Dödligt virus från Kina orsakar panik (SARS-CoV-2, COVID-19)

Maternal vaccines are important because pregnant women and their babies can get sick from diseases like COVID-19, flu, RSV and more. When doctors recommend and offer these vaccines, more pregnant women get vaccinated, which helps keep them and their babies safe from these serious illnesses.


The Importance of Maternal Vaccines

Pregnant women or their babies are at increased risk for COVID-19, influenza, RSV, and pertussis complications. Immunization rates for these vaccines are low, leaving many pregnant women or their infants unprotected against these serious vaccine-preventable diseases.

Studies confirm that your recommendation and offer of vaccines are essential. One study showed that patients who were offered influenza vaccination during an office visit were seven times more likely to be vaccinated for influenza than patients who reported their provider did not recommend or offer vaccination. Patients who received a recommendation alone were twice as likely to be vaccinated as those that received no recommendation.

Assuring your patients are protected by recommended vaccines is key. Each vaccine recommended for pregnant women is important for the protection of the patient and/or their baby.

Tetanus, Diphtheria, and Pertussis (Tdap)

Pertussis is on the rise and outbreaks are happening across the United States. On average, about 1,000 infants are hospitalized and typically between five and 15 infants die each year in the United States. Most of these deaths are among infants who are too young to be protected by the childhood pertussis vaccine series that starts when infants are 2 months old. These first few months of life are when infants are at the greatest risk of contracting pertussis and having severe, potentially life-threatening complications from the infection. Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period. When Tdap is given during pregnancy, antibodies are passed from the pregnant women to the developing baby providing protection. Postpartum Tdap administration does not provide protection to the infant, who is most vulnerable to the disease’s serious complications.

Influenza (inactivated)

Influenza is more likely to cause illness that results in hospitalization in pregnant women than in women of reproductive age who are not pregnant. Influenza also may be harmful for the developing baby. A common influenza sign can be fever, which has been associated in some studies with neural tube defects and other adverse outcomes for a developing baby. Getting vaccinated while pregnant also can help protect a baby from influenza after birth (because antibodies are passed from the pregnant parent to the developing baby during pregnancy). Women who get the influenza vaccine while pregnant or breastfeeding also develop antibodies against influenza that they can share with their infants through their breast milk.

Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is recognized as one of the most common causes of childhood illness and is the most common cause of hospitalization in infants. It causes annual outbreaks of respiratory illnesses in all age groups. In most regions of the United States, RSV season starts in the fall and peaks in the winter, but the timing and severity of RSV season in a given community can vary from year to year. Generally, there are two options to protect infants from RSV: either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody). RSV vaccination is recommended for pregnant women at 32 through 36 weeks gestation, and it is administered seasonally from September through January in most of the continental United States*. Nirsevimab is recommended for all infants under 8 months of age who are born shortly before or during their first RSV season, and it is administered seasonally from October through March in most of the continental United States*.

In a 2024 survey among pediatric and obstetrician/gynecologist (OB/GYN) providers, 77% of pediatricians had offered nirsevimab to pregnant patients. 63% of OB/GYNs in the survey had offered respiratory syncytial virus (RSV) vaccine to pregnant patients. Providers were confident in the safety and effectiveness of nirsevimab and maternal RSV vaccine.

Results
Out of 1406 studies screened, 29 were included in the systematic review. These studies, conducted in Israel (34.5 %), USA (24.1 %), Russia (20.7 %) China (10.3 %), Italy (3.5 %), North America (3.5%) and Turkey (3.5 %) were of poor (34.5 %), moderate (58.6 %) and good (6.9 %) quality. Meta-analyses were performed for pre- and post-vaccination sperm progressive motility (44 %, 95 % CI 42 %-62 % vs 43 %, 95 % CI 31 %-59 % p = 0.07) and concentration (50.6 mln/ml, 95 % CI 35.1–72.8 vs 55.4 mln/ml, 95 % CI 37.4–82.2p = 0.12). Biochemical (0.51, 95 % CI 0.40–0.66 vs 0.60, 95 % CI 0.53–0.68p = 0.45) and clinical (0.45, 95 % CI 0.37–0.54 vs 0.47, 95 % CI 0.40–0.55 p = 0.31) pregnancy rate did not differ among vaccinated and not vaccinated groups. Subgroup meta-analyses based on the type of vaccine showed no significant difference: between vaccinated with mRNA vaccines and non-vaccinated regarding biochemical pregnancy rates; pre- and post-vaccination with Gam-COVID-Vac regarding testosterone, FSH and LH levels; pre- and post-vaccination with BNT162b2 vaccines regarding sperm volumes.

Conclusion
Based on the studies published so far, there is no scientific proof of any association between COVID-19 vaccines and fertility impairment in men or women.

6.1. Conclusions
So far, there is no scientific proof of any association between COVID-19 vaccines and fertility impairment in men or women. Considering that COVID-19 infection could pose a threat to the human reproductive health, vaccination represents an important choice to prevent adverse COVID-19 outcomes.

Conclusion
COVID-19 vaccination during pregnancy was associated with a reduction in stillbirth and preterm birth, and not associated with any adverse impact on fetal growth or development. Vaccine coverage was substantially influenced by known social determinants of health.

Interpretation
We found evidence that pregnancies starting within 12 months from a first COVID-19 vaccination, compared to those in unvaccinated women, experienced fewer adverse birth outcomes, overall or in selected subgroups of the general population, accounting for potential confounders. An mRNA vaccine should be preferred to a viral-vector vaccine, to minimise safety issues, but where the latter is the only choice, it is still to be preferred to starting a pregnancy unvaccinated. The venous thromboembolism risk of the viral-vector vaccine was substantially lower compared to that attributable to SARS-CoV-2 infection in pregnancy or to commonly used medications such as hormone replacement therapy and oral contraceptives in the non-pregnant population.

COVID-19 vaccination was not appreciably associated with fecundability in either partner (Table 2). Female participants who received at least 1 dose of vaccine before a given menstrual cycle had 1.08 times the probability of conceiving during that cycle compared with unvaccinated participants (95% CI: 0.95, 1.23). The corresponding adjusted FR for female receipt of a full vaccine regimen (i.e., 2 doses of the Pfizer-BioNTech or Moderna vaccines, or 1 dose of the Johnson & Johnson vaccine) before a given menstrual cycle was 1.07 (95% CI: 0.93, 1.23). For male partners, the adjusted FR for at least 1 dose was 0.95 (95% CI: 0.83, 1.10) and for a full vaccine regimen was 1.00 (95% CI: 0.86, 1.17). The FR for couples in which both partners had received at least 1 dose compared with couples in which neither partner had received any doses was 0.97 (95% CI: 0.82, 1.16).

However, I do not think the authors provide any concrete evidence of a causal role for the vaccines - indeed, the data in some respects seems to undercut such a hypothesis. The simplest explanation of the discrepancy is that the two cohorts are not properly matched, and the burden of proof is on those who would claim otherwise.