Severe COVID-19 in pregnancy is almost exclusively limited to unvaccinated women – time for policies to change

Engjom, Hilde; Akker, Thomas van den; Aabakke, Anna J M; Äyräs, Outi; Bloemenkamp, Kitty W. M.; Donati, Serena; Cereda, Danilo; Overtoom, Evelien; Knight, Marian

doi:10.1016/j.lanepe.2022.100313

Cited by 57 publications

(86 citation statements)

References 8 publications

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“…In addition, available data demonstrate that maternal COVID-19 vaccination is effective in preventing COVID-19 hospitalization in infants up to 6 months of age 29 , likely due to the persistence of maternal antibodies in the infant for up to 6 months 86 . Importantly, for unvaccinated individuals who become pregnant, the CDC, the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM) recommend vaccination as soon as possible, including in the first trimester 75 , 87 , 88 to maximize the amount of time during which the mother and fetus are protected from the harms of COVID-19 infection during pregnancy, which includes severe and critical maternal illness 20 – 23 as well as poor neonatal outcomes resulting from spontaneous or medically indicated preterm birth or stillbirth 7 – 10 . The data presented here demonstrate a comparable, if not increased, first trimester maternal immune response, as well as enrichment of functional antibodies in the cord and high transfer efficiency following first trimester vaccination.…”

Section: Discussionmentioning

confidence: 99%

Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms

et al. 2022

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The availability of three COVID-19 vaccines in the United States provides an unprecedented opportunity to examine how vaccine platforms and timing of vaccination in pregnancy impact maternal and neonatal immunity. Here, we characterize the antibody profile after Ad26.COV2.S, mRNA-1273 or BNT162b2 vaccination in 158 pregnant individuals and evaluate transplacental antibody transfer by profiling maternal and umbilical cord blood in 175 maternal-neonatal dyads. These analyses reveal lower vaccine-induced functions and Fc receptor-binding after Ad26.COV2.S compared to mRNA vaccination and subtle advantages in titer and function with mRNA-1273 versus BN162b2. mRNA vaccines have higher titers and functions against SARS-CoV-2 variants of concern. First and third trimester vaccination results in enhanced maternal antibody-dependent NK-cell activation, cellular and neutrophil phagocytosis, and complement deposition relative to second trimester. Higher transplacental transfer ratios following first and second trimester vaccination may reflect placental compensation for waning maternal titers. These results provide novel insight into the impact of platform and trimester of vaccination on maternal humoral immune response and transplacental antibody transfer.

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Section: Discussionmentioning

confidence: 99%

Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms

et al. 2022

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“…Globally, the vaccination rate of pregnant women varied depending on countries. For instance, the vaccination rates among pregnant women are 80% in Norway (December 15, 2021), 9 67.1% in the United States (January 29, 2022), 10 and 20% in Italy (May-October 2021). 9 The pregnant women's vaccination rates also varied according to their occupation.…”

Section: Discussionmentioning

confidence: 99%

The vaccination status and adverse effects of COVID‐19 vaccine among pregnant women in Japan in 2021

Komine‐Aizawa

Haruyama

Deguchi

et al. 2022

J of Obstet and Gynaecol

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To investigate the vaccination status and adverse reactions to the COVID‐19 vaccine among pregnant women in Japan, we conducted an online questionnaire survey from October 5 to November 22, 2021. The number of participants in the online survey was 6576. Of the participants, 4840 (73.6%) were vaccinated twice, and 557 (8.5%) were vaccinated once. A total of 1179 (17.9%) responders had never been vaccinated against COVID‐19. The most frequent adverse reaction was local pain at the injection site. The incidence of local adverse reactions was almost identical after the first and the second vaccinations, while systemic reactions, such as fever and fatigue/malaise, and adverse reactions outside the vaccination site such as headache and arthralgia, were more frequent after the second vaccination than after the first vaccination. Regarding the obstetrical complications, uterine tension and/or contraction was observed in 1.65% of the pregnant women after the first vaccination and in 2.98% after the second vaccination, and uterine pain appeared in 1.06% of the pregnant women after the second vaccination. However, serious symptoms, such as hemorrhage, decreased fetal movement, edema, increased blood pressure, and amniorrhexis, were seen in less than 1% of vaccinated women after both the first and second vaccinations. This study clarified the characteristics of vaccination, adverse reactions, and obstetrical symptoms in pregnant women in Japan who had the COVID‐19 vaccine up to the second dose. As a booster vaccination is currently underway, further study is needed to improve the management of pregnant women during the current pandemic.

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“…Data for fetal outcomes are reassuring, with rates of preterm birth, small-for-gestational age, congenital anomaly, pregnancy loss, and stillbirth not being increased above the background population 9596. A recent analysis in six European countries showed that almost all pregnant women admitted to intensive care units with covid-19 in the latter half of 2021, when vaccination was universally available, were unvaccinated 97. A national study from Scotland showed that all babies who were stillborn or died in the neonatal period after maternal covid-19 were born to mothers who had not been vaccinated 17.…”

Section: Prognosis Of Covid-19 In Pregnancymentioning

confidence: 99%

Diagnosis and management of covid-19 in pregnancy

Nana

Hodson

Lucas

et al. 2022

BMJ

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Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.

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Severe COVID-19 in pregnancy is almost exclusively limited to unvaccinated women – time for policies to change

Cited by 57 publications

References 8 publications

Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms

Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms

The vaccination status and adverse effects of COVID‐19 vaccine among pregnant women in Japan in 2021

Diagnosis and management of covid-19 in pregnancy

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