pregnant women

No, Covid is Not Unusually Deadly for Pregnant Women

The Royal College of Obstetricians and Gynaecologists (RCOG) was in the news yesterday encouraging pregnant women to get vaccinated against Covid by quoting new data showing that “nearly 20% of the most critically ill COVID-19 patients are pregnant women who have not been vaccinated”. According to their website:

Since July, one in five COVID-19 patients receiving treatment through a special lung-bypass machine were expectant mums who have not had their first jab.

Pregnant women have been treated with a therapy, called Extracorporeal Membrane Oxygenation (ECMO), used only when a patient’s lungs are so damaged by COVID-19 that a ventilator cannot maintain oxygen levels.

Out of all women between the ages of 16 and 49 on ECMO in intensive care, pregnant women make up almost a third (32%) – up from just 6% at the start of the pandemic, March 2020.

The numbers from ICNARC back up the claim that pregnant and recently pregnant women have been admitted to ICU with a positive Covid test in greater numbers during the Delta surge than previously.

Preg-CoV: New Trial to Study Potential Side-Effects of Covid Vaccination on Pregnant Women on Babies

A new clinical trial based in the U.K. will seek to determine the most suitable gap between the first and second Covid vaccine jabs for pregnant women, as well as the potential side effects on their unborn children. Those running the trial hope it will make pregnant women feel more comfortable about getting vaccinated. The Guardian has the story.

Last week, Professor Jacqueline Dunkley-Bent, Chief Midwifery Officer for England, urged expectant mothers to get vaccinated as soon as possible, with evidence suggesting the Delta variant poses a significantly greater risk to pregnant women than previous forms of the virus.

A clinical trial called Preg-CoV has been launched to help determine the best gap between doses for pregnant women as well as exploring in greater detail potential side-effects and the impact on babies – something the researchers hope will offer reassurance. …

Asma Khalil, Lead Obstetrician for the trial and Professor of Obstetrics and Maternal Fetal Medicine at St George’s, said that while the U.K. Covid vaccination programme had been a success, uptake has been low among pregnant women.

According to research in her own hospital, “among pregnant women who’ve given birth between March this year until beginning of July, less than one third – 28% – of women who were eligible according to the guidance actually received [at least one dose of] the Covid vaccine” during pregnancy, said Khalil. …

“Pregnant women are still concerned because pregnant women were not included in initial Covid vaccine trials,” said Khalil.

In the first phase of the Preg-CoV trial, the team hope to recruit 600 pregnant women, aged between 18 and 44, from 13 sites across England.

Two groups of 200 unvaccinated pregnant women at different gestation times will be randomised both with respect to whether they receive a Moderna or Pfizer/Biontech jab and to whether they are given their second dose four to six weeks or at eight-12 weeks after the first dose. 

Participants will not know which Covid jab they are given… while a routine vaccination to protect against whooping cough will also be included in the schedule so that participants are not aware which dosing regime they are following.

A third group of about 100 pregnant women will be given one dose of a Covid jab at 28-34 weeks gestation, with the second dose of the same vaccine given after delivery, while the fourth group of 100 women will already have had their first dose of any Covid jab before or very early in pregnancy and will get the second dose of the same vaccine.

All the women will have follow-up visits and blood tests, and fill in an electronic diary to help the researchers monitor any potential vaccine side-effects. The team will also track outcomes for the babies up to 12 months of age to explore safety and impact on their development. …

“I think there will be some lessons learned from this pandemic,” said Khalil. “And one of them is that we should consider including pregnant woman at a relatively early stage for vaccine trials.”

Worth reading in full.

16% of Pregnant Women in U.S. Have Been Vaccinated Against Covid

Just over 15% of pregnant women in the U.S. have had at least one dose of a Covid vaccine, according to data from the Centers for Disease Control and Prevention (CDC). Black and Hispanic mothers are up to four times less likely to have been vaccinated than white and Asian mothers. The CDC believes that vaccine hesitancy (or refusal) is likely caused by there being limited safety data available on the new vaccines. The MailOnline has the story.

Vaccination rates diverge significantly by race: 25% of Asian pregnant women and 20% of white women were vaccinated compared to 12% of Hispanic women and only six per cent of black women…

The CDC researchers expect vaccination coverage among pregnant women to increase as vaccine access continues to improve and more information on the shots’ safety becomes available.

When Covid vaccines went through clinical trials, they were not tested in pregnant or breastfeeding women despite their increased risk of severe illness or death.

