Once again, some might argue that a topic like COVID-19 vaccination and pregnancy is not really an emergency medicine topic.

True, but I believe it falls within that hotbed of issues which, although more closely related to local medicine, tends to involve us all.

A thorny issue

We know well, not only as health professionals, but as people how much any pharmacological intervention is feared in pregnancy.

Personally I have seen women in the throes of very painful renal colic or other conditions that cause intense pain, refuse any drug, sometimes even paracetamol.

Let alone vaccination.

We ourselves are rightly extremely cautious.

What do we know

I mentioned this in the post on COVID-19 vaccination questions and answers link .

Now, however, several scientific societies have taken a specific position in favor, so I believe it is worth trying to investigate

SIGO Position Paper

The SIGO Federation which includes four scientific societies SIGO AOGOI AGUI ACT released a position paper on this topic link with the intent to clarify and answer the many questions posed not only by technicians from health, but especially by women who are pregnant.

It seems ugly but …

Actually it is not nice to copy and paste this position paper, but it seems to me a good starting point for any discussions

Effects on the course of the COVID pathology

Mortality

The risk of maternal mortality in pregnant women with COVID-19 infection is 22 times greater than in women without the infection. These data emerge from the “ INTERCOVID Multinational Cohort Study ”, an international study that sees many Italian centers represented.

Morbidity

More marked impact on pregnant women in terms of morbidity with increased admissions to intensive care and the need to resort to extracorporeal circulation procedures such as ECMO, in the second wave of COVID-19 infection compared to the first.

Increase in the number of pregnant women requesting ICU admission between the first and second waves: 70 women during the first wave (March 1 – August 31, 2020) VS 277 women during the second wave (September 1, 2020 – 4 March 2021). based on the latest report from the Intensive Care National Audit & Research Center of 5 March 2021

Hospitalization and serious illness

Pregnancy is a significant risk factor for hospitalization and severe COVID-19 disease, with a more than doubled risk of ICU admission and invasive ventilation for pregnant women with COVID-19 compared to infected women of childbearing age, on the based on the results of a recent systematic review and meta-analysis.

Effects on the course of pregnancy and on the newborn

Pregnant women with COVID-19 infection are at greater risk of developing serious pregnancy pathologies such as preeclampsia, eclampsia and HELLP syndrome with consequent increase in hospitalizations and in the incidence of preterm births and caesarean sections due to alterations in maternal well-being and / or fetal.

The risks of serious neonatal complications, including stay in NICU (Neonatal Intensive Care Unit) for more than seven days, seem to be higher in infants of infected women COVID 19.

The vertical transmission of the virus seems to occur primarily through exposure post- natal (70.5%) although approximately 5.7% may be congenital.

How safe is COVID-19 vaccination in pregnancy?

The JCVI (Joint Committe on Vaccination and Immunization) stated that no specific safety issues related to vaccination during pregnancy have been identified: in the United States, approximately 90,000 pregnant women have been vaccinated, mainly with Pfizer and Moderna vaccines, without being No safety issue was raised.

Women planning pregnancy, early postpartum or breastfeeding can also be vaccinated depending on their age and clinical risk group. There does not seem to be any limitations in terms of the type of vaccine for the latter category.

These are the conclusions of SIGO

Pregnancy is a risk factor for severe COVID-19 disease

Pregnant women must be considered a fragile population towards Covid-19 infection and therefore its prevention a priority.

Vaccination is a central tool to protect women and consequently babies and therefore must be offered to all women during pregnancy.

What the international associations say

CDC

On the same wavelength the CDC – Vaccines & Pregnancy: Top 7 Things You Need to Know – link

WHO

The WHO recently broadcast a webinar on this topic with the indication of vaccination against COVID-19 in pregnancy when the benefits outweigh the risks and in particular:

• there is a high risk of exposure
• there are comorbidities and therefore a risk of contracting the severe form of the virus.

It should also be considered that, although there are currently ongoing studies on this category of people, pregnant women were initially excluded from the covid-19 vaccine trials.