COVID-19 vaccination advice further improved for women who are pregnant or planning to become pregnant

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As studies continue to find no adverse reproductive or pregnancy effects from the COVID-19 vaccination, agencies and investigators have stepped up their recommendations in its favor.

In August, the U.S. Centers for Disease Control and Prevention (CDC) improved their COVID-19 vaccine advice for women who are or may wish to be pregnant. (1) The update had two axes: any known or potential risk of vaccination during pregnancy ”; and second, that pregnant and recently pregnant women are at higher risk of serious illness from COVID-19 than non-pregnant women. The CDC also reaffirms the vaccine safety record and reiterates reports that antibodies have been found in umbilical cord blood and breast milk – which the CDC says may “help protect their babies.” ( 2,3) As noted in a recent FoR report, other agencies, including the Royal College of Obstetricians and Gynecologists UK, have also improved their vaccination advice during pregnancy. (4)

Exploring the epidemic of vaccine myths involving COVID-19 and pregnancy, Scientific American magazine sought expert advice and questioned the widely reported fake news (apparently German in origin in a message to l European Medicines Agency, EMA) that the vaccine could cause infertility in women. (5) The mechanism speculated was the presumed similarity between the SARS-CoV-2 spike protein and a protein known as syncytin-1, a protein essential for the formation of a developing embryo. The social media hypothesis was therefore that the cross-reactivity (after vaccination) would lead to damage to the developing trophoblast, thus preventing the implantation of embryos. In June of this year, disinformation was verified in a series of frozen embryo transfers among women who were vaccine-positive, HIV-positive and HIV-negative (6). No difference was found in serum implantation rates documented by hCG or sustained implantation rates between the three groups. “Doctors and public health personnel can advise women of childbearing age that neither a previous illness with COVID-19 nor the antibodies produced by the COVID-19 vaccination will cause infertility,” the author concluded. insistently.

Meanwhile, an August report from the EMA’s Pharmacovigilance Risk Assessment Committee, discussing cases of menstrual disturbances reported after COVID-19 vaccination, found “no causal association between COVID-vaccines. 19 and menstrual disorders ”, attributing these“ common ”symptoms to stress, fatigue, and underlying conditions such as fibroids and endometriosis. (7)

Concerns about male infertility resulting from infection were initially inspired by the discovery that men generally seemed to be more severely affected than women. Although primarily affecting the lungs, where there is increased expression of angiotensin converting enzyme (ACE-2) receptors (for which COVID-19 has a strong affinity for binding and subsequent entry ), the ACE-2 receptor is also widely expressed in the testes. With that in mind, there is some evidence that the male reproductive system, especially the testes, may be the target of COVID-19 infection. A study published earlier this year found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism for how COVID-19 can cause infertility. (8) However, the results of an effect of infection or vaccination on male fertility have been variable, and a more recent study of semen parameters before and after two doses of an mRNA vaccine has not revealed no significant decrease in sperm parameters among a small cohort of healthy men. (9) Since the vaccines studied contain mRNA and not live virus, the authors concluded “that the vaccine is unlikely to affect semen parameters”.

As reassuring data against any ill effects of COVID-19 vaccination grows, the authorities’ message now appears to be – as evidenced by the latest CDC report – that infection during pregnancy or before pregnancy is associated. at a much higher risk of complications than vaccination. As the Scientific American report concluded: “The key to protecting yourself against the reproductive and sexual effects of COVID-19 is to get vaccinated.”

1. See https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html
2. Gray KJ, Bordt EA, Atyeo C, et al. Vaccine response against 2019 coronavirus disease in pregnant and lactating women: a cohort study. Am J Obstet Gynecol 2021. doi.org/10.1016/j.ajog.2021.03.023
3. Perl SH, Uzan-Yulzari A, Klainer H, et al. Antibodies specific to SARS-CoV-2 in breast milk after COVID-19 vaccination of lactating women. JAMA 2021; 325: 2013-2014. doi: 10.1001 / jama.2021.5782
4. See https://www.focusonreproduction.eu/article/News-in-Reproduction-COVID-vaccinations
5. See https://www.scientificamerican.com/article/covid-vaccines-show-no-signs-of-harming-fertility-or-sexual-function/
6. Morris RS. SARS-CoV-2 spike protein seropositivity due to vaccination or infection does not cause infertility. Fertil Steril Rep 2021; doi.org/10.1016/j.xfre.2021.05.010
7. See https://www.ema.europa.eu/en/news/meeting-highlights-pharmacovigilance-risk-assessment-committee-prac-5-august-2021
8. Achua JK, Chu KY, Ibrahim E, et al.
Histopathology and ultrastructural findings of fatal COVID-19 infections in the testes. World J Mens Health 2021; 39: 65-74. doi.org/10.5534/wjmh.200170
9. Gonzalez DC, Nassau DE, Khodamoradi K, et al. Semen parameters before and after COVID-19 mRNA vaccination. JAMA 2021; 326: 273-274. doi: 10.1001 / jama.2021.9976


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