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Covid-19: Breastfeeding women can have vaccine after guidance turnaround

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n64 (Published 08 January 2021) Cite this as: BMJ 2021;372:n64

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Why were breastfeeding women denied the covid-19 vaccine?

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Covid-19: should patients going through assisted conception be offered covid-19 vaccination prior to their becoming pregnant?

Dear Editor

Abi Rimmer’s helpful article discusses the use of vaccines against covid-19 during pregnancy. (1) This is a very important issue indeed.

The RCOG states that pregnant women are included in the list of people at moderate risk (clinically vulnerable) as a precaution, (2) and WHO suggests that “when pregnant women develop severe disease, they also seem to more often require care in intensive care units than non-pregnant women of reproductive age.” (3) Experience in the USA indicates that pregnant women may be more likely to end up on a ventilator, and that the risks of premature birth and caesarean delivery are greater, while “….their babies are more likely to be admitted to a neonatal unit.” (4)

In light of this background information, that vaccination could be considered for use in women who are already pregnant, but only when the potential benefits are considered to outweigh any potential risks for the mother and baby, (1) is a clinically important matter meriting the fullest possible discussion.

There is one particular group of women contemplating pregnancy where the circumstances are more challenging, the degree of urgency is greater, and a planned medical intervention is always involved. This is the case with women who are obliged to go through assisted conception (eg. IVF, ICSI) in order to have any chance of becoming pregnant. They are usually an older group of mothers - in 2018 the average age of an IVF patient in the UK was 35.3 years (5) - and as fertility declines with age (5) there is less time left in which to achieve a pregnancy. Unsurprisingly it has been stated that “time is precious in IVF” (6), and few would dispute that it is. Assisted conception is a very high stakes process for patients, and people can end up going into considerable personal debt attempting to fulfil their ambition to become pregnant. (7)

The presence of a massive pandemic has certainly not helped patients who are obliged to go down this route, but UK fertility clinics are continuing to operate during the pandemic. (8)

Taking everything into account, it may therefore be worth contemplating offering effective vaccination against covid-19 earlier rather than later to this group of patients, possibly prior to any pregnancy beginning, so as to best ensure that they are at all stages fully protected against the virus.

As far as can be determined by the author with a preliminary review of the literature, this specific issue - looking at the case of assisted conception - has to date not yet been explicitly advised upon by authoritative bodies such as the HFEA or the JCVI.

Because of the planned nature of the process, and the fact that medical intervention is always a factor in the timing of a pregnancy, there therefore exists an opportunity to offer preventative treatment to patients, rather than waiting till a problem develops after the act.

Accordingly, it would be good if attention were to be directed towards this important issue.

References

1. https://www.bmj.com/content/372/bmj.n64
2. https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-pr...
3. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coron...
4. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/preg...
5. https://www.hfea.gov.uk/about-us/publications/research-and-data/fertilit...
6. https://www.theguardian.com/society/2020/apr/27/time-precious-ivf-women-...
7. https://www.independent.co.uk/voices/ivf-fertility-treatment-add-ons-pre...
8. https://portal.hfea.gov.uk/media/1670/covid-19-clinic-faqs-10-february-2...

Competing interests: No competing interests

18 February 2021
Stephen T Green
Honorary Professor of International Health
Sheffield Hallam University & Sheffield Teaching Hospitals, UK