Covid and pregnant women: including vaccination after exit from deaths

The recurrence of the novel coronavirus pandemic in Brazil has led to a weekly average of deaths of pregnant and postpartum women due to covid-19. More than doubled In the first months of 2021 compared to the previous year – the number jumped from 10.5 deaths per week to 25.8. The seriousness of the situation prompted the Ministry of Health to recommend, in March, in a technical note, the vaccination of pregnant women, despite the lack of studies on the negative effects of immunity in the public.

On April 16, Minister of Primary Care in the Ministry of Health, Rafael Parente, requested the women Postponement of pregnancy For a “better time”.

“We know that at the time of Zika, for a year or two, you had a decrease in pregnancies in Brazil and then they increased. It’s normal. Obviously we can’t say this to someone who is 42 or 43. But for a young woman, who is She can choose the moment she is pregnant a little bit there, the best thing now is to wait a little while until the situation calms down a little, “she said.

Pregnancy is a factor that can exacerbate COVID-19. A survey conducted by the Center for Disease Control and Prevention (CDC) in the United States, with 23,434 pregnant women out of 400,000 women with coronavirus, showed that pregnant women have a 62% greater chance of entering intensive care units (ICUs). Compared to other women in the same age group.

3

The risk of a pregnant woman with covid-19 needing mechanical ventilation is higher than for women of the same age who are not pregnant, according to the CDC.

In Brazil, which causes three out of every four deaths of pregnant women in the world due to the emerging corona virus. Recommendation from the Ministry of Health Is to vaccinate pregnant women with any of the pre-existing comorbidities:

• Diabetes
• Chronic arterial hypertension
• obesity
• Cardiovascular disease
• Chronic kidney failure
• Autoimmune diseases
• Bronchial asthma
• Immunosuppressants
• Implanted

Pregnant women without comorbidities are also allowed to receive the vaccine, according to the technical note issued by the ministry in March, but they must first conduct a risk-benefit assessment with their doctor. They must follow the municipal vaccination schedule.

Pregnant women vaccinated in Brazil

COVID-19 vaccination schedules are determined by states and municipalities according to local realities. The priority groups are health professionals, the elderly, indigenous people, quilombolas, professionals from the security forces, and teachers, depending on the region.

In the case of pregnant women, cities like Rio de Janeiro and Campo Grande, in Mato Grosso do Sol, are already vaccinating pregnant women with previous comorbidities. There are no contraindications.

In São Paulo, a declaration made by the Minister of State for Health, Jan Gornstein, It caused confusion. On April 17, he said that all pregnant women who have a medical report will be able to search for health clinics. However, pregnant women who tried to get vaccinated in the following days were banned, and it was necessary to call the police to a health facility. Three days later, the secretary is back, Saying that pregnant women can only be immunized if they belong to priority groups already called health professionals, teachers or security agents.

Vaccination of pregnant women who are classified within the priority groups, namely the group [de profissionais] Health, education, as well as public security are authorized persons. Whether she was pregnant or gave birth recently, that is, she gave birth in the last 60 days. In fact, these people will be eligible at this time, “the minister said.

What are the risks a pregnant woman is exposed to

None of the clinical trials that evaluated the safety and efficacy of vaccines against COVID-19 currently in use around the world included pregnant women and postpartum volunteers. Therefore, it is not known what the potential adverse effects may be in these groups.

However, many women were vaccinated without knowing they were pregnant and were being monitored by specialists. As of mid-April, there was no record of serious adverse symptoms. In the United States, for example, 86,000 pregnant women vaccinated with immunity from Pfizer or Moderna are being monitored by the CDC.

Adverse events observed among pregnant women are the same as those in the rest of the population. However, international medical societies are calling for the inclusion of pregnant and breastfeeding women in the new studies to assess the efficacy and safety of vaccines specifically for these groups.

In Brazil, the high number of pregnant women dying from COVID-19 is linked to a lack of adequate maternal care. According to data from the Brazilian Obstetrics Observatory Covid-19, an initiative conducted by researchers from the University of São Paulo (University of São Paulo) and UFES (Federal University of Espírito Santo), one in five pregnant women and postpartum women have been killed by the Coronavirus since the beginning of the virus. The epidemic of access to the intensive care unit. A third of the victims were not even intubated.

“When we look at the condition of pregnant women and women who have recently given birth, we already have a health network that is not very organized to deal with serious cases of this public, to the point that [o Brasil] The maternal mortality rate is 55 [mortes por 100 mil nascidos vivos; o recomendado é abaixo de 20]This shows that we are already facing difficulty in caring for women’s health, especially pregnant women and women who have recently given birth, ”said Dr. Rosana Francisco, a professor at the University of the South Pacific and one of the founders of the observatory, To Agência Brasil, On April 19.

145.4%

The increase in the average weekly mortality of pregnant women by covid-19 in 2021 compared to the average of 202; In the general population, the increase was 61.6%.

Vaccination around the world

Immunizing pregnant women against COVID-19 is not a consensus in the world. A survey conducted by the Ministry of Health showed that of the 27 countries with available data on this topic, 12 countries recommended the vaccination of pregnant women in priority groups, an approach adopted in Brazil. However, the recommendation in nine countries is that no pregnant woman should be vaccinated until studies indicate the safety of the vaccination device for the group.

In the United States, the CDC confirms that vaccination is Personal decision And that any vaccine for authorized use against covid-19 should be offered to a pregnant woman. The agency advises women to talk to their doctors to assess points such as the degree of exposure a pregnant woman is exposed to, the risk of infection and the potential risks of the disease to the mother and the baby.

No United kingdomThe vaccination for pregnant women was launched in April, based on data from the U.S. Centers for Disease Control. In Canada, the expert committee that directs immunization procedures in the country believes that a vaccine should not be offered to groups excluded from clinical trials, unless the benefits outweigh any risks, as is the case with vaccines against the Coronavirus. -19.

In Brazil, the vaccination committee of the Brazilian Federation of Obstetrics and Gynecology recommended that pregnant and breastfeeding women at risk be vaccinated after “evaluating the risks and benefits in a joint decision between the woman and the doctor prescribing.” According to WHO, vaccines used in Brazil use “dead” viral platforms (Coronavac) and non-replicating viral vectors (Oxford vaccine).

The organization says: “Scientific evidence indicates that vaccines that use these platforms to prevent other viral diseases in pregnant women and women who have recently given birth will be sufficient to recommend covid-19 vaccines.”

A group of doctors argued that the vaccines were purchased by the federal government With Pfizer It should be reserved for pregnant women when they are born, because data from observational studies in the United States, where the immune system is widely used, show that the product is safe for this group.

“The advantage of Pfizer is that it has a larger cohort that is under surveillance, simply by the number of pregnant women who have already been vaccinated. On Wednesday (21), O Globo defended pediatrician and infectious disease scientist Felipe da Vega, that it is up to For the national immunization program to direct this small amount of vaccines to pregnant women, as quickly as possible.