Pregnant in the pandemic? Ways to protect your baby and yourself

The coronavirus vaccine also provides pregnant women the best and safest form of protection against a serious COVID-19 infection. It’s also important that they follow the recommendations on distancing, hygiene, wearing masks and airing rooms. Anyone with close contact (from age 12) to a pregnant woman should also be vaccinated. If a coronavirus infection is suspected, it’s best to call your doctor and discuss the next steps. Read on for more on what expectant parents need to know and consider.

Increased risk of serious COVID-19 infection for unvaccinated pregnant women

Due to the physical changes involved in pregnancy, it can place a burden on the body and pose a risk factor for a serious COVID-19 infection. This increased risk exists for all pregnant women, not just those with pre-existing illnesses or conditions such as obesity, chronic hypertension and diabetes. The risk further increases with age. Data contained in studies[MM2]  indicates that a coronavirus infection is more likely to be severe in pregnant women than in others who become infected. A pregnant woman with a coronavirus infection is likely to be hospitalised and require intensive care. Around one in ten pregnant women who are hospitalised with COVID-19 symptoms require intensive care.

Wolfgang Heinrich, Gynaecologist and Director of the Maternity Clinic at the Berlin Charité, describes a typical working day:

“What we’re seeing more and more are pregnant women with life-threatening illnesses who lose their babies or have premature births – and women who will suffer permanent effects if they survive. For a woman who becomes ill during pregnancy (…) the risk of dying before the birth, during the birth or in the first few weeks after delivery is 50 times greater.”

Risks for the baby if the mother catches COVID-19

Owing to insufficient data, the Standing Committee on Vaccination (STIKO) is unable to issue a general statement on the effects of COVID-19 on an unborn child. It would appear that the transfer of SARS-CoV-2 from mother to a newborn baby is rare and that only in rare cases do newborns show symptoms. However, an infection involving symptoms such as high fever during the first trimester increases the risk of complications and birth defects. Some studies also indicate that pregnant women with severe COVID-19 infections are more likely to have premature births and that the newborns are more likely to be placed in neonatal intensive care for premature and newborn babies.

While few still births or newborn deaths have been reported, isolated studies show that where a pregnant mother suffers a severe COVID-19 infection, there is a greater risk that her baby will be stillborn.

Vaccination for pregnant women

The STIKO urgently recommends that women who wish to have children should be vaccinated before becoming pregnant. This provides the best possible protection for the mother and her child from the start of the first trimester.

The Standing Committee on Vaccination (STIKO) recommends that from the second trimester, women be vaccinated against COVID-19 by receiving two doses of the mRNA vaccine from BioNTech/Pfizer at an interval of three to six weeks. This recommendation is based on the risks described for severe COVID-19 infection in pregnant women and a significantly improved availability of data that indicates no increase in severe undesired side effects following a coronavirus vaccination. The safety data available to date shows no occurrence of clusters of stillbirths or premature births.

Why the STIKO only recommends the Comirnaty® vaccine from BioNTech/Pfizer for pregnant women

Recent data shows that in young people vaccinated with the Spikevax® vaccine from Moderna, rare side effects, such as myocarditis and pericarditis, were observed more frequently when compared with the vaccine from BioNTech/Pfizer. Given this new data source, the STIKO recommends that only persons aged 30 and above be vaccinated with Moderna. In the absence of comparative data for Comirnaty® and Spikevax® for pregnant women, the STIKO recommends that as a precautionary measure and irrespective of age, vaccination of pregnant women (from the second trimester of pregnancy) should only be carried out using Comirnaty® from BioNTech/Pfizer.

Coronavirus vaccination while breastfeeding

The STIKO recommends that unvaccinated mothers who are breastfeeding be vaccinated with the Comirnaty® mRNA vaccine from BioNTech/Pfizer. Vaccination with this particular vaccine does not require a break from breastfeeding following vaccination. Speak to your gynaecologist or family doctor to assess the benefits and risks of vaccination.

Good to know: The use and safety of coronavirus vaccines is subject to continuous monitoring, including in pregnant women. A global study conducted by BioNTech/Pfizer involving 4,000 pregnant women is already underway with results expected in August 2022. In an updated risk-benefit assessment, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e. V. in conjunction with other specialist organisations has been calling since May 2021 for prioritised COVID-19 vaccination for pregnant women using an mRNA vaccine. The DGGG welcomes the STIKO’s decision.

“The recommendation matches our own thoughts entirely – the scientific justification is extremely fact-based, not least as it also uses information previously unpublished by the RKI. Gynaecologists can now advise their patients on the benefits of vaccination and recommend immunisation against COVID-19 based on sound knowledge and information,” says Prof. Dr. Ekkehard Schleußner, Head of the working group behind the DGGG’s vaccination recommendations.

Getting medical advice prior to vaccination

Vaccination is always a personal decision that should ideally be taken after speaking with your doctor. This is why pregnant mothers and especially those with pre-existing illnesses (see above) and a high risk of exposure to infection should seek detailed advice from their doctor. Although both during and after pregnancy, midwives are the main contact person, they are neither qualified nor authorised to provide advice on vaccination. Giving vaccine-related information and advice is the sole responsibility of doctors.

Vaccination has no adverse effect on fertility

Despite the rumours and false reports circulating in social media, there are no indications whatsoever that women can become infertile after receiving a vaccination. Nor has there been an increase in the number of miscarriages or complications following a COVID-19 infection and the associated production of antibodies.

COVID-19 vaccination does not increase the risk of miscarriage

A study conducted in the US shows that vaccination does not increase the risk of miscarriage. Miscarriages occurred in pregnant women who had been vaccinated equally often as in non-vaccinated pregnant women prior to the pandemic. An average 10 to 15 percent of pregnancies end in miscarriage. This often occurs in the first 12 weeks of pregnancy and goes undetected. Of the women participating in the study, 13.9 percent (115 out of 827) had a miscarriage. This rate is in the normal rage.

See the Robert Koch Institute website for further information.