A reasoned approach towards administering COVID-19 vaccines to pregnant women

Gender inequity and COVID-19 vaccination policies for pregnant women in the Americas

The region of the Americas has been the epicenter of the COVID-19 pandemic’s worst outcome in terms of number of deaths due to COVID-19. SARS-CoV-2 infection during pregnancy and the postpartum period has been found to be associated with increased risk of mortality and severe disease. Several Latin American and Caribbean countries have disproportionally high maternal mortality rates due to COVID-19. Although this region achieved relatively high vaccination rates among the general adult population, there were differing restrictions regarding the vaccination of those who were pregnant. In a pandemic, policies reflect political priorities in responses to the threats posed to populations and play an important role in promoting gender equity. This paper reports the results of an ethical analysis of 45 national COVID-19 vaccination public policies from seven countries – Argentina, Brazil, Canada, Colombia, Mexico, Peru, and United States. The analysis drew on reproductive justice and feminist bioethics frameworks, paying close attention to whether and how gender and social and economic inequities were addressed. It found that exclusionary approaches in immunization policies which restricted access to vaccination during pregnancy were often justified on the basis of a lack of evidence about the effects of immunization of pregnant persons, and on the grounds of medical expertise, to the detriment of women’s autonomy and agency. As such these policies reiterate patriarchal moral understandings of women, pregnancy and motherhood. In practice, they counter human rights gender equity and equality principles, and became lethal, particularly to racialized women in Latin America. During an emerging lethal disease, policies and policy development must consider the intersection of oppressive structures to protect and guarantee rights of women, girls, and pregnant persons.

COVID-19 Vaccine Hesitancy and Related Factors among Unvaccinated Pregnant Women during the Pandemic Period in Turkey

The COVID-19 virus appeared in Wuhan, China in 2019 and spread rapidly all over the world. Vaccination guidelines have recommended pregnant women to get vaccinated against COVID-19 to prevent disease. This study aimed to understand the willingness of pregnant women to vaccinate and the factors associated with their hesitation and resistance. This cross-sectional study was conducted between March and April 2022. The sample size was not calculated and tried to reach all pregnant women who did not have any COVID-19 vaccine. In the first part of the questionnaire, socio-demographic questions, and in the last part, the short form of the 12-item anti-vaccine scale, which was prepared as a 5-point Likert scale, were applied. The study was completed with 561 pregnant women. The mean score of the pregnant women who participated in this study from the vaccine hesitancy scale was found to be 33.40 ± 6.07. It was found that as the income of pregnant women decreased, the vaccine hesitancy scores decreased. Vaccine hesitancy scores of those who stated no one gave advice were significantly higher. The vaccination of pregnant women will bring significant success to the fight against the COVID-19 pandemic when implemented as part of the public health policies of countries.

Data-driven commentary on SARS-CoV-2 infection, vaccination, and fertility

A recent study by Wesselink et al. (Am J Epidemiol. 2022 Jan 20;kwac011. doi: 10.1093/aje/kwac011. Online ahead of print) adds to the growing body of research finding that vaccination for coronavirus disease 2019 (COVID-19) is safe for individuals either seeking pregnancy or who are pregnant. The study's authors found no effect of COVID-19 vaccination on fecundity in a population of individuals with no known infertility who were attempting conception. The finding reinforces the messaging of the American Society for Reproductive Medicine COVID-19 Task Force, the aim of which is to provide data-driven recommendations to individuals contemplating pregnancy in the face of the COVID-19 pandemic. As safe and effective COVID-19 vaccines became available, and with an increasing number of studies showing a heightened risk of severe disease during pregnancy, an important role of the Task Force is to encourage vaccination during the preconceptual window and in early pregnancy. The Task Force supports ongoing research to address gaps in knowledge about safe and effective therapies and preventive measures for individuals contemplating pregnancy and during pregnancy. Such research will help optimize care for reproductive-age individuals in the face of current and future health crises.

