COVID 19

The effect on your scan at Beard Mill and general advice about the infection in pregnancy

Beard Mill Clinic remains open and operating normally as long as Victoria is testing negative. The utmost importance is the safety of the people attending Clinic and adjustments have been made to reduce the risk of infection and these remain in place for the foreseeable future, despite the lifting of lockdown measures. These include:

Regular cleaning in Clinic, with increased and stringent processes in place
Limiting visitors to just the person having the scan and just one other person
Asking you not to bring any children into Clinic if at all possible
Encouraging everyone to wash their hands and / or use the hand sanitiser on entering Clinic and wear a face-covering at all times
Suggesting that you wait in your car in our carpark until your appointment time if you arrive really early to limit the number of people in the waiting room at any one time. We have ample free parking outside Clinic
Postponing your appointment if you have any symptoms of Covid-19 or have tested positive in the previous 7 days

You are likely to have lots of questions relating to the risks to you and your baby if you contract COVID-19 while you are pregnant and whether or not you should have the vaccination if you are offered it. Studies from the UK show that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 may be at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester. Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution.
Pregnant women should follow the latest government guidance on staying alert and safe (social distancing) and avoid anyone who has symptoms suggestive of COVID-19. If you are in your third trimester (more than 28 weeks’ pregnant) you should be particularly attentive to social distancing.

The Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk) has published advice to pregnant women and update this regularly. It addresses many of the many questions that you may have and I would encourage you to look this and hope that you will find it both reassuring and informative. Some of the frequently asked questions and RCOG advice are given below.

Q1. What effect does coronavirus have on pregnant women?

Current evidence from the UK suggests that pregnant women are no more likely to get COVID-19 than other healthy adults, but they are at slightly increased risk of becoming severely unwell if they do catch COVID-19, and are more likely to have pregnancy complications like preterm birth or stillbirth. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 are at slightly increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester.

Studies have shown that there are higher rates of admission to intensive care units for pregnant women with COVID-19 compared to non-pregnant women with COVID-19. It is important to note that this may be because clinicians are more likely to take a more cautious approach when deciding whether to admit someone to the intensive care unit when a woman is pregnant.

At present, it is unclear whether pregnancy will impact on the proportion of women who experience ‘long COVID’ or a post COVID-19 condition.

In the UK, information about all pregnant women requiring admission to hospital with COVID-19 is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).

In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. A recent study has also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

Q2. What effect will coronavirus have on my baby if I am diagnosed with the infection?

Current evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far.

There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.

Transmission of the COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a newborn baby gets COVID-19 is not affected by mode of birth, feeding choice or whether the woman and baby stay together. It is important to emphasise that in most of the reported cases of newborn babies developing COVID-19 very soon after birth, the babies remained well.

Studies have shown that there is a two to three times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. In most cases this was because it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are.

The UK Obstetric Surveillance Study (UKOSS) report from January 2021 describes 1,148 pregnant women with COVID-19 who were admitted to hospital between March and September 2020. Nearly one in five women with symptomatic COVID-19 gave birth prematurely. However, women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely. The babies of women with COVID-19 were more likely to be admitted to the neonatal intensive care unit (NICU), but almost all these babies did well. There was no statistically significant increase in stillbirth rate or infant death for babies born to women who had COVID-19. Not all the babies were tested, but overall, only 1 baby in 50 tested positive for COVID-19, suggesting that transmission of the infection to the baby is low.

A recent study from the UK compared 3,500 women who had COVID-19 at the time they gave birth to over 340,000 women who did not have COVID-19 at the time they gave birth. This study found that pregnant women who tested positive for COVID-19 at the time of birth were twice as likely to have a preterm birth, and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

Q3. Why are pregnant women in a vulnerable group?

Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution. This is because in a small proportion of women pregnancy can alter how your body handles severe viral infections, and some viral infections such as flu, are worse in pregnant women. Amongst pregnant women, the highest risk of becoming severely unwell (should you contract the virus) appears to be for those who are 28 weeks pregnant or beyond. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and they are used to caring for pregnant women in this situation.

Current evidence suggests that hospital admission may be more common in pregnant women with COVID-19 than in non-pregnant women of the same age, however this is partly because pregnant women are also admitted to hospital for reasons unrelated to COVID-19. In the UKOSS study, which examined women with COVID-19 in pregnancy during the spring and summer in the UK, the majority of pregnant women with COVID-19 admitted to hospital were in the third trimester of pregnancy. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and that this is particularly important at 28 weeks’ pregnancy and beyond.

Q4. What impact will COVID-19 have on my pregnancy?

The NHS has made arrangements to ensure that women are supported and cared for safely through pregnancy, birth and the period afterwards during this pandemic when there will be extra pressures on healthcare services.

