Pregnant women need good advice about COVID-19 and vaccine safety, say Quebec specialists

Pregnant women and vaccines There’s not much data yet, but a Montreal obstetrician says the benefits of the vaccine in pregnancy seem to outweigh any potential risks.

MONTREAL — Quebec could be in for a mini-baby boom it seems, following a period at the beginning of the pandemic when many women put new pregnancies on pause, according to a Montreal obstetrician-gynecologist.

If not an official ‘boom,’ at the very least, baby making appears to be back on track.

“There was a huge dip in the number of consultations for new pregnancies,” when COVID-19 first hit, said Dr. Gabrielle Cassir. The specialist at St. Mary’s Hospital attributes the slowdown to women’s apprehension about associated risks.

Even the doctors had questions about safety in the early days when so little was known about the disease, said Dr. Haim Abenhaim, an obstetrician-gynecologist at the Jewish General Hospital.

“We were concerned at first because of what we had seen with H1N1 which was quite dangerous in pregnancy. We had seen certain deaths in pregnancies...so when we saw this one coming,” he said. “We didn’t know what to expect.”

But since those early days last March, much has changed. Doctors know better how to manage pregnancies in a COVID world, what to expect and how to advise their patients.

“And so I think the opposite has happened now. Everyone who put their pregnancy plans on hold has realized that we’re now kind of in this, and it’s not something that’s going away anytime soon and so I can honestly tell you I’ve never seen more pregnancies over the last few weeks, maybe last two months,” said Cassir who specializes in high-risk pregnancies.

Cassir says her colleagues are making the same observation. She points out the uptick could also be a result of the resumption of fertility treatments after those services were temporarily suspended last spring.

More babies, growing families - it’s all happy news but just because there’s more acceptance about the presence of the virus for now and the need for life to go on, doesn’t mean women’s concerns have gone away entirely.

On the contrary, being in the midst of a roaring third wave, with contagious new variants on the scene, and an onslaught of confusing information about vaccines in the public domain, means health decisions can still be fraught with worry.

But Dr. Abenhaim said he tells patients who come for any pre-pregnancy counselling, “you want to have a family, you want to have a child, go get pregnant and we’ll take good care of you.”

WILL THE VACCINE AFFECT MY FERTILITY?

The number one comment Dr. Cassir hears in her office these days from her patients is, “Oh my God, I can’t get the vaccine, it’s going to affect my fertility,” she said.

She quickly tries to address the disinformation with her patients when they raise it. From what she can tell, it’s the result of fear-mongering that seems to be spreading widely online.

“There’s no basis for that in the ob/gyn world. It’s something that has been rife with myth and propagated by social media but if there were an impact on fertility, we would in this case expect to have an increase in miscarriage rates,” but she says they “haven’t seen that happen.”

SHOULD PREGNANT WOMEN GET THE VACCINE?

There's no longer any doubt in 2021 about how severely some people are affected by COVID-19, with cumulative numbers of hospitalizations and deaths still being tallied daily.

At the same time, pregnant women are generally young and healthy so it’s about trying to balance the risk-benefit to the individual.

“It’s a delicate subject because we don’t have much data on this new technology, the mRNA vaccines," the specialist said, “but we think it’s a safe option.”

“I usually advise them if they’re at risk, if they’re health care workers, if they’re taking care of elderly people, if they have chronic illnesses, that they should be vaccinated,” said Abenhaim.

Cassir added that “vaccines have had a very safe track record in pregnancy, and [after] decades of experience with other vaccines administered during pregnancy we would tend to think that this vaccine would have similar efficacy in a pregnant population.”

In mid-March, the Society of Obstetricians and Gynaecologists of Canada (SOGC) reaffirmed its consensus statement on vaccination first issued in mid-December:

“Women who are pregnant or breastfeeding should be offered vaccination at any time during pregnancy if they are eligible and no contraindications exist,” because the risks of COVID-19 outweigh the “theorized and undescribed” risk of being vaccinated.

“I really try to reassure them...and tell them the SOGC has not said they should be excluded from [vaccination],” said Cassir.

Being vaccinated while pregnant with either the Moderna or Pfizer vaccine could actually have a beneficial effect on the baby, according to a published study conducted in Massachusetts by researchers at several hospitals, MIT and Harvard University.

According to an article in the Harvard Gazette, the study “demonstrated the vaccines confer protective immunity to newborns through breast milk and the placenta.”

Most of Cassir’s patients have chosen to get the vaccine, she said, including the ones who are doctors and nurses, because an unvaccinated pregnant woman is at risk for some complications if she develops COVID-19.

But she says hopefully pregnant women will be included in future vaccine trials so they will all be able to rely on more solid data.

THE RISKS OF COVID-19 IN PREGNANCY

A study published last month in the Canadian Medical Association Journal (CMAJ) reviewed and analysed other observational studies that focused on the impact of COVID-19 on pregnancy.

“I’m cautious as interpreting this to say that the effect is as large as they describe,” said Abenheim, referring to the results,” however he said, “I still think it’s concerning because COVID does have adverse effects on pregnancy.”

The paper concluded that if a woman gets the illness while pregnant, she has an increased risk for a number of complications including “preeclampsia, stillbirth, preterm birth and NICU admission.”

But Dr. Abenhaim said the review has some limitations, namely that it involves women who were only pregnant at the very beginning of the pandemic.

“What you’re seeing in the CMAJ are those that were sickest because those were the ones that were being tested for COVID in the early stages of the pandemic,” the obstetrician-gynecologist said.

In other words, COVID-positive pregnant women with mild illness would not have been included, which likely casted the results in a more negative light.

Health experts didn’t yet know how prevalent the disease was. But last May, the Jewish General Hospital started testing every pregnant woman receiving care.

“We saw most women are asymptomatic or have minimal disease,” Abenhaim said and most of them do well. But he doesn’t downplay the seriousness of the illness.

“We’ve seen women admitted to the intensive care unit, one admitted to the hospital for supplemental oxygen,” he said.

Dr. Cassir also said “a growing body of evidence” shows pregnant women with the illness do face some serious health concerns.

With regards to preterm birth, “the national estimate is 8 per cent and in Canadian studies has been shown to be 12.9 per cent with COVID,” Cassir said, adding that the third trimester seems to be a risk factor for more severe disease.

Both doctors guide their patients to be careful and to follow all the usual public health recommendations stringently to avoid becoming infected.

“And women have a right to have preventative leave with respect to work if they are in contact with people,” and can decide to take that extra precaution, said Cassir.

“Luckily the patients I’ve had who have been COVID positive have evolved very well,” Cassir said, and so have their babies.

If a patient does get sick while pregnant, she and the fetus will be monitored more closely through “increased ultrasounds every four weeks,” but the emphasis is on prevention, because “the treatments for COVID are just not there,” she said.