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Pregnant healthcare professionals are assessing the risk of the COVID-19 vaccine due to lack of research

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As a public health nurse, Stephanie Pizzie knows better than most people how the COVID-19 vaccine works and how it was developed, and encourages people to take them when provided. I will.

However, Pittsey, 26 weeks pregnant, has not yet been vaccinated on the advice of her doctor.

“Initially, I used a lot of vaccines and was very happy to get them,” said Pizzy. “This is a little tricky, as it has not been thoroughly studied in pregnant and lactating women.”

Clinical trials of Pfizer-BioNTech and Moderna, two vaccines available to Canadians, did not include pregnant or lactating people. Although the vaccine has been approved for use in other adults, there are still no definitive studies on the safety and efficacy of the vaccine for either the mother or the fetus.

Pfizer Announced this month Twelve women who have begun a global clinical trial to test the vaccine for pregnant people, vaccinated during the wider trial, and later became pregnant have been monitored so far. No adverse effects have been reported.

However, simply choosing to wait for the conclusions of the study poses a dilemma for healthcare professionals like Pizzie.

Stephanie Pizzie, a registered nurse of Red Deer, is 26 weeks pregnant. (Stephanie Pizzie)

Evidence collected in Canada and internationally shows that pregnant people with COVID-19 are at increased risk of having more serious consequences from their illness. The Canadian Society of Obstetricians and Gynecologists recommends providing vaccines to pregnant and lactating women unless there are contraindications.

“This decision outweighs women’s personal values ​​and the risk of infection and / or morbidity with COVID-19 outweighs the theoretical and unexplained risk of being vaccinated during pregnancy or lactation. It is based on, “said a social statement.

It is unclear when the vaccine will be widely available in Albertan. But for now, pregnant healthcare professionals have to weigh the risks and make their own decisions.

In addition to public health work, Pizzie sometimes works in the neonatal intensive care unit of the Red Deer Regional Hospital Center. She said that spending more time in the hospital or working in an environment that is likely to be COVID-19 positive is more likely to cause seizures.

“It still weighs heavily on my mind,” she said, and if the doctor’s advice changed, or if the obstetrician she was going to meet thought she should get it right away, she said. Open to change your mind.

“You don’t have to rely on others”

Calgary’s recreation therapist, Emily Shell, will be vaccinated early in late pregnancy.

She works in the Neurorehabilitation Unit at Calgary Hospital and has a patient with a stroke, brain and spinal cord injury.

She said she didn’t think she would be vaccinated until an email recommending sign-up arrived in her inbox in January. She spoke to a friend who was a gynecologist in another state and said it was her choice.

Emily Charlton, a Calgary hospital-based recreation therapist, is in late pregnancy. (Emily Shell)

“I was excited, I was excited,” she said. “I waited and talked to my doctor, and she basically backed it up. She ….” If you want to get it, get it “said. “

She studied the mRna vaccine and said it made her feel more comfortable.

“So it sounds like a very low risk to me. The more I looked at it and the more I read about it, the less anxious I was.”

Chel has some examples of close contact with positive COVID-19 cases at work. She feels safe at work using PPE, physical distance, and other safety measures, but her primary motivation was to have some control over protection against viruses.

“It was hard to know that I could be shot myself and protect myself and not have to rely on others,” she said.

Chel’s appointment was canceled due to the state’s lack of dose supply, and she was still unable to book another appointment.

Shared discussion

Pregnant individuals should consider their potential exposure to COVID-19 and consult a doctor, said Dr. Suchandra, a maternal and fetal expert and associate professor at the University of Alberta School of Medicine.

“In the end, it always comes down to patient autonomy,” said Chandra, who sees patients at the Royce Hall Women’s Hospital in Edmonton. “Our job as a provider is to provide them with the best information so they can use it to guide their decisions.”

Dr. Suchandra is a maternal and fetal specialist at the Royce Hall Women’s Hospital and an associate professor at the University of Alberta School of Medicine. (Suchandra)

She said the first exclusion of pregnant and lactating people from clinical trials (a long-standing concern in health research) puts practitioners in a difficult position.

“One of our considerations and challenges as a prenatal care provider is the fact that the administration of this vaccine is safe for pregnant women, or how much immunity it conveys compared to its effectiveness. It does not necessarily support the fact that even points are valid. People in trial. “

Although mRNA technology is new, Chandra, like other vaccinations offered during pregnancy, such as whooping cough and flu, allows pregnant and lactating people to respond effectively to the vaccine. I’m expecting.

Alberta Health Services Guidance document for practitioners Experts say they believe that the mRNA vaccine is unlikely to pose a risk to pregnant or lactating individuals, or to the feet or lactating baby.

According to Chandra, most pregnant people do not suffer serious consequences from being infected with COVID-19, but they are at greater risk of entering a hospital or intensive care unit than others of the same age. ..

She observes during a pandemic that pregnant people over the age of 35, overweight, or have underlying health conditions such as high blood pressure, diabetes, or existing heart and lung problems are at risk of serious consequences. Said showing that is high.

Regarding fetal risk, Chandra shows that current information shows that COVID-19-positive mothers have a very low risk of transmitting the virus to their babies and have so far correlated with birth defects. He said there was no evidence. However, she said COVID-19 appears to increase the risk of obstetric complications, including increased risk of preterm birth and possible fetal growth restriction.

She said that factors to consider when considering a decision for a pregnant person to be vaccinated include:

  • COVID-19 infection rate in their community;
  • Possibility of their personal exposure (are they working from home? With the general public? In healthcare?);
  • And other risk factors for pregnant people, such as age, weight, and underlying health.

Chandra said it should be a shared debate between pregnant people and their healthcare providers.

Canadian study on COVID-19 and pregnancy

As of February 17, Alberta reported 898 COVID-19 cases in pregnant women. Canada COVID-19 Pregnancy Surveillance (CANCOVID-Preg)An ongoing initiative led by Dr. Deborah Money, a researcher at the University of British Columbia.

To Report Researchers have put together information from five states to make a “crude” calculation of the rate at which pregnant people are infected with COVID-19, and as of November 30, 2020, Alberta had 1,000 people. Reported the highest rate of COVID-19 infection per pregnant individual. :

  • 10.8-Alberta
  • 6.4-British Columbia
  • 6.4-Manitoba
  • 6.0-Ontario
  • 9.1-Quebec

However, a spokesperson for the program pointed out that underreporting of COVID-19 among pregnant women in other states may be behind the rise in prevalence in Alberta. She said the updated data will be released within a few days.

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