Like Israel, Belgium has just included pregnant women in the populations eligible for anti-Covid vaccination.
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JACK GUEZ / AFP
Belgium has just included pregnant women in the populations eligible for anti-Covid vaccination.
In the absence of scientific data on the safety of vaccines in pregnant women, the French health authorities do not currently recommend vaccination during pregnancy.
Clinical trials should be conducted to evaluate anti-Covid vaccines in pregnant women.
Vaccinate priority populations quickly and protect them from serious forms of Covid-19: this is the government's strategy.
For the time being, it is the over 75s, caregivers and 50-64 year olds with co-morbidities who can claim anti-Covid vaccination.
Belgium has just reviewed its strategy and now recommends vaccinating pregnant women against the coronavirus.
Should France do the same and include them in the priority populations, they who are not foreseen in the French calendar?
More risk of premature birth in the event of contamination by Covid-19
"Pregnancy increases the possibility of being treated in intensive care for a Sars-CoV-2," said Dr. Frédéric Debiève, head of the obstetrics department at the Saint-Luc University Clinics, on Saturday at a press point. of the Belgian vaccination taskforce.
Due to the physiology of a pregnant woman, mechanical and invasive ventilation is often necessary ”.
The Belgian doctor is based on recent studies carried out on 4,000 pregnant women with Covid-19 in the United Kingdom and the United States, according to which these patients have "a 60% additional risk of giving birth prematurely".
In consultation, Dr Françoise Coux, obstetrician gynecologist, reassures his patients.
" We are talking about it.
In the vast majority of cases, there is no specific risk to the pregnancy and the fetus if the woman is in good health.
But it is true that in certain cases, in the event of pathologies or comorbidities such as obesity or diabetes, there may be an increased risk at the end of pregnancy, with respiratory complications, which can lead to cesarean sections or premature delivery;
in which case the patients are closely monitored ”.
"There is no reason to think that the vaccine would not be effective or that it would be dangerous," said Dr Debiève on the Belgian side.
“Vaccination prevents severe forms of Covid-19, premature deliveries as well as maternal and perinatal mortality.
In addition, the antibodies are transmitted during pregnancy and breastfeeding, which protects the baby ”, underlined the practitioner and Dr. Isabelle Dehaene, obstetrician gynecologist at the University Hospital of Ghent, calling on caregivers to recommend vaccination to patients. pregnant women or women planning to become pregnant.
No data yet on the safety of vaccines in pregnant women
A recommendation also formulated by Israel, but relatively unprecedented in view of the prescriptions issued for the moment.
In early January, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization, which reviewed the vaccine developed by Pfizer-BioNTech, recommended that it not be used in pregnant women.
"Exceptions are possible if the benefits of vaccination outweigh the potential risks of the vaccine, for example for people with other diseases or for health workers at high risk of infection," said experts from the 'WHO.
At the end of January, they issued the same recommendations for the Moderna vaccine.
A position also adopted by France.
“In the absence of robust data on the safety and efficacy of the vaccine during pregnancy, the French National Authority for Health (HAS) recalls that its use in pregnant women should be considered only if the potential benefits outweigh on the potential risks for the mother and the fetus ”, she indicated in her opinion of January 8, advising against vaccination during pregnancy and breastfeeding.
For the HAS, only women with comorbidities such as obesity or diabetes may be eligible, if their state of health so requires, and on prescription from their attending physician.
A notice renewed on February 2 on the occasion of the arrival in France of the AstraZeneca vaccine, not recommended for pregnant women and those over 65, two populations excluded from clinical trials.
Studies soon to be launched
“AstraZeneca is not currently recommended for people over 65.
But this recommendation may vary in the coming weeks depending on the data we have, ”said Dominique Le Guludec, president of the HAS in early February.
But while studies have just demonstrated the effectiveness of the British vaccine on people over 65, the HAS could as soon as this week revise its recommendations for this age group.
And if new data concerning pregnant women and the fetus were published, the HAS could, again, review its position.
What about messenger RNA vaccines from Pfizer and Moderna?
"The fact of not using viral vectors suggests that there is no risk of adverse effects for the embryo induced by the vaccine itself," says IVI, a large Spanish network of clinics specializing in the medically assisted procreation (MAP).
Thus, the only reason for not recommending vaccination for pregnant women is based solely and exclusively on the fact that no experience has yet been carried out with this population ”.
BioNTech and Pfizer announced on Feb. 18 the launch of a study to determine the efficacy and safety of the vaccine in healthy pregnant women, a group that had been excluded from the first large clinical trial.
The trial will involve 4,000 people in the United States, Canada, Argentina, Brazil, Chile, Mozambique, South Africa, United Kingdom and Spain.
For now, “there is still the risk of possible side effects, even if messenger RNA vaccines are not transmissible on the genome, comments Dr. Coux, obstetrician gynecologist.
When we assess the benefit / risk balance, there are more questions than proven benefits: we do not yet know what can happen in the long term.
On the other hand, if it is proven that the vaccine is effective and without risk for pregnant women and the fetuses, then there will be an interest to vaccinate them so that they have a quiet third trimester and without induced risk of prematurity ”.
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