Maternity services are absolutely essential and the RCOG is supporting units to coordinate staff in maternity services, to ensure safe and personalised care is provided. This includes reducing staff commitments outside maternity units, reducing any non-essential work within hospitals and re-organising staffing.

In some areas of the UK, maternity units are providing consultations on the phone or by video link, when this is appropriate, so you do not have to travel unnecessarily to the hospital. However, some visits in person with a midwife or doctor are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks. You will be required to follow guidance about face coverings during visits to healthcare settings.

Q5. Which pregnant women are being offered a COVID-19 vaccine?

On 16 April 2021, the Joint Committee on Vaccination and Immunisation advised that all pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, in line with the age group roll out.

Previously their advice was that pregnant women at high risk of exposure to the virus or with high risk medical conditions should consider having a COVID-19 vaccine in pregnancy.

COVID-19 vaccines are recommended in pregnancy and all pregnant women in the UK over the age of 18 have now been offered a COVID-19 vaccine. The benefits and risks of COVID-19 vaccination in pregnancy should be considered on an individual basis.

Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.

Q6. Is COVID-19 vaccination safe and effective in pregnant women?

Robust real-world data from the United States – where over 130,000 pregnant women have been vaccinated mainly with mRNA vaccines, such as Pfizer-BioNTech and Moderna – have not raised any safety concerns.

Therefore, the JCVI advises that it is preferable for the Pfizer-BioNTech or Moderna mRNA vaccines to be offered to pregnant women in the UK, where available.

Public Health Scotland have reported that 4,000 pregnant women have received a vaccine until May with no serious adverse effects recorded.

The large clinical trials which showed that COVID-19 vaccines are safe and effective did not include pregnant women. As the COVID-19 vaccines were not tested in pregnant women, we cannot say for sure that they work as well in pregnant women as they do in other adults. However, there is no reason to think that the vaccines will not protect pregnant women effectively against COVID-19. Similarly, there is no reason to think that the vaccine will have worse side-effects in pregnant women.

COVID-19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to a developing baby. Studies of the vaccines in animals to look at the effects on pregnancy have shown no evidence that the vaccine causes harm to the pregnancy or to fertility.

The COVID-19 vaccines that we are using in the UK are not ‘live’ vaccines and so cannot cause COVID-19 infection in you or your baby. Vaccines based on live viruses are avoided in pregnancy in case they infect the developing baby and cause harm. However, non-live vaccines have previously been shown to be safe in pregnancy (for example, flu and whooping cough). Pregnant women are offered other non-live vaccines, such as those against flu.

Q7. What are the side effects from COVID vaccines?

In non-pregnant individuals, the COVID vaccines are known to have mild and short-lasting side effects, such as a fever or muscle ache lasting a day or two. Reports of serious side effects, such as allergic reaction or clotting problems, have been very rare.

Regarding serious blood clots, the JCVI has stated that “there are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine”. This means that someone is not necessarily at higher risk of this serious side effect just because they have a higher risk of other blood clots, for example because they are pregnant. Because this side effect is so rare, however, and has not been reported in any pregnant women, we can’t know the exact risk in pregnancy.

This information on the AstraZeneca vaccine may be less relevant for pregnant women now that the JCVI recommends that the Pfizer-BioNTech or Moderna vaccines are offered in pregnancy, where available.

The government has also advised that individuals under the age of 40 should be offered an alternative vaccine to the AstraZeneca vaccine, based on the risk/benefit ratio for that age group.

Q8. What are the benefits of vaccination in pregnancy?

COVID-19 vaccines are recommended in pregnancy. Vaccination is the best way to protect against the known risks of COVID-19 in pregnancy for both women and babies, including admission to intensive care and premature birth.

More than half of women who test positive for COVID-19 in pregnancy have no symptoms at all but some pregnant women can get life-threatening illness from COVID-19, particularly if they have underlying health conditions. In the later stages of pregnancy, women are at increased risk of becoming seriously unwell with COVID-19.

COVID-19 infection can also affect the pregnancy. In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. A recent study has also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

The benefits of vaccination include:

reduction in severe disease for the pregnant woman
reduction in the risk of stillbirth and prematurity for the baby
potentially reducing transmission to vulnerable household members.

Q9. When in pregnancy can I have the vaccine?

The vaccine is safe and effective at any stage of pregnancy.

However, some women may choose to delay their vaccine until after the first 12 weeks (which are most important for the baby’s development) and have the first dose at any time from 13 weeks onwards.

One dose of COVID-19 vaccination gives you good protection against infection, but it is thought that this is not long-lasting and may not protect you for the whole of pregnancy. Second doses are given 8 to 12 weeks after the first dose and we recommend that you complete the course of vaccination before giving birth, or before you enter the third trimester, when the risk is greatest.