Press Release N°45/2021 Pregnancy and breastfeeding: extension of COVID-19 vaccination, update of ISS Guidance

ISS, September 24th 2021

The Istituto Superiore di Sanità – ISS (Italian National Institute of Health) has updated its information on access to COVID-19 vaccines by pregnant and breastfeeding women. These are the main conclusions.

Vaccination of pregnant women

· On the basis of the growing evidence on the safety of vaccination in pregnancy for both the foetus and the mother, the new evidence on the greater morbidity associated with the Delta variant, the increasing circulation of this variant and the significant lowering of the median age of infection in Italy, the ISS has updated its previous interim guidance recommending that vaccination with mRNA vaccines be extended to all pregnant women in the second and third trimester who wish to be vaccinated.

· Although vaccination can be considered at any stage of pregnancy, to date there is still little evidence of vaccinations performed in the first trimester. Women wishing to be vaccinated during this gestational period must assess the risks and benefits with a healthcare professional, also in light of the evidence that fever, which is one of the possible reactions to the vaccine, may constitute an increased risk of congenital malformations.

· Women at greater risk of contracting SARS-CoV-2 infection (e.g. healthcare professionals, caregivers) and / or at greater risk of developing severe COVID-19 disease (women with risk factors such as age > 30 years, BMI > 30, comorbidities, women from countries where the migration pressure is high) remain the priority target for vaccination during pregnancy.

· Healthcare professionals are required to illustrate as clearly as possible the risks and benefits involved, so as to allow each woman to make the most appropriate decision for her case. Healthcare professionals must recommend vaccination of domestic partners to further limit the risk of contagion of pregnant and breastfeeding women.

· It should be noted that if a vaccinated woman discovers that she is pregnant after having already received the vaccine, there is no evidence in favour of terminating her pregnancy. Also, if a woman discovers that she is pregnant between the first and second doses of the vaccine she may consider delaying the second dose until the second trimester.

Vaccination during breastfeeding

· Breastfeeding women, as already provided for in the previous interim guidance of the ISS, may be vaccinated without the need to interrupt breastfeeding.

· Breastfeeding women must be informed that vaccination does not expose the infant to risks who, on the contrary, will receive the antibodies against SARS-CoV-2 through their mother’s milk.

· Breastfeeding women who have been vaccinated may continue their vaccination schedule without any changes.

Other behavioural measures

We recommend that all pregnant and breastfeeding women, regardless of whether they choose to be vaccinated or not, observe the following preventive measures:

- wash hands frequently

- use masks indoors and in the vicinity of unvaccinated people and of people other than their domestic partners

- comply with the social distancing rules

- air the rooms in which they live.