34 CLINICAL
Mythbuster
Debunking common patient myths and misconceptions
‘ Covid jab might make you infertile and you can ’ t get it if pregnant or breastfeeding ’
T he reality : Concerns about medicines in pregnancy are natural and it wasn ’ t until April 2021 that the Joint Committee on Vaccination and Immunisation advised pregnant women should be offered a Covid vaccine alongside people in their age or risk group . 1 , 2
Covid-19 can be very serious in pregnant women , notably in the third trimester , so healthcare professionals should give a clear message that vaccination in pregnancy is safe . We ’ ve been giving flu and pertussis vaccines to pregnant women for years and we routinely vaccinate breastfeeding women .
During drug development , testing often excludes pregnant women so it can be difficult to assert that a new drug is safe . The advice to give the Covid-19 vaccine to pregnant women is based on the following data , available in a decision aid 3 that women may find useful : by August 2021 , 147,000 pregnant women had had a Covid vaccine in the US , and 55,000 in England and Scotland . No adverse effects have been recorded . None of the vaccines contains live virus , so it is impossible for a woman , or her baby , to catch Covid from them .
Studies involving 40,000 women have shown the vaccine does not increase the risk of miscarriage , stillbirth , congenital abnormalities or small gestational age . However , contracting Covid-19 while pregnant doubles the risk of prematurity and stillbirth , as well as the risk women will become severely ill . More than 99 % of women admitted with Covid-19 in England ? between February and August 2021 were unvaccinated .
Pregnant women starting a vaccination course should be offered the Pfizer-BioNTech or Moderna vaccine , as these have the most relevant data . Those who have already had a first dose of the AstraZeneca vaccine should have the same for their second dose , as there is limited information as yet on a ‘ mix and match ’ approach .
There is no plausible mechanism by which any ingredient in the vaccine could pass to a baby through breast milk , so there is no reason for breastfeeding women to avoid the vaccine , or to express and discard their milk for any length of time after being vaccinated .
Vaccine hesitancy was named among the top 10 threats to global health in 2019 4 and many women are hesitant about the Covid vaccine . If a patient is unsure about being vaccinated during pregnancy , point her towards the RCOG decision aid 3 or suggest she discuss it with her midwife or consultant . The RCOG also has helpful videos , including one for midwives . 5 However , it is important to make it clear that a pregnant woman who wants to be vaccinated should book the vaccine as soon as possible , via her GP or the government website . 6 Another fear for women of childbearing age is having problems conceiving in the future . This was highlighted in late 2020 after a former Pfizer employee wrote to the European Medicines Agency with concerns about a similarity between a protein involved in placental function ( syncitin ) and the spike protein in the Covid vaccine . The suggestion was an antibody response to the spike protein could cause conception issues or increase miscarriage risk , possibly by damage to placental function . In reality there is very little similarity between the proteins , so there is no plausible mechanism for the vaccine to harm future fertility . 5 There were also reports of women ( around 0.5 % of those vaccinated 7 ) experiencing changes in their periods post-vaccine . This is likely to be a short-term response , similar to that caused by stress . Other trial data show no difference in the rate of accidental pregnancy between a group given the vaccine and a placebo group ; if the vaccine caused subfertility , you would expect an effect . The British Fertility Society has a useful document 8 to which you could signpost patients . But it is important that a women with a prolonged change in her bleeding pattern contact her GP , as there may be causes , such as infection or malignancy , unrelated to the vaccine .
The Covid-19 vaccine is a lifesaving intervention . As healthcare professionals we have an obligation to understand issues of concern to patients and be well enough informed to give a clear message that vaccination is safe and patients who remain unvaccinated are taking a significant risk .
Dr Toni Hazell is a GP in north London
References 1 RCOG . COVID-19 vaccines , pregnancy and breastfeeding . Q & A . 2021 . bit . ly / 3np6Zof 2 UK Health Security Agency . COVID-19 vaccination : women of childbearing age , currently pregnant or breastfeeding . 2021 . bit . ly / 3Dsz4Aq 3 . RCOG . Coronavirus infection and pregnancy . Decision aid . 2021 . bit . ly / 3co1Ead 4 World Health Organization . Ten threats to global health in 2019 . bit . ly / 3owJQiW 5 RCOG . COVID-19 vaccines , pregnancy and fertility . Information for pregnant women and their families . 2021 . bit . ly / 30DsRUb 6 NHS . Book or manage your coronavirus ( COVID-19 ) vaccination . bit . ly / 3qN50ME 7 Zoe COVID Study . Are COVID vaccines affecting periods ? 2021 . bit . ly / 3CqTmZG 8 British Fertility Society . Covid-19 vaccinations and fertility . FAQs . 2021 . bit . ly / 3CpAp9O nursinginpractice . com Winter 2021