Situation in Switzerland
Update for the week of September 13, 2021
The FOPH updated its recommendations this week regarding COVID-19 mRNA vaccination for pregnant women. Vaccination is now recommended for all pregnant women starting in the second trimester. It is possible during the first trimester and can be administered at the patient’s request. The patient’s written consent, as well as a doctor’s prescription, are no longer required.
More information here.
Situation prior to September 13, 2021
Since our last article on this topic in May 2021, recommendations for vaccination during pregnancy and breastfeeding have evolved cautiously in Switzerland. While vaccination remains recommended starting in the second trimester for pregnant women at risk (women with chronic conditions or at high risk of exposure), it is now available to all women who wish to receive it. Vaccination during the first trimester of pregnancy is not recommended in Switzerland, and the patient’s written consent—following an informational consultation with the gynecologist and/or family physician—remains required. (FOPH, as of July 21, 2021)1
Global Situation
Medical societies in our neighboring countries and across the Atlantic are taking a stronger stance in favor of vaccination during pregnancy. As we face a fourth wave, which is expected to be particularly severe for unvaccinated young people, pregnant women represent a particularly vulnerable population. In fact, they not only have a higher risk of becoming infected with SARS-CoV-2 but also of developing a severe form of the disease.2,3 Consequently, many experts strongly recommend vaccination for all pregnant women, starting now, at any stage of pregnancy. Our French neighbors encourage vaccination as early as possible—now possible as early as the first trimester—so that pregnant women are protected by the second trimester. (video link).
Our Take
Recommendations vary by country, and this is causing significant confusion among our patients, who remain hesitant to get vaccinated during pregnancy and while breastfeeding. As we face the emergence of more virulent variants, we believe it is urgent to adapt our recommendations and convey clear messages to both our patients and healthcare professionals. Recently published data on mRNA vaccines during pregnancy show, once again, no increase in the rate of miscarriages, preterm birth, or obstetric complications.4,5,6 At the same time, studies confirm that severe SARS-CoV-2 infection during pregnancy increases the risk of preterm birth and neonatal complications.7,8 Therefore, we must continue to actively inform our patients about the potential risk of a COVID-19 infection to their health and that of their fetus, and offer all of them the option to receive the vaccine, which they may choose to accept.
Dr. med., MSc Agnès Ditisheim, PD Dr. med. Nicole Jastrow Meyer, Dr. Romaine Robyr
References
1. https://www.bag.admin.ch/dam/bag/fr/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/impfempfehlung-covid -19.pdf. download.pdf/Recommendations%20for%20Vaccination%20with%20mRNA%20Vaccines%20against%20COVID-19.pdf
2. Lokken EM et al., AJOG 2021, doi: 10.1016/j.ajog.2021.02.011. Epub 2021 Feb 16.
3. Allotey J et al. BMJ 2020, doi: 10.1136/bmj.m3320
4. Blakeway H et al. AJOG 2021, DOI:https://doi.org/10.1016/j.ajog.2021.08.007
5. Trostle ME et al. AJOG MFM 2021, https://doi.org/10.1016/j.ajogmf.2021.100464
6. Shimabukuro TT et al. N Engl J Med 2021;384:2273-82. DOI:10.1056/NEJMoa2104983
7. Ciapponi A. et al., PLoS One 2021, DOI: 10.1371/journal.pone.0253974
8. Chinn J, et al. JAMA Netw Open. Aug 2, 2021;4(8):e2120456. doi: 10.1001/jamanetworkopen.2021.20456.
Video link