Israel’s Health Ministry and council for gynecological health on Tuesday recommended the coronavirus vaccine for pregnant women and women needing or undergoing fertility treatment, particularly those at high risk exposure or suffering underlying conditions.
The recommendation follows a rise in cases of pregnant women hospitalized for the virus; some of their lives are at risk, as well as those of their unborn babies.
The Health Ministry particularly warned women with underlying illnesses or those who come into contact with the public that they should get the coronavirus vaccine. The statement by the ministry said, "pregnant women who contract the virus have a higher probablity of getting seriously ill, more than their cohorts in the general population. This requires extra caution in maintaining social distancing and wearing masks."
“The illness caused by the coronavirus is liable to cause harm during pregnancy ... and lead to early delivery, so it is important to immunize,” says a position paper published by the council with the cooperation of Israel’s fertility research association.
“In light of reports about women and young couples avoiding the vaccine for fear of it damaging fertility, it is important to stress that there are neither facts nor a scientific basis pointing to damage to fertility as a result of any of the recognized vaccines.”
Neither pregnant nor breastfeeding women were included in Pfizer’s clinical trials. But now the Health Ministry says there is no reason against vaccinating a pregnant woman with a Pfizer-BioNTech vaccine, especially if she works or lives in a high-risk environment or may suffer serious symptoms if infected.
Only a modest amount of information is available on the vaccine’s effects on pregnant women, though the U.S. authorities say pregnant women may be inoculated. At first, British regulators disagreed but now are in line with the Americans.
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Israeli hospital physicians are also on board. “It’s very clear to me that it’s worth vaccinating during pregnancy, before pregnancy, at the outset of pregnancy and at the end of pregnancy,” says Prof. Gili Regev-Yochay, head of the infectious diseases unit at Sheba Medical Center near Tel Aviv.
She added: “In recent days there have been severe cases involving pregnant women. At least at the theoretical level, the vaccine is much less risky than other vaccines that we give pregnant women, whether for the flu or whooping cough. I think if I were pregnant or my daughter were pregnant, I would tell her unequivocally to get the vaccine.”
Not through the placenta
Prof. Yariv Yogev, obstetrics and gynecology chief at Lis Maternity and Women’s Hospital at Tel Aviv’s Ichilov Hospital, told Haaretz that “Israel is experiencing a peak rate of new infections, and we’re seeing younger people including pregnant women, most of whom haven’t yet been vaccinated.
“There has been an overall rise in infection rates, many more people are being exposed, and apparently there are variants out there that are more contagious – and this also involves pregnant women. Pregnant women are largely young and healthy and aren’t considered an at-risk population, and their infection rate is low. But when the number of cases rises in general, especially of young people, it also affects pregnant women.”
Regarding the risk of the fetus being infected, Yogev says: “From what we know so far, the virus apparently isn’t passed on through the placenta, and the chances of the fetus becoming ill during pregnancy or birth are very small. But the fetus is affected by the mother being ill, so in some of the difficult situations the fetus must be extracted so that the mother can be put on a ventilator.”
Health officials are worried that more pregnant women will have to be hospitalized because of COVID-19. On Monday, a 35-year-old woman was admitted to Beilinson Hospital in Petah Tikva around seven months pregnant. After her condition deteriorated, she needed an urgent caesarean section. The baby was transferred to Schneider Children’s Medical Center in stable condition. The woman is in intensive care, her life at risk.
At Sheba’s intensive care unit for coronavirus patients, a woman in her 30s nearly five weeks pregnant is on a ventilator and in serious condition. During the pandemic, many pregnant women have come down with the virus but few have needed ventilation and/or an early C-section.
“This is a more serious and violent wave than in the past that’s also affecting young pregnant women,” says Prof. Arnon Wiznitzer, head of the Women’s Hospital at Beilinson.
Dr. Yael Haviv, director of the intensive care unit at Sheba, added: “In this wave we’re seeing more and more cases of young people where the illness puts them in a life-threatening situation. It’s no longer a disease of older people with risk factors,”
Nursing mothers shouldn’t worry
According to the U.S. Centers for Disease Control and Prevention, pregnant women are at higher risk of developing serious disease if they come down with the coronavirus.
”Observational data demonstrate that, while the chances for these severe health effects are low, pregnant people with COVID-19 have an increased risk of severe illness, including illness that results in ICU admission, mechanical ventilation, and death compared with non-pregnant women of reproductive age,” the CDC website says. “Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19.”
The Israeli gynecological council wrote that breastfeeding women “have not been included in the vaccine trials, but experts on the issue don’t see any risk to the baby as a result of the nursing mother being vaccinated, based on experience with other vaccines against other viruses, the vaccine’s operating mechanism, the fact that there are nonviral particles in the vaccine and the negligible chances of the vaccine leaking into the mother’s milk. Furthermore, since the vaccine creates antibodies against the illness in the mother’s body, if and when these antibodies reach the newborn from the mother’s milk, the baby is also likely to be protected against the illness.”
One worry is whether the vaccine could impair fertility in either men or women. According to the report, “the scientific literature doesn’t provide any basis, mechanism or proof, nor does it claim that there is a possibility, of women’s fertility being harmed.”
Regarding men, it says: “There have been no reports and certainly no established proof of any specific damage caused by the virus to male fertility more than any other virus that can cause an inflammation in the male sexual organs – and the same would apply to the vaccine, which does no harm as a disease but rather protects against one.
“At this time, after millions of vaccinations have been given worldwide, there have been no reports in the scientific literature of any harm to fertility as a result of a vaccine, not to women or men. And certainly there is no proof of any damage or reduction in fertility for couples seeking to reproduce.”