Data-Driven Commentary on SARS-CoV-2 Infection, Vaccination, and Fertility

A recent study by Wesselink et al. (Am J Epidemiol. 2022;191(8):1383-1395) adds to the growing body of research finding that vaccination for coronavirus disease 2019 (COVID-19) is safe for individuals either seeking pregnancy or who are pregnant. The study's authors found no effect of COVID-19 vaccination on fecundity in a population of individuals with no known infertility who were attempting conception. The finding reinforces the messaging of the American Society for Reproductive Medicine COVID-19 Task Force, the aim of which is to provide data-driven recommendations to individuals contemplating pregnancy in the face of the COVID-19 pandemic. As safe and effective COVID-19 vaccines became available, and with an increasing number of studies showing a heightened risk of severe disease during pregnancy, an important role of the Task Force is to encourage vaccination during the preconceptual window and in early pregnancy. The Task Force supports ongoing research to address gaps in knowledge about safe and effective therapies and preventive measures for individuals contemplating pregnancy and during pregnancy. Such research will help optimize care for reproductive-age individuals in the face of current and future health crises.

Pharmacological consideration of COVID-19 infection and vaccines in pregnancy

COVID-19 is a pandemic of the 21st century that recorded 234 809 103 confirmed cases and more than 4 800 375 deaths. Many studies report the effect of COVID-19 in the overall population; nevertheless, there is information scarceness related to pharmacological management and pregnancy and fetal outcomes during the epidemic. Pregnancy is a state of change in immune physiology and anatomy modulation in preference to immune suppression. Additionally, manifold interactions with the health care system during pregnancy increases the chance of infection, and managing, pregnant population poses a more significant challenge. This review will summarize the available data on pharmacological considerations and vaccines in pregnancy and their adverse effects on fetal outcomes. Several drug choices include but are not limited to antivirals and antimalarial and combinations, corticosteroids, nonsteroidal anti-inflammatory drugs, and antipyretics. Approved vaccines for pregnancy include Pfizer/BioNTech and mRNA-1273 Moderna/National Institutes of Health. COVID-19 treatment approaches vary across different countries; the WHO and the Centers for Disease Control and Prevention guidelines and country regulators advise managing adverse effects on pregnancy and fetal outcome. But the efficacy of these drugs is questionable. There is no adequate literature to demonstrate the safety of these drugs in pregnant and lactating women. Hence, well-conducted studies that assess the safety of anti-COVID-19 medications and vaccines in pregnancy and lactating women are needed.

The Effect of COVID-19 Endemicity on the Mental Health of Health Workers

Objectives

A major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020.

Design

Cross-sectional survey study.

Setting and Participants

HCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020.

Methods

A survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed.

Results

We surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001).

Conclusions and Implications

HCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.

A reasoned approach towards administering COVID-19 vaccines to pregnant women

There are over 50 SARS-CoV-2 candidate vaccines undergoing Phase II and III clinical trials. Several vaccines have been approved by regulatory authorities and rolled out for use in different countries. Due to concerns of potential teratogenicity or adverse effect on maternal physiology, pregnancy has been a specific exclusion criterion for most vaccine trials with only two trials not excluding pregnant women. Thus, other than limited animal studies, gradually emerging development and reproductive toxicity data, and observational data from vaccine registries, there is a paucity of reliable information to guide recommendations for the safe vaccination of pregnant women. Pregnancy is a risk factor for severe COVID-19, especially in women with comorbidities, resulting in increased rates of preterm birth and maternal morbidity. We discuss the major SARS-CoV-2 vaccines, their mechanisms of action, efficacy, safety profile and possible benefits to the maternal-fetal dyad to create a rational approach towards maternal vaccination while anticipating and mitigating vaccine-related complications. Pregnant women with high exposure risks or co-morbidities predisposing to severe COVID-19 infection should be prioritised for vaccination. Those with risk factors for adverse effects should be counselled accordingly. It is essential to support patient autonomy by shared decision-making involving a risk-benefit discussion with the pregnant woman.