccinated, as there is no evidence that any vaccine ingredients pass to the baby through breastmilk.3,5
The vaccines being used in the UK are not live vaccines and contain no ingredients that are known to be harmful to pregnant women or to their developing baby.5 Pregnant women are already offered other non-live vaccines, such as those against flu.5
The JCVI advises that women don’t need a pregnancy test before vaccination, and that women planning a pregnancy don’t need to avoid pregnancy after having the vaccination.3 Women trying to become pregnant don’t need to avoid having the vaccination as there is no evidence to suggest that Covid-19 vaccines will affect fertility.5
If women are pregnant at the time of the vaccination, they should tell the vaccination team so that this can be recorded.2 If pregnant women are inadvertently given a Covid-19 vaccine, healthcare professionals can report this via the PHE Inadvertent Vaccination in Pregnancy (VIP) System.5
Covid in babies
According to Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists (RCOG), the pandemic has led to many parents feeling anxious and stressed about the infection risk to their babies.
A study published in The Lancet Child & Adolescent Health in November 2020 found the risk of severe Covid-19 infection for new-born babies is low.6 Researchers at Imperial College London and the Nuffield Department of Population Health at the University of Oxford traced all babies across the UK who were less than 29 days old with Covid-19 and needed to be admitted into hospital.
The study found 66 babies required hospital treatment for Covid-19 infection in this period. This is the equivalent of one in 1,785 births. None of the babies in the study died from the virus, and 90 per cent had fully recovered from the infection and been discharged from hospital.
“Existing evidence suggests that whether or not a new-born baby gets the virus is not affected by mode of birth, feeding choice or whether a woman and her baby stay together,” says Dr Morris.
“While the overall percentage of babies requiring hospital treatment for Covid-19 infections was low (0.6 per cent), we are concerned that such a high proportion were from BAME groups – a disparity also seen in pregnant women and new mothers.”
If parents think their baby has contracted Covid-19, they should contact their GP surgery for advice. Most babies have no symptoms, while others may have only mild symptoms, similar to those of a cold or flu.7 These symptoms may include a cough, runny nose, sneezing, fever, diarrhoea/vomiting and changes in mood or behaviour (e.g. sleeping more or less often and feeding difficulties).7
Babies can get very unwell very quickly.8 As with any infection, parents should therefore monitor their baby’s temperature, breathing and overall health.7 They should seek medical advice if their baby:
Signs that a baby needs urgent medical care include:
1. JCVI issues new advice on COVID-19 vaccination for pregnant women. Joint Committee on Vaccination and Immunisation (JCVI). https://www.gov.uk/government/news/jcvi-issues-new-advice-on-covid-19-vaccination-for-pregnant-women, published 16 April 2021
2. I am pregnant and have been offered a Covid-19 vaccination. What are my options? Royal College of Obstetricians and Gynaecologists. https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf, updated 24 March 2021
3. Joint Committee on Vaccination and Immunisation (JCVI): advice on priority groups for COVID-19 vaccination. Joint Committee on Vaccination and Immunisation (JCVI). https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-30-december-2020/joint-committee-on-vaccination-and-immunisation-advice-on-priority-groups-for-covid-19-vaccination-30-december-2020, updated 6 January 2021.
4 New JCVI advice on use of the AstraZeneca COVID-19 vaccine. Joint Committee on Vaccination and Immunisation (JCVI). https://www.gov.uk/government/news/new-jcvi-advice-on-use-of-the-astrazeneca-covid-19-vaccine, published 8 April 2021
5. Covid-19 vaccines, pregnancy and breastfeeding. Royal College of Obstetricians and Gynaecologists. https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19-vaccines-pregnancy-and-breastfeeding/, updated 22 March 2021.
6. Gale C et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the United Kingdom: a prospective national cohort study using active surveillance. Lancet Child and Adolescent Health. 2021 Feb; 5(2): 113–121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818530/
7. How to recognise Covid-19 in babies and what to do. Medical News Today. https://www.medicalnewstoday.com/articles/covid-19-symptoms-in-babies#treatment-and-prevention, published 5 June 2020.
8. Coronavirus in children. NHS. https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/coronavirus-in-children/, last reviewed 1 April 2021