Should pregnant women have a COVID vaccine? The evidence says it’s safe and effective


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Hannah Dahlen, Western Sydney UniversityHaving a baby brings enough stress and uncertainty without having to deal with a pandemic. Added to that is the difficult decision to have a recently developed vaccine or not.

Last week, pregnant women of all ages were added to Australia’s priority phase 1b of the COVID vaccine rollout. Pregnant women are now eligible for Pfizer.

But some are unclear if they should get vaccinated. Our survey (still ongoing) of 519 women who had a baby 12 months ago asked their intention to be vaccinated. We found 62% said they would, 12% wouldn’t and 26% were unsure, mainly due to fears over safety during pregnancy and breastfeeding.

Increasingly, international evidence supports the safety of COVID vaccines for pregnant women and demonstrates it is effective at preventing severe disease. Here’s what it says so far.




Read more:
Generation COVID: pregnancy, birth and postnatal life in the pandemic


What does the new advice say?

The peak medical body for Australian obstetricians and gynaecologists recently updated its advice in a joint statement with the Australian Technical Advisory Group on Immunisation (ATAGI), the government’s vaccine advisory group.

The two groups recommend:

pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy […] because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby.

There are also other benefits. During pregnancy, antibodies that pass through the umbilical cord may offer protection to the baby. We don’t know how long this protection lasts.

The statement also recommends breastfeeding women should get vaccinated. Evidence suggests antibodies pass to the baby through breastmilk and may protect the baby.

Why the change?

The main reason the advice has changed is new data from recently published studies.

A study from the United States of 827 pregnant women who had mRNA vaccines such as Pfizer, mostly in their third trimester, found no safety concerns.

The rates of miscarriage (12.6%), stillbirth (one baby), preterm birth (9.4%) small babies (3.2%) and abnormalities in the baby (2.2%) were similar to what would be expected in an unvaccinated group of women.

This study is still under way and includes nearly 4,000 pregnant women in total, many of whom were yet to give birth when this paper was published.




Read more:
Should I get the COVID-19 vaccine while pregnant or breastfeeding? Experts explain the safety, evidence and clinical trials


In July, a paper from Israel looked at 7,530 pregnant women who were vaccinated and 7,530 unvaccinated pregnant women.
Rates of COVID were higher among unvaccinated pregnant women (202) than vaccinated pregnant women (118).

Of the pregnant women who were vaccinated, 68 reported possible vaccine-related side effects, such as headache, body aches, pain at the injection site, but none were severe or prolonged or different to non-pregnant people. There was no difference in any other pregnancy outcomes.

Pregnant woman in a mask rolls up her sleeve to be vaccinated.
The research so far hasn’t detected any safety concerns.
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What about clinical trials?

The studies above looked at what was happening in real world data, rather than testing the vaccine in trials, where people don’t know if they got the vaccine or a placebo (disguised as a vaccine).

Pregnant women are often excluded from vaccine trials. This is because vaccinating pregnant women has the potential to affect both mother and baby, and testing medications on them rightly makes us nervous.

But while animal studies of COVID vaccines show no fertility or pregnancy effects, we need more than mouse models to test safety and efficacy in humans. Calls are therefore growing for pregnant women to be involved in trials.

One such trial of Pfizer involving pregnant women is currently under way but only started in February this year so data won’t be available yet.

Real world data from the UK and US

In the UK, the professional bodies for midwives, obstetricians and gynaecologists have expressed concern about the effect easing restrictions will have on pregnant women.

Around 58% of pregnant women in the UK have declined the vaccine. The main reason for declining is waiting for more evidence to reassure them it’s safe for their baby.




Read more:
Pregnant women at increased risk of severe COVID – new study


One in ten pregnant women admitted to hospital with COVID symptoms in the UK go to intensive care. These women are more likely to have a baby born early (preterm), develop high blood pressure, need a caesarean during labour and become very ill, particularly after 28 weeks.

More than 100 pregnant women have been admitted to hospital in the UK in the past couple of weeks with COVID; none had received both doses of the vaccine and five had one dose.

Hospital trolley in a corridor.
Unvaccinated pregnant women are more likely to be admitted to hospital than those who have been immunised.
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Meanwhile in the US, more than 130,000 pregnant women have received a COVID vaccine to date, and the data so far is reassuring. Side effects such as getting a sore arm or headache or feeling tired are common but don’t appear to affect the pregnancy.

What else do pregnant women need to know?

The Pfizer vaccine is recommended in Australia for pregnant women and doesn’t contain live coronavirus or additional ingredients harmful to pregnant women.

It’s now one of three vaccines offered in pregnancy, along with the whooping cough (pertussis) and influenza vaccines.




Read more:
Vaccines to expect when you’re expecting, and why


Pregnant women are higher risk of becoming very unwell with COVID-19 if they:

  • have underlying medical issues such as high blood pressure, diabetes, asthma, heart disease, immune problems
  • are overweight
  • are over 35 years of age
  • in their final trimester.

