22 September 2021
COVID-19 vaccine uptake challenges illustrate serious problems with communicating risk in pregnancy, charities warn, as new data shows 122 pregnant or recently pregnant women were admitted to intensive care with COVID-19 in August.
A coalition of reproductive rights charities and healthcare providers are today calling for an “urgent rethink in how we communicate risk in pregnancy” in response to the challenges faced in encouraging pregnant women to take up the COVID-19 vaccine, as new data shows as many as 122 pregnant or recently pregnant women with COVID-19 were admitted to Intensive Care Units (ICUs) during August.
Although numbers are increasing, uptake of the vaccine among pregnant women remains relatively low, with data published in September suggesting that the majority had not been vaccinated. This may be due in part to messages issued at the outset of the vaccination programme, but vaccine hesitancy is also the inevitable consequence of a culture which encourages women to avoid taking any even hypothetical risk in pregnancy – even to the detriment of her own health. Charities are also reporting that they are hearing from women who have been advised by health care professionals to wait to have the vaccine post-partum.
The ongoing vaccine hesitancy has thrown a spotlight on the on the problems caused by not including pregnant women in clinical research. As is standard in pharmaceutical trials, pregnant women were excluded from the initial vaccine trials, causing uncertainty about the safety for this cohort. In the last 30 years, only one new drug has been specifically licensed for use in pregnant women in the UK. Most women need to take some medication during pregnancy, yet the majority of drugs have no safety information in pregnancy. However, absence of evidence to prove safety cannot and should not be equated with evidence of harm.
Women can become seriously ill and indeed die because risks to their own health are not emphasised. Sudden unexpected death among pregnant and postnatal women with epilepsy has doubled since a programme designed to prevent risks to children of being exposed to the medication valproate in the womb was introduced. When hyperemesis gravidarum (HG) is not appropriately managed with medication not only are there lifelong development risks to the baby from malnutrition and dehydration but there is high risk of fetal death and significant mental and physical health consequences for the woman.
However, women can struggle to access the medications they need – both for pregnancy related issues like severe sickness but also existing conditions pregnancy like depression – on the basis that “nothing is safe” in pregnancy, even though the risks of not treating may be significantly greater than any risks posed by the treatment itself.
Even where there is no or poor-quality evidence of harm, such as with low intake of alcohol and caffeine, women are increasingly advised to avoid this. Recent suggestions from the WHO that women of childbearing age avoid alcohol add to harmful climate of fear around pregnancy, in which even small quantities of alcohol or caffeine around conception is deemed “risky” despite little evidence to suggest harm. Meanwhile, NICE is still considering proposals to record any and all alcohol consumption in pregnancy on a child’s health record, regardless of evidence of harm or whether a woman consents.
Clare Murphy, Chief Executive at the British Pregnancy Advisory Service, said:
“We have created a climate where women are expected to avoid any possible risk to their pregnancy, and even women with no pregnancy plans are now urged to modify their behaviours in case they became pregnant. Messages regularly go out to women about the dangers of particular behaviours – a cup of coffee or a glass of wine – in the absence of any good evidence of harm. Doing so is not however harmless. The challenges we are seeing with Covid vaccine uptake are an inevitable consequence of this climate. We need to really re-evaluate how we communicate risk to women in pregnancy – and ensure women’s own health needs are deemed as important – and indeed not mutually exclusive – from those of her fetus.”
Joeli Brearley, Founder and Chief Executive of Pregnant Then Screwed, said:
“Since the guidance changed back in April to say that pregnant women could have the vaccine, we have been inundated with messages from women who have been turned away at vaccine centres or given conflicting advice from medical professionals. This has resulted in the majority of pregnant women deciding not to have the vaccine at a time when they are vulnerable to severe illness from COVID-19.
“The needs of pregnant women should be considered from the outset, they should not be an afterthought, or a problem that we will get to at a later date. The neglect of pregnant women during the development of this vaccine and its delivery has undoubtedly lead to illness and in some cases, death. We must learn from this pandemic and ensure pregnant women’s needs are placed at the heart of future medical developments and their communication.”
Caitlin Dean, chairperson for Pregnancy Sickness Support, which runs a helpline for those suffering from Hyperemesis Gravidarum, said:
“Unfortunately, we are receiving a high volume of calls from women unsure about having the vaccine and many of them have been discouraged by their own healthcare professionals. Some women have called us because they say their doctor wasn’t sure if the vaccine was safe in combination with their anti-sickness medications, and so were told it is safer to wait until after the pregnancy. This is particularly worrying as women with Hyperemesis Gravidarum are more likely to be exposed through frequent hospital visits, and should they contract COVID may be more likely to suffer badly in combination with an already severe vomiting condition.”
Birthrights’ Programme Director Maria Booker, who leads on Birthrights’ Covid response, said:
“It is vital that pregnant women and birthing people have access to good quality information regarding the Covid vaccine: up-to-date, evidence-based, and clearly explained. This is the only way a meaningful choice can be made about whether the vaccine is right for them. In the longer term the Government needs to look at how it contributes to a culture where taking any hypothetical risk in pregnancy is discouraged, which now means that unvaccinated pregnant women and birthing people and their babies are at risk.”
Professor Catherine Nelson-Piercy, consultant obstetric physician at Imperial College Healthcare NHS Trust and Guy’s and St. Thomas’ Hospitals Trust, said:
“Advice about the safety of the vaccine in pregnancy has changed as we have gathered more safety data. We now know that mothers and their babies are at far higher risk from covid-19 infection than from having the covid vaccine, and this is reflected in the number of unvaccinated pregnant and recently pregnant women in intensive care units across the country.
“If you are pregnant, the best thing you can do to protect yourself and your baby is to have your COVID-19 vaccine.”
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BPAS is a charity that sees over 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception at clinics across Great Britain. It supports and advocates for reproductive choice. BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here: https://www.bpas.org/get-involved/centre-for-reproductive-research-communication/
Later in 2021, BPAS will launch England’s first not-for-profit fertility service, to provide ethical, evidence-based, person-centred care that supports patients. We will provide a safe, high-quality, and accessible service, without profiteering from patients. Our service will give those ineligible for NHS funding an affordable option to access the care they need.