Maria Laura Avignolo
02/18/2021 14:06
Clarín.com
World
Updated 02/18/2021 2:06 PM
Pregnant women can be vaccinated against Covid, since the disease increases the risk of serious complications for the mother during pregnancy.
The current vaccines in Argentina are not a risk for pregnant women because "the vector is a virus like the flu."
The recommendation not to get pregnant until four weeks after vaccination is a "more than conservative" decision.
The vaccine does not affect fertility and
an infected mother can continue breastfeeding because it is proven that the milk does not become infected.
Respiratory viruses hardly cross the placenta and there is
very little risk that the baby will be infected in the mother's womb,
but it can be done at delivery, in the hospital.
They must take precautions and isolate it in the first three weeks of life to avoid contagion.
But the coronavirus increases hypertension in pregnant women and has generated
more premature births.
These are the recommendations and diagnoses of Dr.
José Villar
, professor specialized in Obstetrics, Gynecology and Perinatology at the Oxford Maternal and Perinatal Health Institute of the University of Oxford, in Great Britain.
This Rosario expert, who left with a scholarship from the World Health Organization to Guatemala in 1985 and later did his Master's degree at Harvard University, is currently
Visiting Scientist
at the prestigious Harvard University School of Public Health.
After 10 years at Johns Hopkins University in the United States as a professor, via the WHO in Geneva, he arrived at the University of Oxford in 2006.
Dr. José Villar was born in Rosario and for years he has been a researcher at the University of Oxford, in Great Britain.
Photo: University of Oxford
Her work on the effect of Covid on pregnant women will soon be published in a prestigious scientific journal.
With more than 260 scientific papers written and published, Professor Villar spoke with
Clarin
exclusively about the coronavirus and its influence on pregnant women, their babies and their discoveries from Oxford, in Great Britain.
-What is the effect of Covid on pregnant women?
-In simple terms, the disease during pregnancy considerably increases the risk of serious complications of the mother, pregnancy complications and also of the newborn, compared to pregnant women who did not have Covid-19.
It is not a good idea to become infected during pregnancy and should be avoided as much as possible.
-In the face of Covid, should pregnant women be vaccinated or not? Are there cases in which they should be exempted? And because?
-The summary is that pregnancy should not be a contraindication to vaccinate in those women who are indicated to be vaccinated.
The vaccines available at this time, basically the two types of vaccines out there, have no obvious risk to pregnancy.
What's more, in the vaccine that is most available in Argentina, the vector is an influenza virus, which is included in almost all influenza vaccines.
Pregnant women have already been exposed to this and are not at risk.
I have recently been informed that the National Immunization Commission of Argentina has decided to exclude a concept that did not recommend vaccination against Covid-19 for pregnant women, nursing mothers, who were immunosuppressed, or who had an autoimmune disease.
At this time they are indicated on them.
So in practical terms, if they can be vaccinated and there are vaccines available, pregnancy should not be a limitation to receive the two types of vaccines available at this time.
"The vaccines available at this time have no obvious risk to pregnancy."
-Can they alter fertility?
-There is also no evidence that these vaccines that are available can alter fertility.
In other words, it is not that they are going to believe that they can have losses in the first months of pregnancy by being vaccinated.
There is no evidence that this is the case.
There is a commonly made recommendation that women should not get pregnant in the first four weeks after vaccination.
That is an ultra conservative measure, because it is based on the recommendation when using live attenuated virus vaccines.
But none of the available vaccines have any attenuated viruses of any species.
You don't have that risk.
People can be totally calm, in case they have been vaccinated while pregnant.
-During delivery and postpartum, what should a mother do to ensure more antibodies, to be more defended? Is there any treatment for pandemic pregnancy?
-Unfortunately no, as within the normal population, there is no treatment in pregnancy for the specific case of the pandemic.
They should have the same preventive care as non-pregnant women, following a strict procedure in the recommendations, taking into account that complications may occur.
They should take this disease seriously even though the moms are young.
-The AstraZeneca laboratory is apparently going to have a third vaccine in August, should pregnant women also apply it or not?
-I don't know exactly what the characteristics of AstraZeneca will be: if it is going to develop a new vaccine.
