Pregnancy should be next priority for COVID-19 vaccine in Quebec: obstetricians

·4 min read
Pregnancy should be next priority for COVID-19 vaccine in Quebec: obstetricians
Quebec's public health director said earlier this week that pregnant individuals are not as at-risk of COVID-19 complications as those with chronic health conditions and pregnancy alone is not enough to warrant priority vaccination at this point.  (Ivanoh Demers/Radio-Canada - image credit)
Quebec's public health director said earlier this week that pregnant individuals are not as at-risk of COVID-19 complications as those with chronic health conditions and pregnancy alone is not enough to warrant priority vaccination at this point. (Ivanoh Demers/Radio-Canada - image credit)

When Quebec expanded its priority list for COVID-19 vaccinations this week, it did not include pregnancy among the conditions warranting an early inoculation.

Quebec Public Health Director Dr. Horacio Arruda said that pregnancy alone is not enough to warrant vaccination at this point.

But, he said, pregnancy combined with a disability or a chronic condition (like diabetes or high blood pressure), does make someone eligible for vaccination in the current round. Those who are healthy and pregnant will have to wait until appointments open up to the general population.

Arruda said that decision was made because the province has a limited number of vaccines to distribute.

"We went always from the ones at higher risk to lower risk. I'm not saying that pregnant women are not at risk at all — they are more at risk than a non-pregnant person, but they are not as at-risk as [the ones] that we're vaccinating first," said Arruda.

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But health authorities in other provinces have taken a different approach.

In Saskatchewan, pregnancy has made people eligible for a COVID-19 vaccine since April 14. Alberta started at the end of March.

New Brunswick and Ontario also added pregnancy to their vaccine priority lists earlier this week, following a surge in intensive care hospitalizations in Toronto among pregnant women who contracted COVID-19.

Dr. Isabelle Boucoiran, a gynecologist-obstetrician at CHU Sainte-Justine, is concerned that Quebec could see a similar situation in its ICUs.

She says that there isn't a lot of data available on COVID-19 during pregnancy, but there is enough to suggest that it is safe for pregnant women to get an mRNA-based vaccine — such as the Pfizer-BioNTech — and that they are at increased risk for complications if they get COVID-19.

"We are not seeing an increased number of pregnant women in the ICU in Quebec yet, but we are seeing more cases of pregnant women as we are seeing more younger people infected with the third wave," said Boucoiran. "So, I'm just afraid that we're going to miss a window of opportunity."

Boucoiran acknowledged that the province does have difficult decisions to make because of limited vaccine supply, but she says pregnant individuals should be included in the next priority group — ahead of the general population.

"We know that there is a risk associated to COVID during pregnancy, especially an increase of severe COVID and increased risk of preterm birth associated with it," she said.

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Just last week, the Society of Obstetricians and Gynaecologists of Canada called for all provinces to vaccinate pregnant women "immediately," citing a possible increased risk of respiratory complications.

"Providing ventilator support in pregnancy is more challenging, and the risks are greater to both mother and child," the group said.

A study published in the journal JAMA Pediatrics on Thursday that included 2,100 women in 18 countries around the world suggested pregnant individuals who contracted COVID-19 were 20 times more likely to die than those who did not have COVID. They also had higher rates of preeclampsia, infections and preterm births.

The researchers also reported the babies born to COVID-19 patients with symptoms were at greater risk of neonatal complications, mostly due to premature birth.

Maria Hoyt, a Quebec City resident in her second trimester, is looking forward to receiving her COVID-19 vaccine. She currently qualifies for a dose because she works with a vulnerable population.

"Now that there's a little person inside of me, it's not just me, it's something else that I'm trying to protect," said Hoyt. "I want to make the best decision for me but also to protect my baby as well."

But in the Eastern Townships, Samantha Rideout, a health journalist who is pregnant, says she is ready to wait for people who are more at-risk than herself to get it first.

"I would get vaccinated when I'm offered the opportunity," she said. "I don't have any chronic health conditions and I don't have pregnancy complications. I also work from home."