So getting vaccinated before 28 weeks will offer protection for mother and baby in the riskiest time.

If you are pregnant, keep in mind no vaccine is 100% effective, so it’s important to continue social distancing, wearing masks when needed, and keeping up good hand hygiene.

The decision to get vaccinated as a pregnant woman is not an easy one. The decision should be the woman’s and that decision should be informed and free of pressure or misinformation.The Conversation

Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Research now backs routinely offering pregnant women the mRNA COVID-19 vaccine


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Michelle Wise, University of AucklandNew Zealand and Australia will now routinely offer the Pfizer COVID-19 vaccine to women at any stage of pregnancy, following an update of vaccination advice.

This comes as research suggests the risk of severe outcomes from infection is significantly higher for pregnant women compared to the general population. At the same time, data from pregnant women who have already been vaccinated around the world have shown no safety concerns associated with COVID-19 vaccines.

Vaccination during pregnancy may also protect the baby. Research has identified antibodies in cord blood and breast milk, suggesting temporary protection (passive immunity) for babies before and after birth.

This is similar to influenza and whooping cough vaccines given during pregnancy to protect pēpi. There are no safety concerns for breastfeeding women receiving a COVID-19 vaccine, and women trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination.

Prioritising pregnant women

When the New Zealand government announced its vaccine rollout plan in March, pregnant women were designated as a priority in the third group, which includes 1.7 million people who are at higher risk if they catch COVID-19.

This decision reflected the available information at the time from international research showing pregnant women with COVID-19 were more likely to be hospitalised and admitted to intensive care, compared to the rest of the population.

Breastfeeding baby
Vaccinating women during pregnancy is likely to provide temporary protection for babies as well.
Shutterstock/Natalia Deriabina



Read more:
COVID-19 vaccines are highly effective for pregnant women and their babies – new study


The higher risk of hospitalisation is similar to other priority populations, including people aged 65 and over, and those with underlying health conditions or disabilities. People in these groups are also more likely to get very sick if they get COVID-19.

New Zealand’s decision was part of a principled strategy that aims to provide fair and equitable care based on scientific evidence, acknowledging research that places pregnant women in a high-risk group if they were to be infected.

Changing advice to pregnant women

Initial advice from the Immunisation Advisory Centre was that women could receive the vaccine at any time during pregnancy, but for those at low risk of exposure, they recommended delaying vaccination until after birth.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published similar early advice, stating that women could choose to have the vaccine at any stage of pregnancy, particularly if they were in a high-risk population. But they did not recommend routine universal vaccination if levels of community transmission were low.

So what has changed since March? It became urgent to review the early advice as local vaccination centres have started vaccinating people in the third group of the rollout. Also, travel bubbles with Australia and the Cook Islands meant people were possibly more exposed to transmission.

The early advice in New Zealand and Australia was also diverging from other countries, such as Canada. And more research is coming out about the risks of COVID-19 infection in pregnancy, while international experience with mRNA-based vaccines (such as Pfizer-BioNTech) in pregnant women is growing.




Read more:
COVID-19 and pregnancy: what we know about what happens to your immune system


Pregnant women were not included in the original clinical trials to test COVID-19 vaccines for safety. But there is no evidence of any harm associated with the vaccine during pregnancy.

Vaccine trials in the US are now actively recruiting pregnant women. We can expect research results by the end of this year. In the meantime, we can be reassured by registries, which are studies that track women who have had the vaccine during pregnancy and have given consent to have information collected about them and their babies.

Researchers in the US found women who received the vaccine during pregnancy had outcomes similar to background rates for the mother (regarding rates of miscarriage, diabetes, high blood pressure) and the baby.

Side effects from receiving the vaccine were also the same in pregnant and non-pregnant women, and it is safe to take paracetamol as needed to manage these.

Other countries, including the UK, have published decision aids to help with this important decision. I encourage professional groups to create one for New Zealand women planning or going through pregnancy.

Research supports routinely offering the vaccine to pregnant women, and it is up to individuals to decide whether to receive it or not, as part of a shared decision-making process with their midwife or doctor.The Conversation

Michelle Wise, Senior Lecturer, Department of Obstetrics and Gynaecology, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should I get a COVID vaccine while I’m pregnant or breastfeeding? Is it safe for me and my baby?



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Nina Jane Chad, University of Sydney and Karleen Gribble, Western Sydney University

From Monday, Australia’s front-line health workers, quarantine staff, border control officers, and workers and residents in aged-care homes will be offered the Pfizer COVID-19 vaccine.

Some of these workers will be women who are pregnant, planning a pregnancy, and/or breastfeeding.

So they may be concerned about whether the vaccine is safe for themselves and their babies.

What issues do these women need to consider?

Remind me again, which vaccine?

Australia’s drug regulator, the Therapeutic Goods Administration (TGA), has approved two vaccines. Pfizer’s vaccine has been approved for people aged 16 years and older; the AstraZeneca vaccine for people aged 18 and older.

