Science

Contraindications, health pass … Four questions on the vaccination of pregnant women

Pregnant women can be vaccinated against Covid-19 as early as the “first trimester” of pregnancy. This is what Olivier Véran indicated on Tuesday during the questioning session to the government at the National Assembly. On this occasion, the Minister of Health announced a very short list of three medical contraindications to the vaccine.

This is called “PIMS syndrome”, or pediatric multisystem inflammatory syndrome, an “extremely rare” complication which has affected some children and adolescents following infection with the coronavirus; “reactions such as myocarditis, pericarditis and severe hepatitis requiring hospitalization and following a first injection of mRNA vaccine” and finally for people allergic to one of the components of the vaccine, PEG2000, or polyethylene glycol, a situation which “must concern about ten cases in our country”, he assured. Being pregnant is therefore not a sufficient reason.

  • Are pregnant women more exposed to Covid-19?

The WHO reminds that pregnant women are at a higher risk of being affected by certain respiratory infections, because of the upheavals that their body and their immune system undergo during pregnancy. According to the National Agency for Medicines and Health Products Safety (ANSM), women who also have co-morbidities (overweight, hypertension, diabetes, etc.) seem to have a higher risk of developing a severe form of the coronavirus, especially during the third trimester of pregnancy.

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As Franceinfo points out, an international study published last April in the scientific journal JAMA Pediatrics, and conducted among 2,130 pregnant women, suggests that women positive for Covid-19 during pregnancy are at higher risk of developing complications specific to pregnancy, like pre-eclampsia, a pathology responsible for a third of very premature births in France, says Inserm. The risk of death during pregnancy or postpartum is also higher, but still low, at 1.6%.

  • When is it advisable to get vaccinated?

In France, until now, the High Authority of Health (HAS) recommended vaccination from the second trimester of pregnancy, that is to say from the 16th week of amenorrhea (absence of rules). Likewise, as relates Le Figaro, the Reference Center on Teratogenic Agents (Crat) recommended starting the vaccination between “10 and 20 weeks of amenorrhea (…) sufficiently early for the pregnant woman to be protected in the third trimester”. Recommended vaccines are messenger RNA from Pfizer-BioNTech and Moderna.

The HAS justified this rule by stating that “vaccination should be considered if the potential benefits outweigh the risks to the mother and the fetus. In particular, pregnant women over 35 years of age or those with other comorbidities such as obesity, diabetes or cardiovascular disease, or pregnant women likely to be in contact with infected people “, it was indicated. In early April, the Directorate General of Health had also allowed pregnant women to be given priority for the anti-Covid-19 vaccine, but “from the second trimester of pregnancy”.

If the Covid-19 vaccine was previously not recommended for women in early pregnancy, it is because of a lack of data. In fact, as a precautionary principle, pregnant women were not included in the clinical trials carried out before their release. However, Moderna has announced that it is launching its own survey of 1,000 pregnant women as of July 22, and for a period of 21 months. According to the WHO, if there is “very little data to assess the safety of the vaccine during pregnancy”, pregnant women can receive the vaccine “if the benefits of vaccination at home outweigh the possible risks of the vaccine. vaccine”.

No particular risk was observed in those who nevertheless received a dose of the vaccine during this period, especially when they did not yet know they were pregnant. The medical dictionary website Vidal points out that if a pregnant woman has tolerated the first dose of any vaccine poorly, it is advisable to postpone the second dose after the end of the pregnancy.

  • Are pregnant women sufficiently protected by the vaccine?

The vaccine protects pregnant women in the same way as other women, according to a study published in March in the American Journal of Obstetrics and Gynecology, reports Franceinfo. The researchers observed that the levels of antibodies generated by the vaccine were similar in the two groups of patients. The researchers also note that the antibodies resulting from the vaccination pass through the placenta, potentially offering protection to the newborn, says Inserm.

Regarding the protection provided by the Pfizer vaccine, a study in the journal JAMA compared two groups of 7,530 pregnant women in Israel over one year, one vaccinated and the other not. The researchers conclude that the vaccine reduces the risk of infection and that no significant side effects have been observed. Few data are available to date on the variants of the coronavirus.

According to data analyzed in April by the Centers for Disease Control and Prevention (CDC) in the United States, on children born to pregnant women who received a messenger RNA vaccine in the third trimester of pregnancy between December 2020 and February 2021 , 9% were premature and 2% had a congenital anomaly. Similar results to those obtained in unvaccinated women. A similar study published by The New England Journal of Medicineout of 35,691 pregnant women in the United States shows the same results.

  • Health pass: soon a relaxation?

The National Assembly must debate from this Wednesday a bill which establishes an obligation to be vaccinated against Covid for caregivers and people working in contact with vulnerable people and which conditions entry into many places upon presentation of a health pass attesting to a complete vaccination, a recent infection or a negative test.

For the moment, pregnant women must provide a certificate of immunity or show a negative PCR test if they want to be able to access the places affected by the extension of the health pass. Several women were worried about having to do more tests in order to be able to access their care centers, especially in the event of a high-risk pregnancy and frequent appointments.

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On Monday, government spokesman Gabriel Attal had promised on Franceinfo “clarifications (…) in the coming days” on how these women will be able to obtain a health pass. The government spokesperson had assured that there was no question “that a pregnant woman (…) must do PCR tests every two days to be able to access a certain number of daily activities”.


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