The COVID-19 vaccine and pregnancy: Everything you need to know, according to a doctor.

In early November, a surge of pregnant, unvaccinated women were admitted to Western Health hospital in Victoria with COVID-19. In a sobering account of the reality of the ICU, Sydney Morning Herald described a "tiny resuscitation table for newborn babies in the corner of the ward," for those babies born preterm to mothers who had contracted the virus.

By mid November, there were unvaccinated pregnant women with COVID-19 in every one of Melbourne's ICUs.    

Almost two years into the coronavirus pandemic, we know that pregnant women who contract COVID-19 are at greater risk of needing hospitalisation. We also know that the babies of women with COVID-19 are at greater risk of being born premature, and of being admitted to the special care unit after delivery. 

Yet reports suggest that vaccination rates in pregnant women in Australia are lagging behind the rest of the population. There are concerns that some women may be receiving incorrect information about the safety of being vaccinated against COVID-19 during pregnancy, and are therefore waiting until after birth to get vaccinated.

Gender Equity Victoria is the independent peak body for gender equity organisations, practitioners and supporters in Victoria. Their CEO, Tanja Kovac, observed that the gendered impacts of the COVID-19 pandemic have hit women and gender diverse people hard, especially working parents. 

Just as the community has adopted mask wearing, physical distancing and hand washing to fight the pandemic, vaccination has a powerful collective benefit in keeping us safe and healthy, and providing a pathway out of the crisis for women and gender diverse people. 

WATCH: COVID-19 Vaccines and Pregnancy. Post continues after video.

Kovac acknowledges the history of gender inequities in health care, where past mistakes like the use of medications have had significant consequences for women and unborn children. From this, Kovac has seen greater care taken in ensuring COVID-19 vaccines are safe. 

"There is more sex and gender disaggregated data about COVID-19 vaccines because women have demanded it. It's understandable to be cautious, but the statistics on unvaccinated pregnant [people] in ICUs, and the advice of health professionals show that there is a far greater risk not taking vaccines than posed by the vaccinations themselves.

"There's a lot of information out there, and it can be hard to get clear and transparent answers to the questions women [and gender diverse people] might have, which is why it's important to take advice from your GP, ObGyn or health professional."

A great article from @wtuohy. "Leah hesitated about the jab while pregnant, now she's 'so grateful". Many unvaccinated pregnant women are being treated in Melbourne's ICUs - but it doesn't have to be that way. https://t.co/5tENY9iUgF

— Gender Equity Victoria (@genderequityvic) November 15, 2021

So, we asked paediatrician and immunisation expert Dr Margie Danchin everything there is to know about the COVID-19 vaccine and pregnancy. 

Is it safe to get vaccinated if I'm pregnant or trying to get pregnant?

According to Dr Danchin, "absolutely".

"It's currently recommended that you can receive an mRNA vaccine - so either Pfizer or Moderna - at any stage in pregnancy," she told Mamamia.

Dr Danchin explained that while there have been concerns in the past about gender biased testing when it comes to vaccines, there's "a lot of safety and effectiveness data" specifically relevant to women about the COVID-19 vaccine. 

A recent study published in the New England Journal of Medicine studied more than 35,000 pregnant women and gender-diverse people, and found that while injection-site pain was reported more frequently among pregnant people than non-pregnant people, side effects like headache, myalgia, chills, and fever were reported less frequently.

In that study, over 800 participants gave birth after vaccination, and there was no increased risk to the baby (i.e. miscarriage, stillbirth, congenital anomalies or low birth weight). 

Why is it so important to vaccinate during pregnancy?

Dr Danchin explained that pregnant women and gender-diverse people with COVID-19 are at increased risk for severe illness. 

"They have a five times increased risk of hospital admission and about a two-three times increased risk of being admitted to intensive care or needing ventilation if they get COVID-19 in pregnancy," she said.

Dr Margie Danchin. Image: Supplied. 

"But also... the baby has double the risk of being born premature, and three times the risk of needing admission to the special care unit after delivery." 