Although neither approval excludes women who are pregnant or breastfeeding, the TGA recommends their use in pregnancy be based on an assessment of whether the benefits of vaccination outweigh the potential risks.

The federal health department has issued a decision guide to help women who are pregnant, breastfeeding, or planning pregnancy assess whether the benefits of having the Pfizer vaccine outweigh the risks.




Read more:
How mRNA vaccines from Pfizer and Moderna work, why they’re a breakthrough and why they need to be kept so cold


Should I get vaccinated if I’m breastfeeding?

Major health authorities worldwide agree it’s safe to breastfeed after getting a COVID-19 vaccine. The Australian health department says it has no concerns about the safety of the Pfizer vaccine for breastfeeding women or their babies.

Although no studies have specifically investigated whether COVID-19 vaccines get into breastmilk, the baby’s stomach acid would destroy them if they did.

Antibodies against the virus have been detected in the milk of mothers who have been infected with COVID-19. So, if the antibodies the vaccine triggers also pass into breastmilk, getting vaccinated while you’re breastfeeding may even help to protect your baby against COVID-19. Antibodies in breastmilk are widely known to help protect infants against a wide range of infections.

Woman breastfeeding newborn baby
Even if the vaccine passed into your breastmilk, it would be destroyed by the acid in your baby’s stomach.
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How about if I’m pregnant?

The Australian health department is encouraging women who are pregnant and at high risk of catching COVID-19, or who have medical conditions that make them more vulnerable to severe COVID-19 disease, to consider getting vaccinated.

The World Health Organization is even clearer in recommending women who are pregnant to be vaccinated if they are at high risk of catching COVID-19 or of developing severe COVID-19 disease.




Read more:
Pregnant in a pandemic? If you’re stressed, there’s help


While it might seem safer to wait until you’re no longer pregnant to be vaccinated, that may be riskier. Pregnant women are more likely to get severe COVID-19 than other infected women, and are slightly more likely to give birth prematurely if they have COVID-19.

So vaccination is important, especially if you are a front-line health, aged-care, or quarantine worker.




Read more:
It’s crucial we address COVID vaccine hesitancy among health workers. Here’s where to start


Are the vaccines safe for pregnant women and their babies?

Almost all vaccines are safe during pregnancy and some are recommended to protect women and their babies from infectious disease. Even those that are not generally recommended can be given to pregnant women in certain circumstances, for instance when it would be safer to have the vaccine than to be exposed to infectious disease without the protection vaccination provides.

COVID-19 vaccines cannot cause coronavirus infection because they do not contain the virus that causes it.

The active ingredient in the Pfizer vaccine is mRNA, a tiny fragment of genetic material (messenger ribonucleic acid) that triggers our own cells to produce a spike protein similar to the one on the surface of the coronavirus. This triggers an immune response that destroys the spike protein and teaches our bodies to recognise the virus that causes COVID-19. mRNA is very fragile, so it is destroyed in our bodies very quickly.

While we are still gathering more information about the use of COVID vaccines in women who are pregnant, there are some encouraging signs. About 20,000 pregnant women in the United States alone have been vaccinated and there have been “no red flags” around safety.




Read more:
COVID vaccines have been developed in record time. But how will we know they’re safe?


What about women in other jobs?

Women who are not working in front-line health, aged care, border protection or hotel quarantine will not be offered COVID-19 vaccination for some time yet.

Fortunately, in Australia it is very unlikely for someone who is not a front-line worker to be exposed to COVID-19 because there are so few cases in the community.

By the time vaccination is offered to healthy women who are not in high-risk occupations, many hundreds of thousands of pregnant women will have been vaccinated worldwide, giving us more information on which to base our recommendations.

So, why the controversy?

Researchers did not include women who were pregnant or breastfeeding in COVID-19 vaccine research. So when the first vaccines were offered to health workers in the United Kingdom, for instance, health authorities did not recommend vaccinating women who were pregnant or breastfeeding.

While this may have been motivated by a desire to protect them, it had the opposite effect. UK women in jobs that placed them at high risk of contracting COVID-19, were left without the protection offered by vaccination. Some women stopped breastfeeding. Others felt it meant choosing between working while unvaccinated and not working at all. Recommendations in the UK have since changed, and pregnant or breastfeeding women in high-risk occupations are now offered vaccination, just as they will be here.

In Australia, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) says that, although there is no evidence COVID-19 vaccines could cause harm when given to women in pregnancy, there is insufficient evidence to recommend Australian pregnant woman routinely get vaccinated. This recommendation may change if the number of COVID-19 cases increases in Australia.

However, RANZCOG does recommend that women with particular underlying medical conditions discuss the pros and cons with their health-care provider. It also suggests pregnant women working in high-risk environments be offered alternative duties that reduce their chance of exposure to the virus.




Read more:
Can my boss make me get a COVID vaccination? Yes, but it depends on the job


So what do we make of all this?

