Following the statements this week from JCVI and MHRA on the Oxford AstraZeneca vaccine, and a change in the guidance for those under 30 years old, the Royal College of Obstetricians and Gynaecologists (RCOG) have considered the impact of this for pregnant women and those undergoing fertility treatment.
The Joint Committee on Vaccination and Immunisation (JCVI) concludes there continue to be benefits and risks of offering the vaccine to younger women in phase 1 of the vaccine roll-out, with younger women included in groups 1 and 2 (carers and frontline health and social care workers) or group 4 and 6 (those at higher risk of complications of COVID-19).
The statements from JCVI and MHRA have made it clear that the risk of this extremely rare adverse event of concurrent thrombosis (blood clots) and thrombocytopenia (low platelet count) following vaccination is not directly linked to increased prothrombotic risks. Although younger women who are pregnant, recently postnatal, or on fertility treatment are all at increased thrombotic risk, the lack of a clear direct association between a thrombotic risk and the likelihood of this extremely rare adverse event should be considered.
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“Healthcare professionals offering COVID-19 vaccination should continue to discuss the benefits and risks and this should include discussion of the side-effects. For pregnant and postnatal women and for those about to start - or who have started - fertility treatment who are in phase 1 of the vaccine roll-out, this should include discussion of the different vaccine types available, including the extremely rare adverse thrombotic events.
"The benefit/risk balance may be different for those who are healthy and receiving the vaccine as a health or social care worker, and those at increased risk of COVID-19 complications. If a woman chooses to have a particular vaccine, for example to avoid vaccination with the Oxford AstraZeneca vaccine, then this choice should be facilitated.”
The RCOG will continue to monitor updates from the JCVI and the MHRA in relation to the AstraZeneca vaccine and will advise accordingly.
Notes to editors:
The JCVI statement noted: ‘There are currently no known risk factors for this extremely rare condition, which appears to be an idiosyncratic reaction on first exposure to the AstraZeneca COVID-19 vaccine.’ Communicating the potential benefits and harms of the Astra-Zeneca COVID-19 vaccine - the advice to offer an alternative vaccine for those under 30 years old is based on the relative benefits and risks of the vaccine in each age group, as represented in the joint briefing slides.
The RCOG have developed a range of information on our website for healthcare professionals and pregnant women eligible for COVID-19 vaccination.
The Faculty of Sexual and Reproductive Heathcare has released the following statement on the AstraZeneca COVID-19 vaccine, combined hormonal contraception and blood clots.
The Association of Reproductive and Clinical Scientists (ARCS) and British Fertility Society (BFS) U.K. statement on Covid-19 vaccine 9th April 2021 can be viewed here.
Pregnancy increases your risk of a deep vein thrombosis, with the highest risk being just after you have had your baby. However, venous thrombosis is still uncommon in pregnancy or in the first 6 weeks after birth, occurring in only 1–2 in 1000 women.