This is a summary, written by members of the CITF Secretariat, of:
- Mahin Delara & Manish Sadarangani(2022) Immunization in pregnancy to protect pregnant people and their newborns against COVID-19, Expert Review of Vaccines, DOI:1080/14760584.2022.2031987
- Piche-Renaud PP, Panetta L, Farrar DS, Moore-Hepburn C, Drouin O, Papenburg J, Salvadori MI, Kakkar F, Morris SK. Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada. medRxiv. 2022 Jan 7.
- Merckx J, Morris SK, Bitnun A, Gill P, El Tal T, Laxer RM, Yeh A, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Papenburg J, Lefebvre MA, Nateghian A, Haghighi Aski B, Manafi A, Dwilow R, Bullard J, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Viel-Thériault I, Piche D, Top KA, Leifso K, Foo C, Panetta L, Robinson J. Infants hospitalized for acute COVID-19: disease severity in a multicenter cohort study. Eur J Pediatr. 2022 Feb 25:1–5. doi: 1007/s00431-022-04422-x.
The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.
Many people who are pregnant, or are thinking about getting pregnant, are concerned about COVID-19 vaccines. The scientific evidence, however, clearly supports the benefits of vaccination for the pregnant person and the newborn. Research by CITF-affiliated experts contributes to the literature on the subject:
- Dr. Manish Sadarangani of the University of British Columbia published a review on vaccination against COVID-19 in pregnant people;
- Dr. Jesse Papenburg of McGill University released a pre-print (not yet peer reviewed) study on COVID-19 in infants.
- Drs. Sadarangani and Papenburg also collaborated, along with Dr. Karina Top of Dalhousie University, in an international study of disease severity among infants hospitalized for acute COVID-19 disease.
Because of the increased health risks to mother and child if the mother contracts SARS-CoV-2, current data suggests that vaccination should be carried out as early as possible in pregnancy, if the regimen wasn’t already completed prior to conception. While data in infants shows that, prior to the Omicron wave, COVID-19 infection was generally mild, premature infants and those of younger age are at higher risk of hospitalization.
Current recommendations support COVID-19 vaccination at any stage of pregnancy . The suggested timing of vaccination, based on the available evidence, varies from early in pregnancy to maximize protection for the pregnant individual, to later in pregnancy to optimize the benefit for the infant. An mRNA vaccine administered during the third trimester of pregnancy provides newborns with antigen specific IgG antibodies detectable at birth. Although vaccination at this stage provides protection to the newborn, it leaves the pregnant individual unprotected at the beginning of the pregnancy. This leads to the possibility of developing a severe form of COVID-19, which poses a greater threat to the pregnant individual as well as to the fetus (due to the direct effects of the virus and/or the administration of antiviral drugs). Thus, immunization as early as possible in pregnancy should be the priority, given the available data .
Regarding the safety of vaccines, studies have found that there is no greater risk of adverse events following vaccination in pregnant people compared to non-pregnant people. Studies have also found that COVID-19 vaccination is not associated with a higher incidence of congenital malformation, stillbirth, preterm birth, or small-for-gestational-age infants compared with historical rates . When comparing vaccinated and non-vaccinated pregnant people, there was no difference in terms of mode of delivery, gestational age, Apgar scores, or the incidence of adverse maternal and neonatal outcomes (eclampsia/preeclampsia, gestational hypertension, thromboembolism, birth trauma, uterine rupture, stillbirth, hypoxic-ischemic encephalopathy, low birth weight, and neonatal intensive care admission) .
When looking at the outcomes of infants (less than 1 year of age) with COVID-19, data from the Canadian Pediatric Surveillance Program showed that from April 8, 2020, to May 31, 2021, a total of 531 infants had COVID-19 . Most infants (58.5%) had a known close contact with a confirmed case of COVID-19. Cases were reported from across Canada, although the majority were in Ontario and Quebec. Most infants were born at term (n=445, 88.8%), with 29 (5.8%) born prematurely between 34 and 36 weeks of gestation, and 27 infants (5.4%) born before 34 weeks of gestation. A total of 59 infants (11.1%) had at least one comorbidity and 14 (2.6%) had more than one comorbidity. Of the 531 cases reported, 199 (37.5%) were hospitalized and 332 (62.5%) were treated as outpatients.
Regarding the symptomatology of reported cases, 66 (12.4%) were asymptomatic. Among symptomatic infants, the most common presenting symptoms were fever (n=353, 66.5%), internal inflammation of the nose (n=250, 47.1%), cough (n=198, 37.3%), and decreased oral intake (n=133, 25.0%). A total of 199 infants were hospitalized, of whom 141 (70.9%) were admitted because of COVID-19 related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Younger infants (less than one month of age), infants with one or more comorbidities, and preterm infants, were more likely to be hospitalized for COVID-19. Among infants hospitalized because of COVID-19-related illness, 111 of 141 (78.7%) had mild disease, 10 (7.1%) had moderate disease, and 20 (14.2%) had severe disease. Hospitalized infants with severe disease were more likely to be premature and be less than 1 month of age.
A global analysis, showed that over one-third of children admitted to a hospital with COVID-19 were infants. However, when comparing to older children, infants had lower rates of severity .
In conclusion, getting vaccinated while pregnant is a safe and effective way to protect the pregnant person as well as the newborn from COVID-19. Although infection in infants tends to be mild, preterm and younger infants as well as those with comorbidities are at a higher risk of hospitalization and severe disease.
For more information on vaccine schedules contact your health provider.
The studies presented here support earlier research presented by CITF-funded researchers Dr. Deborah Money and Dr. Deshayne Fell during the CITF/CanCOVID webinar, “The impact of COVID-19 disease & vaccination on pregnancy and newborns”.