From what we know so far, breastfeeding women can be vaccinated without risk to their babies. And the World Health Organization says vaccination is safer for pregnant women who work in places where they are at high risk of exposure to COVID-19 than not getting vaccinated.

Women who are not working in high-risk occupations, whose risk of exposure is low because community transmission is low, will not be offered vaccination for some time. By the time it’s their turn, health authorities should be able to make clearer recommendations.The Conversation

Nina Jane Chad, Infant Feeding Consultant, World Health Organization; Research Fellow, University of Sydney School of Public Health, University of Sydney and Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pregnant in a pandemic? If you’re stressed, there’s help



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Monique Robinson, Telethon Kids Institute

If you’re pregnant during the COVID-19 pandemic, you might be feeling a unique type of stress.

You might be uncertain about how an infection could affect your unborn baby. That’s over and above the stress you might be feeling about the pregnancy itself, and its impact on your relationship, job or lifestyle.

But there’s professional support to help you manage these stresses. And there’s lots you can do at home to ease your worries.




Read more:
Coronavirus while pregnant or giving birth: here’s what you need to know


How will the coronavirus affect my unborn baby?

One of the first studies to look at the effect of coronavirus infection while pregnant found the health of unborn babies or newborns of women infected in their final trimester did not differ to those expected with uninfected pregnancies.

But this small study, from Wuhan in China, was rushed to publication and didn’t look at infection earlier in pregnancy.

A review of 41 pregnancies complicated by COVID-19, as well as another 38 complicated by other coronaviruses (SARS, severe acute respiratory syndrome and MERS, Middle East respiratory syndrome) gave us more information.

It found a small but significant increase in preterm birth (before 37 weeks’ gestation) in COVID-19 pregnancies.

However, the researchers couldn’t differentiate between spontaneous preterm birth and babies who were induced to arrive before 37 weeks.

So far, the evidence of harm to you or your unborn baby is limited, and should not cause concern.

Pregnancy can be stressful anyway

Separate to the fear of being infected with COVID-19 is the fear and stress related to simply living through the pandemic while pregnant.

Pregnancy can often be stressful as lifestyle, relationship and income changes create challenges for families.

Pregnancy can be stressful at the best of times.
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Worries about the baby’s health are present in any pregnancy, but adding concerns of what infection would mean for the unborn child can exacerbate feelings of anxiety.

Before the pandemic, about 20% of women had a clinical anxiety disorder (for example, generalised anxiety, specific phobia) while pregnant.

We now have some early indicators of how the COVID-19 pandemic is affecting that statistic.




Read more:
Health Check: can stress during pregnancy harm my baby?


And when you add the pandemic into the mix

Canadian researchers surveyed nearly 2,000 pregnant women in April 2020 (in research yet to be peer-reviewed). They found 57% of pregnant women showed anxiety symptoms but 68% reported an increase in pregnancy-specific anxiety.

Only one of the 1,987 participants had a confirmed case of COVID-19, with another 25 cases suspected but not confirmed. So, for most participants, just being pregnant during the pandemic (without being infected) led to three times as many women being anxious during the pandemic than before it.




Read more:
Coronavirus with a baby: what you need to know to prepare and respond


Pregnant women are also concerned about how the pandemic will affect their maternity care, including who can visit them in hospital and after the birth of their baby.

A review of pregnancy stress during previous infectious disease outbreaks, including SARS, MERS, Ebola and Zika, found that as well as feeling vulnerable, pregnant women were anxious about disruption to pre- and postnatal care, and exposure to treatments not fully tested in pregnancy.

We can’t avoid stress, but we can manage it

We know stress during pregnancy has been linked to a range of poor outcomes for the child, such as pre-term birth, being more susceptible to disease, and behavioural problems through childhood.

Post-traumatic stress symptoms in pregnant women following the September 11 attacks and various natural disasters have significantly affected both emotional and cognitive development in children later in childhood.

But there is good news. While we cannot avoid the stress that comes with the COVID-19 pandemic, we can manage it.




Read more:
Coronavirus is stressful. Here are some ways to cope with the anxiety


In fact, it’s not necessarily the stressful event itself that can lead to poor outcomes. It’s how a pregnant woman assesses the stress of the event and how she chooses to move forward that might determine what happens to her child.

So, if we can manage our stress and not let it overwhelm us, we may be able to avoid the negative consequences of stress in pregnancy with benefits right through our children’s lives.

Here’s what you can do

Social support is key for managing stress, but social distancing makes it harder to gather with the friends and loved ones who might typically provide that support.

Still, there are many online pregnancy support and birth groups targeted to particular stages of pregnancy. These could provide reassurance and a sense of belonging while the outside world looks different.

You can still exercise outside. But if you prefer to exercise at home, there are many online pregnancy yoga and pilates classes.

Yoga and pilates classes for pregnant women are available online.
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You can practise guided relaxation and meditation with an app. And if you can work from home, this might give you some much-needed flexibility.

