Pregnant women are under-vaccinated and under-boosted compared with the general population, says Dr Michelle Wise. But the vaccine is safe in pregnancy and also protects their unborn baby.
It is a really challenging time for parents-to-be right now. We are in the peak of an Omicron outbreak in Aotearoa New Zealand with thousands of new cases a day, and many of them among pregnant women and babies.
When my daughter got Covid during her gap year in 2020 and then returned to New Zealand, she was the only person anyone knew who had it. But now most people know someone who has had it. This should be reassuring because at least you know what to expect if you were to get it and how to prepare: rest, chicken soup, throat lollies and paracetamol are all safe in pregnancy. Pregnant women seem to be getting the same symptoms as everyone else, and most cases will be mild.
That said, pregnancy is a vulnerability because of an altered immune system, even without any other underlying health condition. In Delta and previous outbreaks, pregnant women were more likely to be hospitalised with moderate or severe Covid, or admitted to ICU. We are not seeing this as much with Omicron, but the research studies are not yet published.
The Ministry of Health doesn’t collect pregnancy status in its daily Covid numbers or in its vaccination rates by District Health Board but, having spoken to obstetrician colleagues all over the country, it is clear that pregnant women are under-vaccinated and under-boosted compared with the general population. This is despite every research study published from every country studying this concluding that the Pfizer Covid vaccine is safe in pregnancy. It is not too late to get vaccinated or boosted, and there are great resources available to help make that decision together with your midwife or obstetrician.
Protecting your baby
However, many pregnant women are vaccinated and boosted. Not only are they reducing the risks to themselves, which is the main reason for vaccination, but they are also protecting their unborn baby. The vaccine itself breaks down in the body within hours, but the antibody response that occurs results in antibodies crossing the placenta to the fetus. Antibodies are also seen in the breastmilk of breastfed babies. Recent studies have shown that babies born to vaccinated mothers are half as likely to be hospitalised in their first six months of life. When I talk to my patients, I explain that we are going to have Covid with us for a long time, and it is unlikely we will see a vaccine for babies, so they are in a unique position to protect their baby by getting the vaccine during pregnancy and not waiting. The risk protection was greatest after the 20th week of pregnancy.
Pregnant women are also using other public health measures to protect themselves and their babies. They are socially distancing, wearing a mask, washing their hands, reducing their exposure to large crowds of people indoors (for example, at baby showers). These measures apply also after their baby is born, by hosting outdoors if possible, minimising visitors, and asking them to wash their hands, wear a mask or stay home if they are sick. This is a safe approach and one that will likely stay with us for the foreseeable future. However, be careful that this approach does not create the unintended consequence of social isolation and depression.
Pregnancy care and support during Omicron
Even during this Omicron peak, midwives and obstetricians are still providing usual care, just wearing more PPE and using telehealth where appropriate. This includes routine antenatal visits, specialist appointments, and acute assessments in hospital. If you find you are Covid positive, let your midwife know, as the Ministry of Health Referral Guidelines recommend a consultation routinely with an obstetrician specialist. There are also clear clinical guidelines for pregnancy, including what you can assess yourself at home (for example, your heart rate and oxygen level), and when to call your midwife, your GP, or go to hospital. If you’re pregnant, your midwife or obstetrician should be able to inform you about visitor policies at your hospital or birthing unit, including rapid antigen tests, and whether a support person can remain with you if you have a caesarean, and what the options are for care after your baby is born.
