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针对 COVID-19 感染的疫苗接种:糖尿病和肥胖孕妇的证据需求。

Vaccination against COVID-19 infection: the need of evidence for diabetic and obese pregnant women.

机构信息

Padova University, Padova, Italy.

出版信息

Acta Diabetol. 2021 Dec;58(12):1581-1585. doi: 10.1007/s00592-021-01764-0. Epub 2021 Jun 28.

Abstract

AIM

The recent availability of vaccines against COVID-19 has sparked national and international debate on the feasibility of administering them to pregnant and lactating women, given that these vaccines have not been tested to assess their safety and efficacy in such women. As concerns the risks of COVID-induced disease, published data show that pregnant women who develop COVID-19 have fewer symptoms than patients who are not pregnant, but they are more likely to need hospitalization in intensive care, and neonatal morbidity. Aim of the present perspective paper is to analyze the current literature regarding the use of the vaccine against COVID-19 infection, in terms of safety and protection, in high risk pregnant women as those affected by diabetes and obesity.

METHODS

Analysis of literature about vaccination against COVID-19 infection in pregnancy.

RESULTS

The main health organizations and international scientific societies, emphasize that-although data regarding the use of COVID vaccines during pregnancy and lactation are still lacking-vaccination should not be contraindicated. It should be considered for pregnant women at high risk of exposure to COVID-19. For such women, the potential benefits and risks should be assessed by the healthcare professionals caring for them. A recent prospective study to test the immunogenicity and reactogenicity of vaccination with COVID-19 mRNA in pregnant and lactating women, has showed that SARS-CoV-2 mRNA vaccination triggers a robust humoral immunity in pregnant and lactating women; there was also evidence of an immune transfer to their newborn.

CONCLUSIONS

We urgently need data on the effect of COVID-19 vaccination, in terms of maternal and fetal outcomes and vaccine related symptoms in high risk women during pregnancy and breastfeeding. It is important to run campaigns to promote vaccination, in particular in pregnant women at high risk to have severe COVID infection as those diabetics and/or obese.

摘要

目的

鉴于针对 COVID-19 的疫苗尚未进行测试以评估其在这些人群中的安全性和有效性,因此最近可获得针对 COVID-19 的疫苗引发了国内外关于向孕妇和哺乳期妇女接种疫苗的可行性的争论。就 COVID 引起的疾病的风险而言,已发表的数据表明,患有 COVID-19 的孕妇的症状比未怀孕的患者少,但她们更有可能需要在重症监护中住院治疗,并且新生儿发病率更高。本观点文章的目的是分析目前关于使用针对 COVID-19 感染的疫苗的文献,从安全性和保护角度来看,在患有糖尿病和肥胖症等高危孕妇中的应用。

方法

分析有关妊娠期间针对 COVID-19 感染的疫苗接种的文献。

结果

主要的卫生组织和国际科学学会强调,尽管关于妊娠和哺乳期使用 COVID 疫苗的数据仍然缺乏,但不应禁忌接种。对于有感染 COVID-19 高风险的孕妇,应考虑接种疫苗。对于这些妇女,应由照顾她们的医疗保健专业人员评估潜在的益处和风险。最近的一项前瞻性研究测试了 COVID-19 mRNA 在孕妇和哺乳期妇女中的免疫原性和反应原性,结果表明,SARS-CoV-2 mRNA 疫苗可在孕妇和哺乳期妇女中引发强大的体液免疫;还证明了对其新生儿的免疫转移。

结论

我们迫切需要有关 COVID-19 疫苗接种对高危孕妇在妊娠和哺乳期中的母婴结局和疫苗相关症状的影响的数据。开展疫苗接种宣传活动非常重要,特别是对于患有严重 COVID 感染风险高的孕妇,如糖尿病患者和/或肥胖者。

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本文引用的文献

1
Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons.mRNA 新冠疫苗在孕妇中的初步安全性研究结果。
N Engl J Med. 2021 Jun 17;384(24):2273-2282. doi: 10.1056/NEJMoa2104983. Epub 2021 Apr 21.
7
Considerations for COVID-19 Vaccination in Lactation.哺乳期接种新冠病毒疫苗的注意事项。
Breastfeed Med. 2021 Jan;16(1):2. doi: 10.1089/bfm.2020.29172.abm. Epub 2020 Dec 23.
8
Genetics and Epigenetics: New Insight on Gestational Diabetes Mellitus.遗传学与表观遗传学:妊娠期糖尿病的新见解
Front Endocrinol (Lausanne). 2020 Dec 1;11:602477. doi: 10.3389/fendo.2020.602477. eCollection 2020.
9
Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis.孕妇感染 SARS-CoV-2 的母婴围生结局:一项荟萃分析。
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:194-204. doi: 10.1016/j.ejogrb.2020.11.038. Epub 2020 Nov 13.

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