COVID-19 vaccination in pregnant and lactating diabetic women

Abstract

To discuss available information on the opportunity for pregnant women affected by diabetes/obesity to receive COVID-19 vaccine. Data synthesis: Pregnant women with SARS-CoV-2 (COVID-19) infection are at high risk for severe acute respiratory syndrome and adverse outcomes. Pregnant women with severe COVID-19 present increased rates of preterm delivery (<37 gestational weeks), cesarean delivery and neonatal admissions to the intensive care unit. Comorbidity such as diabetes (pregestational or gestational) or obesity further increased maternal and fetal complications. It is known that diabetic or obese patients with COVID-19 present an unfavorable course and a worse prognosis, with a direct association between worse outcome and suboptimal glycol-metabolic control or body mass index (BMI) levels. Critical COVID-19 infection prevention is important for both mother and fetus. Vaccination during pregnancy is a common practice. Vaccines against COVID-19 are distributed across the world with some population considered to have a priority. Since pregnant women are excluded from clinical trials very little information are available on safety and efficacy of COVD-19 vaccines during pregnancy. However, it is well known the concept of passive immunization of the newborn obtained with transplacental passage of protective antibodies into the fetal/neonatal circulation after maternal infection or vaccination. Moreover, it has been reported that COVID-19 vaccine-induced IgG pass to the neonates through breastmilk. Therefore, maternal vaccination can protect mother, fetus and baby. Conclusions: After an individual risk/benefit evaluation pregnant and lactating women should be counselled to receive COVID-19 vaccines.

Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy

“…Those diagnosed with this condition are at higher risk for a severe COVID-19 infection due to predisposing factors such as hyperglycemia, obesity and hypertension ( 242 ). Critically, the most common underlying conditions of pregnant women with SARS-CoV-2 that were hospitalized for severe disease were pre-pregnancy BMI ≥30 kg/m 2 (41.7%) and diabetes mellitus (Type 2) (12.5%) ( 243 ). An interplay of several pathophysiological mechanisms is thought to increase the risk of an unfavorable course and a worse prognosis for patients with GDM.…”

COVID-19 vaccine uptake and associated factors among pregnant women attending antenatal care in Debre Tabor public health institutions: A cross-sectional study

“…Pregnant women are especially vulnerable during the current COVID-19 pandemic because they are at an increased risk of morbidity and mortality from COVID-19 ( 9 , 10 ). Pregnant women are generally at a greater risk of severe illness, hospitalization, admission to the intensive care unit (ICU), invasive mechanical ventilation, preeclampsia, and death when compared to non-pregnant women with COVID-19 ( 1 , 11 – 15 ). Compared to pregnant women without COVID 19, pregnant women with COVID-19 have also a higher risk of adverse birth outcomes such as preterm birth, stillbirth, cesarean delivery, and neonatal ICU admissions, implying a high likelihood of neonatal morbidity and mortality ( 11 , 13 , 14 , 16 – 18 ).…”

“…Pregnant women are generally at a greater risk of severe illness, hospitalization, admission to the intensive care unit (ICU), invasive mechanical ventilation, preeclampsia, and death when compared to non-pregnant women with COVID-19 ( 1 , 11 – 15 ). Compared to pregnant women without COVID 19, pregnant women with COVID-19 have also a higher risk of adverse birth outcomes such as preterm birth, stillbirth, cesarean delivery, and neonatal ICU admissions, implying a high likelihood of neonatal morbidity and mortality ( 11 , 13 , 14 , 16 – 18 ). Vertical transmission has also been observed in a few cases in SARS-CoV-2 positive pregnant women, albeit it is extremely rare ( 19 ).…”

Overview of Breastfeeding Under COVID-19 Pandemic

“…Specific antibodies with neutralizing activity against SARS-CoV-2 are produced in serum and breastmilk following maternal infection with SARS-CoV-2 ( 22 ) or immunization ( 18 ), while the antibodies can be transferred to the infants via the placenta or breastmilk, protect the infants from infection ( 92 , 93 ). Even when the mother is too uncomfortable to breastfeed, the baby should be fed with expressed milk or pasteurized donated breastmilk in the human milk bank ( 114 , 115 ).…”

“…In this case, the incidence rate of respiratory diseases in the infants also decreased significantly, which suggested that specific antibodies produced in the breastmilk could be transferred to the infants and protect them from being infected after vaccination ( 18 ). Similarly, antibodies produced in mothers with the COVID-19 vaccine or infected with COVID-19 can transfer protective antibodies to fetuses or newborns through the placenta or breastmilk, thus protecting fetuses and newborns ( 92 , 93 ) ( Table 1 ).…”