Why is COVID more dangerous for those that are pregnant? 

"A woman's immune system when she's pregnant is not the same as a non-pregnant woman," Dr Danchin told Mamamia. 

"We wouldn't say that they're immunocompromised but their immune response is not as robust, so they're a bit more vulnerable to infections. And that's because of the increased pressure of the baby and the pregnancy and lots of physiological factors."

Just like women and gender-diverse people are advised to get the whooping cough and influenza vaccines during pregnancy, because you're at much higher risk than other adults of complications and possible hospitalisation, those that are pregnant are also advised to be vaccinated against COVID-19. 

Is my baby protected from COVID‑19 if I get vaccinated while pregnant?

"Yes," said Dr Danchin. "And that's the whole premise behind maternal vaccination, is it gives you two for one protection. 

"It protects the parent in pregnancy from becoming unwell, but it also provides the opportunity for the antibodies that the parent produces to travel through the umbilical cord, across the placenta, into the infant, to provide protection in the first few months of life to the baby."

Dr Danchin also explained that there's early evidence of protection against COVID-19 through breastmilk. 

"Again, through the passage of antibodies through the breastmilk to protect the baby," she said. "Not the passage of the vaccine itself – but the antibodies."

Are the vaccines safe if I'm breastfeeding?

Dr Danchin explained the COVID-19 vaccines available in Australia are all safe if you are breastfeeding. 

"There's no evidence to suggest that the vaccine is unsafe if you're breastfeeding," she said.

"Of course, if you're breastfeeding and planning pregnancy you can also have the AstraZeneca vaccine – it's just in pregnancy it's restricted to the mRNA vaccines at the moment in Australia."

Do COVID-19 vaccines affect fertility?

"There's no evidence to show that the vaccine is unsafe in pregnant women [or gender-diverse people], or those planning pregnancy," Dr Danchin said.

"That's the whole premise behind maternal vaccination, is it gives you two for one protection." Image: Getty. 

"And that's another really important point – that there's no evidence the vaccines have an impact on fertility, and that's particularly looking at the chance of [those with a uterus] being able to fall pregnant or sperm count in others as well.

"There's also no proven impacts on the menstrual cycle."

If you did notice a change to your menstrual cycle after your vaccine, Dr Danchin explained, "it's thought now that any changes in menstrual cycle could be more related to the risk of the pandemic itself, or potentially the stress of vaccination, rather than the vaccine."

Why is it important to get two doses within the recommended time frame?

According to Dr Danchin, the advice around the timing of your vaccine doses is the same for pregnant and non-pregnant women and gender-diverse people – three weeks apart for Pfizer, and four weeks apart for Moderna. 

"That's how the vaccines have been studied, and that's what we know gives a really nice, robust immune response," she said. 

Should I get my booster shot if I'm pregnant?

Again, Dr Danchin explained the advice is the same for pregnant and non-pregnant women and gender-diverse people. 

"There's the concept of the primary series of the two doses to give you a really high antibody response, so immune response, and then those antibodies start to drift down or wane after a few months – even as early as say four months," she said.

"So at six months you get a booster dose which takes your antibody levels up again quite high. And that's the same for pregnant and non-pregnant women [and gender-diverse people]." 

"Those that are pregnant – you could argue – it's even more important they get their booster dose because they are at higher risk of COVID infection."

For more information about COVID-19 vaccination for women and gender-diverse people who are pregnant, breastfeeding or planning pregnancy, you can visit this decision guide provided by the Australian government. 

Ultimately, the advice from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian Technical Advisory Group on Immunisation is that pregnant women and gender-diverse people are routinely offered an mRNA vaccine at any stage of pregnancy. 

In a joint statement, they said: "This is because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby."

Gender Equity Victoria have compiled health information about the COVID-19 vaccine by and for women and gender-diverse people, and encourage anyone who feels uncertain to speak to their doctor.

Book your COVID-19 vaccine today. It’s free for everyone in Australia, and you don’t even need a Medicare card. 

Feature Image: Supplied/Mamamia.