Prof Thangaratinam added that leaving pregnant women out of trials caused a “vicious cycle” where, even when drugs or vaccines were shown to work, they were still unavailable for this group.
“This population is ignored, and then when we see a beneficial effect it is still not applied to this group because people then say we don’t have any evidence. It becomes a vicious cycle, and there should be a big push to say that research needs to be done on pregnant women,” she said.
The UK guidance has changed since the vaccinations began, when pregnant women were told not to get the jab.
Now, in line with guidance from the World Health Organisation, pregnant women are not routinely advised to have the Covid-19 vaccine but those with pre-existing health conditions or high-risk jobs are advised to discuss vaccination with their doctor. Breastfeeding women are recommended to get the jab if offered it. The position in the United States is similar.
“You may feel that it is better to go ahead and receive protection from the vaccine,” the British guidance for pregnant women reads.
Israel goes further, actively recommending that pregnant women at all stages get the vaccine.
The risks of Covid-19 for babies have recently raised the alarm after doctors said a stillborn foetus in Israel had died with coronavirus, transmitted from the mother in utero.
However, Professor Thangaratinam said more work was needed in order to ascertain whether this was the case, and stressed that the WHO has recently put out rigorous guidance on how to define mother-to-child transmission of Sars-Cov-2, with a number of criteria that need to be met.
“I wouldn’t necessarily make pregnant women worried based on this case report. The risks to the baby are extremely low. We know pregnant women themselves are at higher risk of having severe Covid, but based on the evidence so far, serious complications like stillbirth or neonatal death are very low,” she said.
A regularly updated systematic review of all of the evidence on Covid-19 and pregnancy, collated by the University of Birmingham, has found that “the overall rates of stillbirths and neonatal deaths in babies born to pregnant women with suspected or confirmed Covid-19 do not seem higher than the background rate.”
There were 72 stillborn babies among 9,020 births, and 41 newborn deaths among 8,263 newborn babies across the 95 studies – tragic numbers but in line with the rates outside of a pandemic, the review found.
For mothers, the risks of Covid-19 are higher than among comparable groups of women of reproductive age, according to the review of 192 studies on more than 64,000 women with suspected or confirmed Covid-19.
It found that four per cent of pregnant women diagnosed with Covid-19 were admitted to intensive care, and 3 per cent needed invasive ventilation. Seventeen per cent delivered preterm, before 37 weeks, and 6 per cent had spontaneous preterm birth.
The data is global, but compares roughly to, for example, data in England from Imperial College showing that 3.5 per cent of people with Covid-19 in the UK were hospitalised in the first wave. Around a third of them needed intensive care.
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