Such a practice is common in clinical trials because researchers don’t want to risk the health of expecting women.

But it left these women with limited information on safety risks that the vaccines may have posed. 

Regulators said the evidence on these vaccines did not raise safety concerns, yet without data specifically on pregnant women, they could not make guarantees.

Despite the limited data, when the U.S. Food and Drug Administration authorised the Pfizer vaccine for emergency use in early December, the agency said that pregnant women could choose to get vaccinated.

At the time, some scientists saw this as a major step forward for pregnant women – they could make their own healthcare decisions…

But the new data from the CDC suggest that many pregnant women in the U.S. chose not to get vaccinated, at least, not in the early months of the vaccine roll-out…

Why the low vaccination rate? The CDC researchers suggest that pregnant women may have been hesitant to get vaccinated due to the limited safety data available on the new Covid vaccines as well as potential access issues.

Older pregnant women were more likely to get vaccinated than younger women. Pregnant women between the ages of 35 and 49 had a 23% vaccination rate, compared to just a six per cent rate for ages 18 to 24.

Worth reading in full.

Women Forced to Wear Face Masks During Labour, Charity Finds

Nearly one in five pregnant women are being forced to wear a face mask during labour, according to research by the charity Pregnant Then Screwed. Some of these women have described the experience as the most terrifying of their lives. They were first seen by their children while masked. For months, a number of hospitals also banned the presence of birth partners for all but the hours of active labour. It is no wonder there was an increase in the number of pregnant women considering freebirth without a medical professional present in 2020. The Guardian has more.

Women described feeling unable to breathe, having panic attacks or even being sick during labour because they were made to wear a face covering [while in labour].

The research was carried out by the charity Pregnant Then Screwed, who surveyed 936 women who gave birth during December. It found that 160 of those who went into labour were made to wear a face covering. This goes against current joint U.K. guidance, published in July 2020 by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

The guidance says that women should not be asked to wear a face covering of any kind during natural labour or during caesarean births because of the risk of harm and complications. Rosie, 39, from London, said she felt as if she was dying because she was in so much pain during advanced labour with her third child, born in December. Yet maternity staff instructed to keep on her face mask.

She told BBC News: “I was feeling claustrophobic and the mask was making me feel really nauseous and making me panic as well. I’m pushing my baby out, I have this mask on my face, and the feeling of claustrophobia is just massive.” 

She said she couldn’t express herself because while struggling to breathe it was hard to talk and staff couldn’t see her whether or not her lips were moving. “I was frightened that amongst everything else that was happening I was then going to be sick inside the mask,” added Rosie, who has a condition called emetophobia, which is a fear of vomiting. At one point she ripped off the mask but was told to put it back on.

Natalie Titherington, from Oldham, says she was not aware of the guidance on face masks during labour when her baby girl was born last December. She said the birth was the most terrifying experience of her life. “I was gasping for air. I felt completely suffocated. I’m never going to be able to forget the feeling of not being able to breathe, and the fear and panic I felt while wearing a mask.”

Titherington says she was made to wear a face mask while she was in advanced labour, around 8cm dilated and having regular and very painful contractions.

“Someone put the mask on me and I said: ‘You can’t be serious,’ and she replied: ‘Yes,’ and then I remember having a contraction,” said Titherington, who has flashbacks of her traumatic birth and has been unable to wear a face covering since because it triggers the memory of struggling to breathe.

She ended up having an emergency caesarean and was told to wear the mask during the entire surgery, which goes against the official guidance.

Worth reading in full.

Vaccine Booking System Hasn’t Allowed Pregnant Women to Book the Specific Vaccines Recommended to Them by the JCVI and the NHS

The NHS’s vaccine booking site hasn’t just failed to keep people’s vaccine status private but has also failed to allow pregnant women to book the vaccines they have been advised – both by the Joint Committee on Vaccination and Immunisation (JCVI) and by NHS England – to receive.

The JCVI says that it is “preferable” for pregnant women to be “offered” the Pfizer or Moderna vaccines “where available” due to there being more “real-world data” from the U.S. on these vaccines and because “more research is needed” on the AstraZeneca vaccine when given to pregnant women. “Where available” is not strong enough for NHS England. GPs at sites that are only administering the AstraZeneca Covid vaccine were told last month to cancel all appointments for pregnant women and to direct them to sites where alternative vaccines are available.

