Covid vaccination during pregnancy and breastfeeding: the indications of the Ministry of Health [CIRCOLARE]

Covid vaccination recommended for pregnant women in the 2nd and 3rd trimester. Relative to the 1st trimester, it can be taken into consideration after a risk / benefit assessment with a referring physician. These are the indications contained in the circular of the Ministry of Health.

Sars-CoV-2 / Covid-19 vaccination is also recommended for breastfeeding women, without needing to stop breastfeeding.

THE CIRCULAR

Ordinarily, the administration of vaccines in pregnancy is immunogenic, safe and effective, and the experience of other vaccinations suggests that, even in this case, the efficacy may be similar to that found among non-pregnant women.

Vaccination of pregnant women

In consideration of the growing evidence on the safety of vaccination in pregnancy for both the fetus and the mother, the new evidence relating to the greater morbidity associated with the Delta variant, the increasing circulation of the same variant and the significant lowering of the median age of infection in Italy, the ISS updates the previous interim indications recommending the extension of the vaccine offer, with mRNA vaccines, to all pregnant women in the second and third trimester who wish to be vaccinated.

· Although vaccination can be considered at any stage of pregnancy, to date there is still little evidence of vaccinations performed in the first trimester. Women wishing to get vaccinated during this gestational period must evaluate the risks and benefits together with a healthcare professional, also in light of the evidence that fever, which is one of the possible reactions to the vaccine, can cause an increased risk of congenital malformations.

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Women at greater risk of contracting SARS-CoV-2 infection (e.g. healthcare professionals, caregivers) and / or at greater risk of developing severe COVID-19 disease (women with risk factors such as age> 30 years , BMI> 30, comorbidities, citizenship of countries with high migratory pressure) remain the priority target for vaccination during pregnancy.

· Healthcare professionals are required to illustrate as clearly as possible the relationship between risks and benefits, so as to allow each woman to make the most appropriate decision for her case. Healthcare professionals should recommend vaccination of cohabitants to further limit the risk of contagion of pregnant and breastfeeding women.

· It should be noted that if a vaccinated woman discovers that she is pregnant after having already received the vaccine, there is no evidence in favor of terminating the pregnancy. Also, if a woman discovers that she is pregnant between the first and second doses of the vaccine she may consider delaying the second dose until the second trimester.

Vaccination in lactation

Breastfeeding women, as already foreseen by the previous interim indications of the ISS, can get vaccinated, without any need to interrupt breastfeeding.

The breastfeeding woman must be informed that vaccination does not expose the infant to risks and allows him to take antibodies against SARS-CoV-2 through milk.

The infant suckled by a vaccinated mother follows her vaccination schedule without any changes.

Other behavioral measures

All pregnant and breastfeeding women, regardless of whether to get vaccinated or not, are recommended to observe the following preventive measures:

hand hygiene,

use of the mask indoors and in the vicinity of other non-cohabiting / unvaccinated people,

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respect for the physical safety distance,

ventilation of the rooms.

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