Covid-19 Vaccination in pregnancy
The Green book guidance on pregnancy has been updated to reflect the changed approach to vaccination of pregnant women.
The specific detail is:
Pregnancy and breastfeeding
There is no known risk associated with giving inactivated, recombinant viral or bacterial vaccines or toxoids during pregnancy or whilst breast-feeding (Kroger A et al., 2013). Since inactivated vaccines cannot replicate, they cannot cause infection in either the mother or the foetus. Although AstraZeneca COVID-19 vaccine contains a live adenovirus vector, this virus is not replicating so will not cause infection in the mother or the foetus. As with most pharmaceutical products, specific clinical trials of COVID-19 vaccine in pregnancy have not been carried out.
Developmental and reproductivity testing of the Pfizer BioNTech, Moderna and AstraZeneca vaccines in animals have not raised any concerns. Adenovirus vectors, similar to those used in the AstraZeneca COVID-19 vaccine, have been widely used to vaccinate women against Ebola without raising any concern; formal trials of these vaccines in pregnancy are due to proceed.
Although the available data do not indicate any harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy. Routine questioning about last menstrual period and/or pregnancy testing is not required before offering the vaccine.
JCVI has advised that vaccination in pregnancy should be considered, however, where the risk of exposure to SARS-CoV-2 infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19. In these circumstances, clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the absence of safety data for the vaccine in pregnancy.
If a woman finds out she is pregnant after she has started a course of vaccine, she may complete vaccination during pregnancy if she is considered at high risk. Alternatively, vaccination should be offered as soon as possible after pregnancy.
Termination of pregnancy following inadvertent immunisation should not be recommended. Surveillance of the inadvertent administration of COVID-19 vaccines in early pregnancy is being conducted for the UK by the PHE Immunisation Department, to whom such cases should be reported https://www.gov.uk/guidance/vaccination-in-pregnancy-vip. As above, women who are inadvertantly vaccinated in early pregnancy may be considered for the second dose during pregnancy where the risk of exposure is high or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19.
The PGD has been updated to allow the vaccinators operating under the PGD to administer the vaccine.
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/01/C1218-Patient-Group-Direction-for-COVID-19-Vaccine-AstraZeneca-ChAdOx1-S-recombinant.pdf
https://www.rcog.org.uk/globalassets/documents/guidelines/2021-02-24-combined-info-sheet-and-decision-aid.pdf
Patients who choose to be vaccinated can also support PHE with monitoring of the vaccine on pregnant women by completing the PHE Monitor programme. https://vaccinemonitor-yellowcard.mhra.gov.uk/resources/invitationletter
If a patient realises they were inadvertently vaccinated whilst pregnant they will need to report this to PHE as set out here https://www.gov.uk/guidance/vaccination-in-pregnancy-vip.
Women booked at Homerton Maternity Services
Women booked at the trust maternity services should be offered the vaccine via primary care or at a Mass Vaccination site in line with the JCVI guidance. The maternity service has a role in supporting the decision making for women. The service is discussing how the maternity helpline can support this process and further information will be communicated to primary care and the mass vaccine sites in the coming days. The maternity service does not plan to run vaccine clinics.