You can also use local, evidence-based telehealth to access mental health care. There are also many free, online programs providing self-guided mental health support.

As long as the COVID-19 pandemic is here, with its accompanying uncertainty, we can best focus on limiting the long-term effects of stress on our mothers, babies and families.The Conversation

Monique Robinson, NHMRC Early Career Fellow, Telethon Kids Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Is it OK to drink coffee while pregnant? We asked 5 experts



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Tessa Ogle, The Conversation

There are so many dos and don’ts associated with pregnancy it can be hard to keep up with them. Coffee is an everyday staple for many people, so it is not surprising women seek reassurance this stimulant is safe during pregnancy.

With guidelines differing between and within countries it can be tricky to assess the risks of having a coffee or two.

We asked five experts whether it’s OK to drink coffee while pregnant.

Four out of five experts said yes

But they all had a pretty big caveat. It’s safe provided it’s consumed in moderation.

It’s also important to remember things like tea, chocolate and energy drinks also contain caffeine, so you’ll need to take that into account when estimating your daily intake.

Here are the experts’ detailed responses:


If you have a “yes or no” health question you’d like posed to Five Experts, email your suggestion to: tessa.ogle@theconversation.edu.auThe Conversation


Tessa Ogle, Assistant Editor, Health + Medicine & Editorial Assistant, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus while pregnant or giving birth: here’s what you need to know




Hannah Dahlen, Western Sydney University and David Ellwood, Griffith University

Having a baby is stressful enough without a coronavirus (COVID-19) pandemic and all the associated misinformation.

If you’re pregnant and/or due to give birth soon, it’s best to get information from trusted sources such as the World Health Organisation, the Royal College of Obstetricians and the Australian Government Department of Health.

Here are the key take-home messages.

It’s a new virus

As COVID-19 is a new virus, we are learning more about it every day. As most pregnant women are young and generally healthy, they’re less likely to be severely affected (which is good news). But as there is also a baby to consider, the picture can be more complex.

A baby born recently to a mother in the UK with COVID-19 recently tested positive soon after birth but we are not sure whether it was infected in the womb (unlikely) or after birth (more likely).

As far as we know, the baby is fine and the mother is being treated. Other reports on babies with COVID-19 have also shown they had mild symptoms and a good recovery.




Read more:
Coronavirus with a baby: what you need to know to prepare and respond


From China’s experience to WHO advice

To date, much of our information on COVID-19 has come from China. This is where one of the first studies, involving just nine pregnant women with COVID-19, came from.

All these women had caesarean sections, none were seriously unwell and all mothers and babies recovered. The study found none of the babies appeared to get COVID-19 and there was no evidence of the virus in the baby, breastmilk or fluid surrounding the baby. It’s not clear why these babies were born by caesarean section. China has a very high caesarean section rate, which is not optimal, and this may have influenced how they responded.

The World Health Organisation’s new guidelines state:

there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester … WHO recommends that caesarean section should ideally be undertaken only when medically justified

Why pregnant women are not more susceptible to COVID-19

Pregnant women are generally more susceptible to viruses that cause breathing problems (like the flu). Their immunity is lowered, their lungs are more compressed and they need more oxygen.

However, this doesn’t seem to be the case with COVID-19. In an analysis of 147 women with COVID-19, only 8% had severe disease and 1% were in critical condition. That’s lower than the general population.

The lowered immune response of pregnancy, which is needed to stop a woman’s body responding to her baby as a health threat, may actually provide extra protection with COVID-19. COVID-19 seems to be more severe in people with an immune system working hard dealing with other health disorders.

With COVID-19, more men than women are affected and women are less likely to get severely ill and die. To date, the death rate is 1.7% for women and 2.8% for men.

However, as the pandemic spreads this may change. Women comprise the majority of the health workforce and caregivers will be in contact with more sick people.

Sneeze or cough into your elbow to reduce the spread of germs.
Shutterstock

How can pregnant women protect themselves and others?

Pregnant women should do the same things as the general public to protect themselves, including:

  • covering the mouth when coughing (by coughing into the crook of your elbow)
  • avoiding people who are sick
  • asking people who are unwell to avoid visiting
  • washing hands often with soap and water or an alcohol-based sanitizer and
  • avoiding large gatherings.

It would be sensible not to travel overseas at the moment; you may have to self-isolate when you return.

Women who think they may have contracted COVID-19 can now consult their GP or other health professional with a bulk billed telehealth call (video call) rather than having to go in person.

Women who are pregnant or have new babies are given priority for telehealth services.

If you have been asked to self-isolate due to contact with someone with COVID-19, or have the illness, make sure you contact your midwife or obstetrician by phone and follow the advice of your health care provider.

What about going to hospital for antenatal visits and birth?

Keep going to appointments but don’t stress if you miss a couple, and early discharge might be a good idea if you’re able.