Now in general terms, the one from AstraZeneca - developed by the University of Oxford - is a vaccine with a vector of a flu virus that is castrated and the vaccine uses it as a transporter for the virus RNA.
Therefore, the criteria are the numbers that are available now.
Both the vaccine from the Gamaleya Institute in Moscow and that of AstraZeneca have the same conceptual principle.
You have to wait and see what the strategy will be.
-In an epidemic, are pregnant women more at risk than a woman who is not?
-In an epidemic, it is not known if a pregnant woman is at higher risk compared to a woman of the same age, with the same characteristics, who is not pregnant.
It seems that you may have more risk but it is not known.
The other thing is that if a pregnant woman has Covid, she does have a higher risk compared to another pregnant woman who does not have Covid.
But compared to the "non-pregnant", it is not known.
A nurse takes a sample for a coronavirus test from a baby, in a hospital in Florida, in the US Photo: AFP
-And the baby can end up infected in the mother's belly or not?
-It is extremely difficult for the baby to end up infected inside the mother's belly.
Respiratory viruses such as the coronavirus, which causes Covid-19, do not cross the placenta easily.
There is no evidence that any of the other coronaviruses previously studied do.
Medical reasons are of various kinds.
But the good news is that these viruses cross the placenta very poorly and in real terms, they should not infect the baby inside the tummy.
In a vaccinated mother, the antibodies also do not cross the placenta, for multiple reasons.
Therefore, newborns are not protected against the disease, even though the mother has been vaccinated.
The chances of the baby becoming infected during pregnancy are very low or practically non-existent.
“It is extremely difficult for the baby to end up infected inside the mother's belly.
Respiratory viruses such as the coronavirus, which produces Covid-19, do not cross the placenta easily ”.
- Should the baby be vaccinated?
-At this time, babies are not in a priority order for vaccination.
But they can get the disease.
Not through the placenta, but during the time of delivery, at birth, by any contagion in a unit that is contaminated or by health personnel or other family members.
They can become infected after they are born and are not protected by the mother's antibodies.
So you must have isolation, control, following normal isolation protocols.
-
And breastfeeding?
-The good news is that it is practically very unlikely that breast milk has the virus.
So if the baby is born to an infected mother, positive at this time, that baby is not going to be transmitted through breast milk.
Even if the mother is infected, if she follows the simple rules of care: wearing a chinstrap, cleaning her neck well, washing her hands, she can breastfeed with complete peace of mind.
And it is recommended.
-And how does a pregnant woman defend herself from the virus, what should she do?
-According to the body's immune responses, you can live the same life as if you were not pregnant.
The point is that you must follow strict precautions not to be infected, because the virus increases the risk of pregnancy, premature delivery and a series of consequences.
Don't feel like a prisoner.
But do take the recommendations to keep your distance as strictly as possible, if she wants to avoid becoming infected.
-What are the complications that Covid can have in a pregnant woman when she is already full term, about to give birth?
-In the last months, in general during pregnancy, if the woman has Covid 19 and does not have a major complication, it resolves in a few weeks with the same symptoms.
Now the vast majority of women who are studied are those who are "full term."
Pregnant women are at risk of premature delivery, which at 35/36 weeks requires termination of the pregnancy.
Covid-19 is associated with an increased risk of hypertension during pregnancy.
It is not known which starts first, if women with hypertension are at higher risk of Covid or women with Covid are at higher risk of hypertension during pregnancy.
But the two things are associated and as is known, hypertension in the last trimester of pregnancy is a relatively important disease.
So that's another risk you have.
-And the diabetics?
-It aggravates this disease if the person is diabetic.
Then they should take care of themselves and as I said before, there is a risk of death if the pregnant woman does not have the corresponding care for pre-existing diseases.
The interesting thing is that the data in those who are asymptomatic show that their near-term risks are very low.
What seems to be an indicator of higher risk are those with symptoms and there they should be treated seriously, because it can lead to a risk of complications.
So: asymptomatic, the pregnancy goes smoothly, no problem.
With symptoms: complications and risk of hypertension increase during the last trimester of pregnancy.
It must be treated with care and be alert to what is happening.
-Natural delivery or cesarean section?