Regardless of the advice given, it has not been possible, for this whole time, for pregnant women to book specific vaccines through the NHS vaccine booking system – an issue which is, at long last, being amended (though how long this might take is anyone’s guess). The Guardian has more.

After the Government announced that people under 40 would be offered an alternative to the AstraZeneca vaccine where possible, the Royal College of Obstetricians and Gynaecologists (RCOG) warned the system for pregnant women – who are advised to have the Pfizer or Moderna vaccines – was not working.

Charities said pregnant women had faced confusion, delays and wasted trips, with the online booking system giving no option to pregnant women to specify what vaccine they wanted…

Professor Wei Shen Lim, the JCVI chair, said he hoped NHS England would be able to overcome difficulties in pregnant women accessing the Pfizer or Moderna jabs. “I understand there have been some reports of difficulties in accessing the vaccines,” he told a televised briefing. “I certainly hope that operationally NHS England will be able to overcome those difficulties in access.”

A letter to health providers from senior bosses, including the National Medical Director for England, Professor Stephen Powis, published on Friday, said: “NHS Digital will be amending the national booking service in the coming days to allow pregnant women to book into specific vaccine appointments in line with JCVI guidance.”

Before news of the letter, Dr Pat O’Brien, the RCOG Vice-President, had said: “The latest Government guidance for pregnant women is to contact their GP for advice on how to receive the appropriate vaccine. However, GP practices are reporting that they don’t have the ability to do this, leaving pregnant women feeling frustrated and helpless as they are passed from pillar to post.” 

Joeli Brearley, of the campaign group Pregnant Then Screwed, said pregnant women had faced “insurmountable challenges” when trying to access the vaccine, including medical professionals giving sometimes inaccurate information.

“Pregnant women are telling us that this is affecting their mental health,” she said. “The Government has had a baby blind spot throughout this pandemic.”

Worth reading in full.

Pregnant Women Should Be Prioritised for Covid Vaccines Regardless of Age, Says Oxford Professor

Only last week, the Government advised that pregnant women should be given Covid vaccines, although preferably the Pfizer or Moderna vaccine rather than AstraZeneca because there was more observational data available about the effect of the first two thanks to the vaccine roll out in America. Now, an Oxford Professor of Foetal Medicine has said that the vaccination of mothers-to-be should be prioritised so they don’t have to wait until the vaccine becomes available to people in their age group, such are the risks of COVID-19 for mothers-to-be and their unborn children. The Mail on Sunday has the story.

Pregnant women should be fast-tracked for Covid jabs because the disease greatly increases the risk of health problems for mums-to-be, a leading medic has said.

A study led by a top Oxford expert found that the virus raises the risk of serious maternal complications by more than 50%, including a fivefold risk of mothers needing intensive care.

It doubles the risk of premature birth and newborn illness and also significantly raises the chance of the mother dying, according to a study of more than 2,000 expectant women.

The call for pregnant women to be put at the front of the queue differs from guidelines by the U.K.’s vaccine advisers, who say mums-to-be should be offered a jab when other people their age get one.

Until now, only pregnant women with underlying health conditions or those with high risk of exposure to the virus were eligible.

The latest study was led by Oxford University’s Professor of Foetal Medicine Aris Papageorghiou, who said: “Fortunately, there were very few maternal deaths [in the study]; nevertheless, the risk of dying during pregnancy and in the postnatal period was over 20 times higher in women with Covid than in the non-infected pregnant women.”

The findings show that of some 1,400 pregnant women without Covid, one died. But in 700 pregnant women with Covid, 11 died – with the majority said to be virus-related. Professor Papageorghiou added: “Our study unequivocally shows that women who are pregnant and become infected with Covid have much worse [health] outcomes than their counterparts not infected.”

He added: “What is often missed is that we are talking here about two individuals, the mother and the child. Covid in a pregnant woman increases complications that can lead to premature birth, which is the number one contributor to newborn death and long-term disability.”

His “personal opinion” was that pregnant women should now be prioritised for Covid vaccination, given that older age groups have already received their first jab. He said: “I believe pregnant women should constitute a high-risk group by virtue of their pregnancy.”

In most areas the NHS is now vaccinating 45-to-49 year-olds. Health bosses insist they will not deviate from the plan of working down through five-year age bands, meaning most pregnant women will have to wait.