If you are booked into a birth centre or hospital, lots of precautions are in place to minimise the risk of infection. Birth will proceed as planned in the vast majority of cases and going home early would be ideal and may be encouraged if you and your baby are well.

Be aware some hospitals are restricting visitors and even support people, other than the partner, to try and reduce risk to the community.

Can the baby be infected with COVID-19 in the uterus?

The placenta is a very efficient filtering system and does an amazing job protecting babies from harm. The Zika virus was an exception to this.

There is no evidence of increased complications, though if a woman was very unwell (with high temperature or pneumonia, for instance) then the baby may be born prematurely.

This may be due to deliberate intervention by health professionals if the woman is very sick.

In general, though, a COVID-19 diagnosis should not lead to a decision for an early birth, unless ending the pregnancy is thought to be beneficial to the mother due to her overall condition.

There is not enough evidence that COVID-19 increases miscarriage and it is too early to know other longer-term impacts on the baby.

What should I do after the birth?

The benefits of breastfeeding are so significant the WHO recommends this should begin within an hour of birth. Skin-to-skin contact should be supported immediately following birth if the baby is well.

Skin-to-skin contact should be supported immediately following birth if the baby is well.
Shutterstock

If the mother is too ill, she should be assisted to express her milk. Breastfeeding is particularly effective against infectious diseases because it transfers antibodies and other important immune factors to the baby. If the woman or the baby have an infection, the composition of breastmilk even changes to increase important components that help the baby fight infection. So, if you were thinking of giving up breastfeeding, perhaps continue until this pandemic ends.

WHO recommends women who have COVID-19 should wash their hands before and after contact with the baby, use a medical mask when near the baby if they have symptoms (such as coughing), and routinely clean and disinfect surfaces they may have touched.

What else can you do?

When the seasonal flu vaccine becomes available, get vaccinated. We know this can be protective during pregnancy. It is free for pregnant women and there are no risks to your baby from flu vaccine. You will not be protected from COVID-19 but you will get some protection from the flu (which can be very problematic for pregnant women). The last thing you want is to have the flu and COVID-19 at the same time.

Free flu vaccinations will be available from GPs mid-April but if women want them earlier, they can get them for a fee at the pharmacy from end of March.

Most of all, try and stay calm and talk to your midwife or doctor if you are getting very worried.




Read more:
Coronavirus: 5 ways to manage your news consumption in times of crisis


The Conversation


Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney University and David Ellwood, Professor of Obstetrics & Gynaecology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pregnant women should take extra care to minimise their exposure to bushfire smoke



Pregnant women should try to stay inside when the air pollution is high.
From shutterstock.com

Sarah Robertson, University of Adelaide and Louise Hull, University of Adelaide

Smoke haze from Australia’s catastrophic bushfires is continuing to affect many parts of the country.

Although there’s no safe level of air pollution, the health hazards tend to be greatest for vulnerable groups. Alongside people with pre-existing conditions, smoke exposure presents unique risks for pregnant women.

Research shows prolonged exposure to bushfire smoke increases the risk of pregnancy complications including high blood pressure, gestational diabetes, low birth weight and premature birth (before 37 weeks).

These conditions can have short-term and lifelong effects on a baby’s health, with increased risk of conditions including cerebral palsy and visual or hearing impairment. Even babies born only a few weeks early can experience learning difficulties and behavioural problems, and have an elevated risk of heart disease in later life.

So it’s especially important pregnant women protect themselves from exposure to bushfire smoke.




Read more:
How does poor air quality from bushfire smoke affect our health?


Why are pregnant women at higher risk?

Pregnant women breathe at an increased rate, and their hearts need to work harder than those of non-pregnant people to transport oxygen to the fetus. This makes them particularly vulnerable to the effects of air pollution, including bushfire smoke.

We often measure poor air quality by the presence of ultra-fine particles called PM2.5 (small particles of less than 2.5 micrometres in size). These particles are concerning because they can penetrate into our lungs, and into blood and tissue to cause inflammation throughout the body.

Importantly in pregnant women, environmental pollutants can cause inflammatory damage to the placenta’s blood supply. This can interfere with the placenta’s development and function, which can in turn compromise the growth of the fetus.

What the evidence says

Many studies have linked poor air quality, particularly high PM2.5 levels, to poor pregnancy outcomes. Data from 183 countries showed in 2010, an estimated 2.7 million premature births, 18% of the total, were associated with PM2.5 pollution.

A 2019 study of more than 500,000 pregnant women from Colorado looked at the effect of bushfire smoke on pregnancy outcomes. The authors analysed data on air quality, fire incidence and pregnancy and birth records from 2007-2015, during which time Colorado was regularly affected by smoke from fires burning in California and the Pacific Northwest.

The study found PM2.5 due to bushfire smoke was linked to spikes in premature birth, especially in women exposed during the second trimester.

In women exposed to smoke during the first trimester, birth weight was lower than average. Further, exposure during any trimester increased the chance of gestational diabetes and high blood pressure.

