“The sooner you book it, the better”. A message that goes straight to the point, that the English health service, through the voice of the Chief Midwifery Officer for England, Jacqueline Dunkley-Bent, addresses pregnant women to encourage them to get the vaccine, “the most effective way to protect the woman and her baby from the effects of Covid-19”. English pragmatism, supported by the latest data documenting a rise in hospital admissions for unvaccinated pregnant women. In recent days, the American Centers for Disease Control, a reference point for health protection, have updated the guidelines recommending the anti Covid vaccine in pregnancy, “in light of the benefits that outweigh any potential risk”.
And in Italy?
In Italy, however, the dividing line is less clear. On the one hand, the attitude of prudence espoused by the Ministry of Health – in a recent circular it is stated that vaccination “is not contraindicated in pregnancy”, however recognizing the possibility of a certificate of temporary exemption – and the caution of the Istituto Superiore di Health. The latter, in the current interim indications, drawn up on 31 January by the Italian Obstetric Surveillance System, underlines that pregnant women are not currently a priority target, and vaccination during pregnancy “is not routinely recommended”, but should be considered. for high-risk women, with a choice assessed on a case-by-case basis, after considering the benefits and risks.
On the other hand, the scientific societies of gynecology and obstetrics gathered in the Sigo Federation which, international data in hand, believe that vaccination should be “strongly recommended” to pregnant women, to be considered as a fragile population against Sars-CoV infection. 2.
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A semantic gap in which uncertainties, doubts and some hesitation can insinuate. So much so that the Sigo has launched an appeal to the institutions to reassure women about the anti Covid vaccination and favor the active offer of the vaccine, since pregnancy is a risk factor for serious Covid-19 disease.
“There is a need for clear, simple and easily understandable communication. We cannot hide behind the words: women ask for it. Who, due to univocal messages, are experiencing great confusion on such a sensitive topic”, she warns. Enrico Ferrazzi, director of Obstetrics at the Mangiagalli Clinic in Milan and full professor of Gynecology and Obstetrics at the University of Milan.
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In the meantime, something is moving: the Istituto Superiore di Sanità, consulted by Salute, announces that it is working on a new document – which will be ready shortly and is destined to replace the interim indications at the beginning of the year – in which recalibrate the recommendations on the anti Covid vaccine for pregnant women, in light of new data that has emerged in the scientific literature in recent months. For example, one of the most up-to-date studies on women vaccinated before 20 weeks of pregnancy, registered in the US in the “v-safe” surveillance register, has shown that immunization with mRna vaccines is not associated with an increased risk of abortion.
The international guidelines
“The most recent international guidelines, from those of the American College of Obstetricians and Gynecologists to those of the English Royal College of Obstetricians & Gynaecologists, recommend vaccination against Covid for pregnant women, on which infection can have a more significant impact in terms of hospitalizations and severity of the disease, as well as reverberating on the development of pathologies of pregnancy and preterm birth “, explains Ferrazzi, who in Mangiagalli is starting to hospitalize pregnant women with Covid, all unvaccinated, again. “The absolute risk, fortunately, remains low, but it should not be overlooked that the danger of ending up in intensive care increases three times compared to non-pregnant women, especially in the case of other concomitant diseases such as diabetes and hypertension, aged over 35 and obesity, bearing in mind that the most delicate phase is the second half of pregnancy “.
What does Lombardy do
Lombardy, a region that has experienced the most violent waves of the pandemic, is leading the way in accompanying women towards a conscious vaccination. From the end of July, the anti-Covid vaccination has been officially recommended to all pregnant women, and appropriate counseling interventions aimed at women by health professionals are foreseen: the interim indications approved by the Region, the result of the work of a panel of experts of the Birth Path Committee, shared by the Lombard Technical Scientific Committee.
Protection even for the newborn
“In the document we explain that pregnant women have not been included in the trials of vaccines against Covid, but that the studies published so far and the observations on 220 thousand vaccinated pregnant women have not revealed safety problems either for the future mother or for the child. – Clarifies Ferrazzi, who was part of the group of experts authors of the Lombard guidelines – In pregnancy, mRna, Pfizer and Moderna vaccines are administered, which from a biological point of view have no effects on the placenta or fetus because the messenger Rna sequences are rapidly degraded without penetrating into the cell nucleus. If anything, the antibodies acquired by the mother are transferred to the unborn child, with the effect of providing the newborn with protection for the first months of life “.
Over 99% of unvaccinated inpatients
The threat of the Delta variant, which is raging with greater contagiousness, should also be included in the assessments of future mothers. A recent study from the University of Oxford, funded by the UK’s National Institute for Health Research, confirms that pregnant women are most severely affected by the Delta variant. If in the first wave 24% of hospitalized pregnant women had moderate-severe Covid, the most serious cases rose to 36% with the Alpha variant and 45% with the Delta. The good news for immunized women is that almost no one is at risk of hospitalization: more than 99% of the hospitalized pregnant women surveyed in the study were not vaccinated.
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