Initially, the Government – acting on the advice of the Joint Committee on Vaccination and Immunisation (JCVI) – said the Pfizer or Moderna vaccines should be given to pregnant women “where available” but that the AstraZeneca vaccine could also be administered. This was in spite of the JCVI’s own admission that “more research is needed” on the AZ vaccine because pregnant women were not included in the vaccine trials. Earlier this week, however, NHS England told GPs at sites that are only administering the AstraZeneca Covid vaccine to cancel all appointments for pregnant women and direct them to sites where alternative vaccines are available.

Worth reading in full.

NHS England Tells GPs Not to Give Pregnant Women AstraZeneca Covid Vaccine

GPs at sites that are only administering the AstraZeneca Covid vaccine have been told to cancel all appointments for pregnant women. This is in contrast to the advice issued by the Government last week, which was that pregnant women should be offered a Covid vaccine regardless of what stage they were at in their pregnancy. While the Joint Committee on Vaccination and Immunisation (JCVI) said that it would be “preferable” for pregnant women to be “offered” the Pfizer or Moderna vaccines “where available” due to there being more real-world data on these vaccines, it said the AstraZeneca vaccine should still be administered where an alternative was not available. This is in spite of the fact that the JCVI also said “more research is needed” on this vaccine because pregnant women were not included in the trials. NHS England has taken a more cautious approach, telling GPs to direct pregnant women to sites where alternative vaccines are available. MailOnline has the story.

A letter sent by NHS England bosses to practices on Saturday specified sites that do not have Pfizer or Moderna vaccines in stock should cancel all scheduled first doses for expectant mothers. 

It takes a more cautious stance than Number 10’s vaccine advisory panel, which says pregnant women should be offered jabs at the same time as their peers.

The JCVI originally said mothers-to-be should hold off on getting jabbed until there was more evidence. But it performed a U-turn last week after data from the U.S. showed they were safe.

It advised pregnant women should be offered Pfizer or Moderna vaccines in the first instance – but did not ban expectant mothers from getting AstraZeneca’s jab…

But the NHS England letter to practices the following day instructed all practices to direct pregnant women to primary care network sites, if they were unable to offer Pfizer or Moderna vaccines.

It said all “sites should implement screening procedures to ensure pregnant women are identified and offered the Pfizer or Moderna vaccine”. 

The letter added pregnant women who have already had a first dose of AstraZeneca should continue with their second dose as planned, in line with guidance for the rest of the population. 

NHS England told MailOnline that patients who have their AstraZeneca appointment cancelled would be rebooked instantly for an alternative.

A spokesperson insisted the cancellation policy would not result in pregnant women receiving their first dose later…

The Royal College of Obstetricians and Gynaecologists says pregnant women are no more likely to catch Covid than others, and that most have no symptoms or suffer mild cold or flu-like warning signs.

But there are a small number who can become unwell with the virus, and may be at increased risk of becoming severely ill compared to other women.

Worth reading in full.

Pregnant Women Should Be Offered Covid Vaccine, New Government Advice Says

Pregnant women should be offered a Covid vaccine at any stage of their pregnancy, according to new Government advice. The Joint Committee on Vaccination and Immunisation (JCVI) advises that it is “preferable” for pregnant women to be “offered” the Pfizer or Moderna vaccines “where available” due to there being more “real-world data” from the US on these vaccines. The AstraZeneca vaccine (the primary Covid vaccine in the Government’s rollout) will, however, still be administered where an alternative is not available, despite the JCVI saying that “more research is needed” on this vaccine because pregnant women were not included in trials. It will “continue to closely monitor” the impact of the AZ vaccine on pregnant women as it is administered. BBC News has the story.

Pregnant women should be offered a Covid jab when other people their age get one, the UK’s vaccine advisers say.

They say the Pfizer and Moderna vaccines are preferable because data from the US in 90,000 pregnant women has not raised any safety concerns.

Up until now, only women with underlying health conditions or those whose risk of exposure to the virus was high were eligible…

The JCVI now advises that pregnant women should all be offered the Pfizer-BioNTech or Moderna vaccines where available, at the same time as the rest of the population. 

They are encouraged to discuss the risks and benefits of the vaccines with their doctor before making the appointment, but it is not a requirement.

“There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed,” it added.

Currently, there is a lack of data on the AstraZeneca vaccine in pregnancy because pregnant women were not included in trials, but the JCVI says more evidence may be forthcoming in the near future…

Women who are planning pregnancy or are breastfeeding can be vaccinated with any vaccine, depending on their age and clinical risk group, the JCVI said.

It said it would closely monitor the evidence on Covid vaccination in pregnancy and update its advice as required.

Worth reading in full.