Coronavirus (COVID-19): letter from Chief Medical Officer on pregnancy and vaccines

To:

• NHS Scotland Directors of Nursing
• NHS Scotland Medical Directors
• NHS Board Chief Executives
• NHS Board Chairs
• NHS Board Immunisation Leads
• NHS GP Practices

(by email)

Dear Colleague

As you will be aware, on 16 April the Joint Committee on Vaccination and Immunisation (JCVI) recommended that pregnant women should be offered the Pfizer or Moderna COVID-19 vaccines alongside the general population. The Royal College of Obstetrics and Gynaecology (RCOG) and the Royal College of Midwives (RCM) also recommend vaccination as one of the best defences against severe infection. However, we are aware that vaccine hesitancy has been high among pregnant women.

COVID-19 infection in pregnancy carries a significant risk of hospital admission and a higher risk of severe illness than for the non-pregnant population – especially so in the third trimester – and a higher risk of preterm birth. Recent data from the UK Obstetric Service (UKOSS), published on 25 July, shows that the number of pregnant women being admitted to hospital with COVID-19 is increasing and many experiencing acute symptoms. The data suggests that the Delta variant that is currently dominant in the UK is associated with an increased risk of severe illness among hospitalised pregnant women, compared with the Alpha and ‘wild type’ variants of previous waves.

Over 130,000 pregnant women from diverse ethnic backgrounds in the USA have received either a Pfizer-BioNTech or Moderna COVID-19 vaccine, with no evidence of harm being identified. In addition, recent figures published show that in the UK over 55,000 pregnant women have received the vaccine (over 4,000 in Scotland). Whilst this is encouraging it is still the case that many remain unvaccinated and this highlights the importance of increasing uptake in pregnant women.

With that in mind, we are writing to seek your help in ensuring pregnant women are aware of the vaccine and its role in protecting themselves and their babies, including that two doses of vaccine are important to achieve high levels of protection against severe illness.

As you know, all healthcare professionals have a responsibility to proactively, as a matter of practice, encourage pregnant women to get vaccinated against COVID-19.

This is why the NHS needs to provide evidence-based advice to women on the benefits of vaccination in pregnancy for them and their babies. By way of an example, the Nursing and Midwifery Council recently made a statement highlighting that the code clearly sets out the importance of fully recognising the responsibility to provide pregnant women with support and accurate information.

NHS Education for Scotland (NES) and Public Health Scotland (PHS) have developed a learning resource to equip healthcare professionals (including vaccinators) with the knowledge to discuss the risks for women of childbearing age. More detailed guidance and evidence on vaccination in pregnancy for clinicians can be found in chapter 14a of the Green Book and on the RCOG website.

Many resources have also been produced to provide the latest information for pregnant women including PHS, RCOG and RCM leaflets/decision aid available online, the PHS/RCOG resources have also been distributed to all Health Boards across Scotland in paper format. This information should be highlighted and made available for women in all antenatal and primary care settings.

The Scottish Government is also working with PHS to produce further resources for use in maternity services which will encourage pregnant women to discuss the vaccine with their healthcare professional and these will be distributed shortly.

Thank you to you all for everything you and your teams are doing across Scotland to ensure good outcomes for women, families and babies during the pandemic. We are confident that midwives, obstetricians, GP practices and all healthcare professionals will take all the necessary steps to ensure pregnant women are fully aware of the vaccines and their safety so that they can make an informed choice to protect themselves and their babies.

Yours sincerely,

Dr Gregor Smith, Chief Medical Officer

Amanda Croft, Chief Nursing Officer

Prof. Alison Strath, Chief Pharmaceutical Officer

Jaki Lambert, Professional Advisor Midwifery