The effects were detectable even with low exposure to smoke and small increases in PM2.5. For every 1 microgram/m³ increase in average daily exposure to PM2.5 during the second trimester of pregnancy, the risk of premature birth increased by 13%.

To put this into context, in Canberra in the first week of January, PM2.5 levels averaged more than 200 micrograms/m³, compared with the typical background concentration of 5 micrograms/m³. EPA Victoria classifies PM2.5 levels above 25 micrograms/m³ as unsafe for vulnerable people.




Read more:
Evacuating with a baby? Here’s what to put in your emergency kit


In another large study, a 24% increase in premature birth was seen after 10 micrograms/m³ increase in PM2.5.

As well as PM2.5, bushfire smoke contains larger PM10 particles, nitric oxides, carbon monoxide and other gases and toxic chemicals. These all have potential to impair lung and heart function in the mother, activate inflammation, and directly affect fetal and placental development.

Smoke threatens fertility, too

Air quality is also a factor for couples attempting to conceive or dealing with infertility.

Population studies suggest air pollution compromises human fertility by reducing ovarian reserve (the number of eggs in the ovary) and affecting sperm number and movement.

Direct exposure to fire, burns and fire retardant chemicals can also negatively impact fertility.




Read more:
How to monitor the bushfires raging across Australia


Precautions to take if you’re pregnant

The best strategy is to reduce smoke exposure as much as possible. Recommendations from NSW Health include staying inside on high-risk days, sealing the house to prevent smoke infiltration and using air conditioning to keep cool.

Avoid creating smoke by cigarette smoking, burning candles, or frying and grilling. Use PM2 (N95) masks and air-filtering devices if possible, and avoid exposure to ash, which contains particulate material you can inhale.

Studies have shown when women are exposed to bushfire smoke during pregnancy, the rates of premature birth increase.
From shutterstock.com

Pregnant women in a fire region should carefully follow emergency services’ direction. It’s better to evacuate early, with an emergency supply kit containing clothes, medications, water and food you don’t need to cook.

Make sure your medication and prenatal vitamins are accessible, continue to take them, and stay well hydrated. Inform authorities and shelters you are pregnant and need to maintain your antenatal care.

Be aware of the signs of premature labour including abdominal cramps or contractions, a heavy vaginal discharge, loss of fluid or vaginal bleeding, pelvic pressure and low backache. Seek help if you think you may be going into labour.

Given what we know about the consequences of poor air quality on pregnancy outcomes, it’s critical pregnant women are given top priority when it comes to bushfire relief and health care support.




Read more:
From face masks to air purifiers: what actually works to protect us from bushfire smoke?


The Conversation


Sarah Robertson, Professor and Director, Robinson Research Institute, University of Adelaide and Louise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Latest Persecution News – 26 May 2012


Pakistani Muslims Rape Girl, Beat Relatives for Prosecuting

The following article reports on the latest news of persecution in Pakistan, where a 13-year-old girl has been raped and a pregnant woman beaten.

http://www.compassdirect.org/english/country/pakistan/article_1544207.html

 

The articles linked to above are by Compass Direct News and  relate to persecution of Christians around the world. Please keep in mind that the definition of ‘Christian’ used by Compass Direct News is inclusive of some that would not be included in a definition of Christian that I would use or would be used by other Reformed Christians. The articles do however present an indication of persecution being faced by Christians around the world.

Vietnam stepping up religious rights abuses, experts say


Government-perpetrated violence against a Catholic village in Vietnam has highlighted a series of human rights abuses in the communist nation, and three U.S. congressmen are calling on the United Nations to intervene, reports Baptist Press.

"A few months ago during a religious funeral procession, Vietnamese authorities and riot police disrupted that sad and solemn occasion, shooting tear gas and rubber bullets into the crowd, beating mourners with batons and electric rods," Rep. Chris Smith, R.-N.J., said at a hearing of the Tom Lantos Human Rights Commission in August.

"More than 100 were injured, dozens were arrested and several remain in custody and have reportedly been severely beaten and tortured. At least two innocent people have been murdered by the Vietnamese police," Smith said.

The Con Dau tragedy, Smith said, "is unfortunately not an isolated incident." Property disputes between the government and the Catholic church continue to lead to harassment, property destruction and violence, Smith said, referring to a report by the U.S. Commission on International Religious Freedom.

"In recent years, the Vietnamese government has stepped up its persecution of Catholic believers, bulldozing churches, dismantling crucifixes and wreaking havoc on peaceful prayer vigils," Smith said.

Persecution is not limited to Catholics, though, as Smith had a list of nearly 300 Montagnard political and religious prisoners. In January, the Vietnamese government sentenced two Montagnard Christians to 9 and 12 years imprisonment for organizing a house church, and others have been arrested in connection with house churches, Smith said.

