Episode 6: COVID-19 and Pregnancy
Listen now to the Pregnancy and Childbirth podcast with Dr Greg
Episode 6 Content and Overview
In episode 6 of the Pregnancy and Childbirth podcast, Dr Greg discusses COVID-19 and pregnancy.
When the pandemic first started, there were many questions surrounding Coronavirus (COVID-19) and pregnancy, with very little research or information to answer them. Over 12 months later and we now have some answers.
Join Dr Greg, Head of Department of Obstetrics at Westmead Hospital, the designated COVID-19 obstetrics and gynaecology hospital for Western Sydney, as he reveals the implications of COVID-19 and pregnancy. With pregnant women now eligible for the Pfizer mRNA COVID-19 vaccine, Dr Greg also shares his thoughts and recommendations regarding vaccination.
Listen to the podcast to learn about:
The impact that pregnancy has on COVID-19 illness (how is COVID-19 illness different if you develop a COVID-19 infection and you happen to be pregnant)
The impact that COVID-19 can have on the progress and outcome of your pregnancy
The implications for the baby if you have COVID-19 during pregnancy, or if you happen to be COVID-19 positive around the time of birth
COVID-19 vaccination in relation to pregnancy
Additional Resources
Click here to read Dr Greg’s ‘COVID-19 and pregnancy’ blog
Pregnancy and Childbirth podcast episode 8: COVID-19 and Pregnancy update
Subscribe
Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.
Transcription
0:00
Hi, I'm Dr. Greg, and welcome to this edition of my pregnancy and childbirth podcast. This edition is about pregnancy and COVID. It's an episode I've been thinking about doing for quite some time, but I've been putting it off because I felt that the information was still evolving in such a way that the content could well be redundant within a few weeks of me releasing a podcast. So it's probably worth date stamping this episode, I think. So today is the 25th of July 2021, we're in the midst of a fairly significant wave of Delta variant COVID virus spreading across Sydney and it's having a wide variety of impacts.
0:43
So I'm not really going to talk about COVID in general. I'm going to talk about the implications around COVID and pregnancy. And of course, I'm going to talk about COVID vaccination in pregnancy. I appreciate for a lot of pregnant women and their partners, the big question is going to be, should I get COVID vaccinated during pregnancy? It is the issue that I'm going to talk about in more detail at the end of this podcast, there are a few things that I think provide useful background that I'm going to go through first. But if vaccination is what you want to hear about, feel free to jump to the end of the podcast. Or I can tell you now that my recommendation is going to be that all pregnant women and women planning pregnancy should get a COVID vaccination.
1:33
Now, as well as the Delta variant sweeping across Sydney at the present time, there's a couple of other things that have changed in the last few weeks that make me think that this is a good time to put out a podcast around COVID and pregnancy. The first of these was a few weeks ago, when ATAGI, which is the advisory group on vaccination in Australia, and RANZCOG which is the College of Obstetricians and Gynecologists for Australia and New Zealand put out a joint statement recommending that Pfizer vaccination in pregnancy and breastfeeding should be considered safe and that pregnant women should consider vaccination.
2:13
The other thing that's happened just in the last few days, is that pregnancy is now considered part of the eligibility criteria for vaccination. So regardless of your age group, regardless of your health status, and regardless of anything else, just being pregnant, makes you eligible for Pfizer vaccination in Australia. So I think both of those things are really important developments and they have changed the discussions around COVID and COVID vaccination with regard to pregnancy.
2:49
In this podcast, I'm not going to talk about COVID in general, but I'm going to talk about the impact that pregnancy has on COVID illness. So how is COVID illness a little bit different if you develop a COVID infection and you happen to be pregnant. Then I'm going to talk about the impact that COVID could have on the progress and outcome of your pregnancy. I'll say a few words about the implications of this for the baby, if you have COVID during pregnancy, or if you happen to be COVID positive around the time of birth. And then finally, I'll be saying a few things about COVID vaccination in relation to pregnancy.
3:30
So what do we know about the impact of pregnancy on COVID illness? So we know that pregnancy does not make you more susceptible to acquiring COVID. So there's no greater likelihood of you developing a COVID infection, whether you're pregnant or not pregnant. The early symptoms of COVID are very similar, again, whether you're pregnant or not pregnant. Now, in the early phases of the pandemic, it appeared that pregnant women didn't do particularly worse in terms of their health outcomes than women who were not pregnant. Now, this was a little surprising, because we knew that with several other severe respiratory viruses, that pregnant women were more likely to develop severe illness, and were more likely to have significant adverse health consequences, compared with non-pregnant women of around the same age have the similar health status. So early in the pandemic, we thought that COVID wasn't such a big problem.
4:38
We now know that if you're a pregnant person who gets COVID there is a significantly greater likelihood of you having a bad health outcome compared with a non-pregnant woman with a similar health status of around the same age. So in real terms, what does this mean? It means If you get COVID and you're pregnant, you've got about double the chance of developing severe illness, meaning that you have double the risk of being admitted to intensive care and you have about double the risk of requiring ventilation.
5:16
So what are we seeing around Sydney at the moment? All of the major obstetric hospitals around Sydney are seeing pregnant women being admitted with COVID related illness. I work at Westmead Hospital and for the entirety of last year, the entire first phase of the pandemic, we did not have a single pregnancy admission with COVID. In the last few weeks, we've had several women admitted with COVID. And just like other hospitals across Sydney, some of these pregnant women with COVID have become severely unwell, and have required admission to our intensive care service.