-The great dilemma is what to do: if it is born by natural birth or by cesarean section.
The most recommended is that if there is no evidence that there are viruses in the vaginal canals during childbirth and that the baby can be infected within a positive woman, they are low.
Therefore, unless there is a compelling need to terminate the pregnancy quickly if the woman deteriorates clinically, take it easy.
Normal delivery does not produce a major contagion, there is no evidence of this.
There is very little viral transmission around the vagina and caesarean section should not be an indication to quickly terminate the pregnancy in a woman who has Covid, unless the clinic requires it.
The biggest complication is premature delivery.
Questions and answers about the coronavirus vaccine, according to the US Centers for Disease Control and Prevention / AFP
-After the baby is born, what happens to the mother and the baby if the woman is infected?
-The short-term answer is that the baby can be infected through different channels, but not in the uterus.
You usually have mild symptoms or a breathing problem, but these usually heal and the symptoms go away.
The risk of infection in a newborn, in the first three weeks, is slightly higher than in older children.
Children older than 2, 3, 4, 5 years old do not have any symptoms.
But in adults a scenario is being seen, which is called the "long-term Covid".
And that seems to be that it produces some effects such as fatigue and multiple manifestations, which is difficult to know how it is related.
We are currently analyzing pregnant women who have had Covid, in a follow-up over a few years, to see exactly what can happen to the mother and the baby.
-Are there more premature births?
-There is considerable agreement that there are more premature births, either because they are born prematurely or because the mother is clinically affected.
It is known to be associated with longer-term growth and development consequences.
Therefore, through premature delivery, Covid can affect the long-term development of these babies.
So it is important to ensure that the mother is not exposed to the disease.
-In the event that the condition of the virus worsens in a pregnant mother and must be induced into a pharmacological coma, what consequences does it have for the baby while her mother is in a coma?
-What happens, whether it is in a coma or intubated, that exposure of the fetus to drugs necessary for the treatment of the mother in intensive care, many of them cross the placenta and can somehow, at least theoretically, affect the fetus.
At that time, there is a great dilemma in balancing between a premature birth or running the risk of possible effects from the treatment the mother receives, due to being in a serious clinical situation.
There is no general rule.
If the mother is seriously ill, there are the risks of being born prematurely, plus the risks probably associated with the termination of pregnancy.
These things are not directly associated with the virus but rather related to the severity of the woman during that period.
-Can the Covid leave sequelae in the newborn?
-Positive babies born to positive mothers, or who for some reason have become positive, in general have some respiratory symptoms, which require observation and close care.
But in general they do not have sequels.
They resolve more or less without complications.
Of all positive moms, at most 10 percent of babies are positive.
So the number of cases that are available are not very extensive.
They are usually between 3 to 4 percent of positive moms who have positive babies.
We are talking about cases of a rarer disease there.
-And what could be the long-term effects, both on the mother and on the baby, on a neurological, psychomotor level, on language, on development in general, if they have Covid?
-In general the consequences directly associated with the virus are not well understood and it is unlikely that it will have a direct effect on the baby.
First, because it has to cross the placenta and the symptoms in the newborn, although it has some respiratory complications, resolve quietly.
The opposite of the Zika virus infection, which passes into the placenta and affects the development of the baby.
This virus luckily does not.
Now, it can have long-term effects, linked to the need to be born prematurely.
There is no direct effect, but there could be one through prematurity.
- Is the mother more at risk of dying than the baby or vice versa in cases like these?
-The baby has moderate to mild symptoms.
The vast majority of cases are easily resolved.
The mother who is infected by a serious illness, associated with hypertension during pregnancy, previous illnesses and has a high risk of complications if she has Covid.
In general that is easily resolved.
The problem is when it requires a major intensive care and is not available.
There, yes, there is an increase in maternal mortality, when women who need important treatment do not have that possibility.
In regions of the world where there is inefficiency in intensive care, you are at high risk.
And compared to pregnant women who did not have Covid, they do have an increase in mortality, although it is still rare.
Paris, correspondent
CB
Look also
Concern in Great Britain about the advance of the coronavirus among children and young people
Is a vaccine that protects against coronavirus forever possible?
The bet of a European laboratory