"The arrests were accompanied by beatings and torture by electroshock devices," the congressman said. "We must not forget the sufferings of Khmer Krom Buddhists, Cao Dai, Hoa Hao, the Unified Buddhist Church of Vietnam and others. The said reality is that the Vietnamese government persecutes any religious group that does not submit to government control."

The violence in the 80-year-old Catholic village of Con Dau in central Vietnam reportedly stemmed from a government directive for residents to abandon the village to make way for the construction of a resort.

International Christian Concern, a Washington-based watchdog group, reported that when Con Dau residents refused to leave, water irrigation was shut off to their rice fields, stopping the main source of income and food.

In May, police attacked the funeral procession, beating more than 60 people, including a pregnant woman who was struck in the stomach until she had a miscarriage, ICC said.

One of the funeral procession leaders later was confronted by police in his home, where they beat him for about four hours and then released him. He died the next day, ICC said. Eight people remain in police custody and are awaiting trial.

"The people of Con Dau are living in desperate fear and confusion," Thang Nguyen, executive director of an organization representing Con Dau victims, told ICC. "Hundreds of residents have been fined, and many have escaped to Thailand."

Smith, along with Rep. Joseph Cao, R.-La., and Frank Wolf, R.-Va., introduced a House resolution in July calling for the United Nations to appoint a special investigator to probe "ongoing and serious human rights violations in Vietnam." In August, the Lantos Commission met in emergency session to address the "brutal murders and systematic treatment of Catholics in Con Dau."

"The Vietnamese government justifies this violence, torture and murder because the villagers of Con Dau had previously been ordered, some through coercion, to leave their village, property, church, century-old cemetery, their religious heritage, and to forgo equitable compensation in order to make way for a new ‘green’ resort," Smith said at the hearing. "Nothing, however, not even governmental orders, grant license for government-sanctioned murder and other human rights abuses."

The U.S. Department of State declined to testify before the Lantos Commission, and the U.S. ambassador to Vietnam characterized the Con Dau incident as a land dispute and refused to get involved.

Logan Maurer, a spokesman for International Christian Concern, told Baptist Press he has publicized about 10 different incidents of persecution in Vietnam during the past few months.

"In some cases, especially in Southeast Asia, religious persecution becomes a gray area. We also work extensively in Burma, where often there are mixed motives for why a particular village is attacked," Maurer said. "Is it because they’re Christian? Well, partially. Is it because they’re an ethnic minority? Partially.

"So I think the same thing happens in Vietnam where you have a whole village that’s Catholic. One hundred percent of it was Catholic," he said of Con Dau.

Maurer explained that local government officials in Vietnam generally align Christianity with the western world and democracy, which is still seen as an enemy in Vietnam on a local level.

"As far as the official government Vietnamese position, that’s different, but local government officials do not take kindly to Christians and never have. We have documented many cases of government officials saying Christianity is the enemy. So here it’s mixed motives as best we can figure out," Maurer said.

"They wanted to build a resort there, and they could have picked a different village but they chose the one on purpose that was Catholic because it represents multiple minorities — minority religion, minority also in terms of people that can’t fight back. If they go seek government help, the government is not going to help them."

A Christian volunteer who has visited Vietnam five times in the past decade told Baptist Press the Con Dau incident illustrates the way the Vietnamese government responds to any kind of dissent.

"In our country, and in modern democracies, there are methods for resolving disputes with the government, taking them to court, trying to work through the mediation process," the volunteer, who did not want to be identified, said. "In Vietnam there is no such thing. It is the government’s will or there will be violence."

Vietnam’s constitution includes a provision for religious liberty, but the volunteer said that only goes as far as the communal will of the people, which is monopolized by the Communist Party.

"So when the Communist Party says you can’t build a church there or you can’t worship this way, those who say, ‘Well, I have religious freedom,’ are essentially trumped by the constitution that says it’s the will of the people, not individual liberty that’s important," the volunteer said.

The government in Vietnam has made efforts during the past 15 years to open up the country to economic development, and with that has come an influx of some western values and a lot of Christians doing work there, the volunteer said.

"I would first caution Christians to still be careful when they’re there working," he said, adding that government officials closely watch Christians who visit from other countries, and books about Jesus cause trouble.

Secondly, the volunteer warned that all news emerging from Vietnam must be tested for accuracy on both sides because both those who are persecuting and those who are sounding the alarm on persecution have their own political goals.

"That being said, I don’t doubt that this happened," the volunteer said regarding Con Dau.

International Christian Concern urges Americans to contact the Vietnamese Embassy in Washington at 202-861-0737, and the Christian volunteer said people can contact the U.S. Commission on International Religious Freedom to encourage changes in Vietnam.

"They can also directly e-mail the ambassador and the consular general in Ho Chi Minh City and encourage them to push for more reform," he said. "And they can contact companies that are having products made in Vietnam and encourage the business leaders to speak out for change in those countries. You go to JC Penney today in the men’s department and pick up almost anything, it’s made in Vietnam. That’s the kind of pressure they could put on them."

Report from the Christian Telegraph