5:56
We also know that there are some risk factors in pregnancy that make it more likely that you will get severe illness. So if you're a pregnant woman over the age of 35, if you're a pregnant woman who's overweight, or if you're a pregnant woman who has other significant medical problems, then it's more likely that you will develop severe illness, it's more likely that you'll require intensive care admission and require ventilation.
6:22
So what about the impact of COVID on the cause of pregnancy? So we know that there is about a 50% increase of having a preterm birth if you develop COVID during pregnancy, particularly if you develop COVID in the last third of your pregnancy or after 28 weeks gestation, and there also appears to be a significant increase in the risk if you're developing a condition called preeclampsia, which is a blood pressure disorder of pregnancy. Some of the studies have shown an increase in the likelihood of stillbirth and this does seem to be related to the severity of maternal illness. So particularly women who become severely or critically unwell, there does appear to be some increase in the likelihood of stillbirth.
7:12
So what about the outcome for the baby? If you develop COVID during pregnancy, we do know that there is a small chance that COVID might be passed on to your baby and your baby might be born with the COVID virus. This can happen around the time of birth, or there have been cases reported where this has occurred during the course of pregnancy, even when the baby was born after the illness had passed.
7:40
Now, if you’re COVID positive around the time when you give birth, the recommendations are that we will try and keep your baby with you. So avoiding separation or breastfeeding is encouraged, however, with precaution, so the mother should wear a face mask and should practice good hand hygiene. In terms of COVID, the other risks to the baby seem to relate to the increased risk of being born preterm. So there don't seem to be any other significant adverse consequences for the baby from the mother developing COVID during the course of pregnancy.
8:16
So let's talk about vaccination for COVID in pregnancy. Now, I think all of the things that we've spoken about so far, can help to inform our decision-making around COVID vaccination in pregnancy. So what do we know about COVID vaccination? So we're going to talk just about the mRNA vaccine, which is the Pfizer vaccine in Australia. And at the present time, it's the only mRNA vaccine that's available in Australia. And for pregnant women who are wanting to be vaccinated, the Pfizer vaccine is the recommended vaccine to have. So firstly, should there be any health concerns about administering an mRNA vaccine during pregnancy? So the evidence is incredibly reassuring. So there aren't any similar vaccines which have been given which have been associated with any sorts of pregnancy harms or any harms related to the baby. And there isn't any reason why we would expect that there would be any harms associated with the administration of this vaccine had any time during pregnancy. So that's the best expert advice we have about the likely safety of this vaccine.
9:35
Now, it's true to say that pregnant women were not involved in the clinical trials which were conducted and which led to these vaccines being approved, and in retrospect, that probably was a significant oversight. Nevertheless, that's the information that we have to move forward with. We know that around the world 10s of 1000s of women have received mRNA vaccines during pregnancy, with no significant case reports of adverse outcomes for either mother or baby. The CDC, which is the Centre for Disease Control in the United States of America, has recently published data on over 90,000 pregnant women who received mRNA vaccines during pregnancy with no adverse events reported.
10:24
Now it's true to say that only a small number of women have completed their pregnancy and gone on to deliver a baby, so the long-term outcomes for their babies are yet to be known. But I come back to the point I made earlier about vaccination; there is absolutely no reason to believe that mRNA vaccines should cause any long-term health consequences for the baby if administered during the pregnancy.
10:53
We also know that the vaccine works during pregnancy this has been extensively studied, and pregnant women produce the same antibody response as non-pregnant people do. We also know that those antibodies cross through the placenta and go to the baby. So the baby is born with some of these antibodies on board which will give the baby some protection from COVID illness in probably the first three to four months of life if this behaves in a similar way to things like influenza vaccine in pregnancy, for example. The antibodies derived from vaccination also pass through breast milk. It's unclear how beneficial this is to the baby, but it provides some reassurance to know that if you've been vaccinated, and you're breastfeeding your baby, that your baby may well derive some benefit from the antibodies that go across through the breast milk. The other point to make is that the best available evidence we have suggests that COVID vaccination is completely safe to give at any time during pregnancy, or whilst breastfeeding.
12:01
So if I could sum up, at the present time, the likelihood of a pregnant woman developing a COVID infection is significant. The Delta variant is circulating in our community and it is highly transmissible. We know that if you develop COVID during pregnancy, most likely you will have a fairly uneventful illness, and your pregnancy will progress along smoothly. Though we also know that there's a possibility that you will develop severe illness and require admission to tensive intensive care, and maybe end up being put on a ventilator. And we know that if you get COVID whilst you're pregnant, the risk of that happening to you is twice as high as somebody who gets COVID who is not pregnant. We also know that if you get COVID during pregnancy, that there's a greater likelihood of an adverse pregnancy outcome, particularly things like preterm birth, and pre-eclampsia, and maybe a small increased risk of stillbirth. And about the vaccine, we have really good evidence to say that the Pfizer vaccine is safe to administer at any time during pregnancy and whilst breastfeeding.
13:18
So to me, the argument is pretty clear. If you're a pregnant woman or are contemplating pregnancy or a breastfeeding woman, you should seriously consider going out and getting access to a Pfizer vaccine at the earliest available opportunity. Now, this of course, is very general advice. There may be people who have other particular health issues that need to be taken into consideration when it comes to decisions around vaccination and it's very important that you discuss these things with either your general practitioner or your pregnancy healthcare provider.
13:54
So that's a wrap for this episode. Please stay safe. Please follow the public health advice. Please raise your concerns with either your GP or your pregnancy health care provider. And I hope you found this episode informative and helpful. As always, we will be very keen to hear your feedback and if you have any suggestions regarding future episodes, please let us know. Bye for now.
