
Dojenje
Tekst je informativnog karaktera i nije zamjena za liječnički savjet.
U prvom dijelu teksta je bilo govora o cjepljenju i trudnoći (dostupno ovdje).
Cilj ovog teksta je prikazati preporuke stručnih tijela vezane za primjenu COVID-19 cjepiva u dojenju.
Koja stručna društva?
ACOG (American College of Obstetricians and Gynecologists), RCOG (Royal College of Obstetricians and Gynaecologists), CDC (Centers for Disease Control and Prevention), WHO (World Health Organization), ABM (Academy of Breastfeeding Medicine), Talijanska društva [the Italian Society of Neonatology (SIN), the Italian Society of Pediatrics (SIP), the Italian Society of Perinatal Medicine (SIMP), the Italian Society of Obstetrics and Gynecology (SIGO), the Italian Association of Hospital Obstetricians-Gynecologists (AOGOI) and the Italian Society of Infectious and Tropical Diseases (SIMIT) – referenca za tal društva je Davanzo et al.2021]
Što kažu stručna društva?
Kad su cjepiva tek izašla na tržište, bilo je zadrške kod stručnih tijela oko preporučivanja cijepljenja u dojilja, no danas svi oni govore da se dojilje trebaju cijepiti jednako kao i svi drugi ljudi, odnosno da dojenje nije prepreka cijepljenju niti je cijepljenje prepreka dojenju. Za sva cjepiva (mRNA i vektorska), se smatra da ne mogu uzrokovati zarazu u majci ili djetetu.
Posebne studije ispitivanja sigurnosnog profila cjepiva na dojiljama nisu u planu (Davanzo et al. 2021).
Izlučuju li se protutijela koja štite dijete u mlijeko nakon cijepljenja?
Da!!
Perl et al. su proveli studiju na 84 žene koje su dale ukupno 500 uzoraka mlijeka. Cijepljene su Pfizer cjepivom s 2 doze u razmaku od 3 tjedna. Cca 60% žena je imalo značajne razine IgA protutijela u mlijeku 2 tjedna nakon prve doze, a 85% žena 4 tjedna nakon prve doze. Gotovo sve žene su imale IgG protutijela 6 tjedana nakon prve doze (IgG su ona koja pružaju dugotrajnu zaštitu i za koje je bitno da idu u mlijeko). (Perl et al.2021)
Pace te al. su proveli sličnu studiju na nešto manjem uzorku i našli slične rezultate.
Zaključno dojenje i COVID-19 cjepiva
1 Majke koje doje ne trebaju prestati s dojenjem da bi se cijepile
2 Majke koje se cijepe mogu nastaviti dojiti
3 Cjepiva ne uzrokuju zarazu kovidom ni kod majke ni djeteta
4 Majka nakon cijepljenja u mlijeko izlučuje protutijela koja štite dojenče
Reference za I. i II. dio teksta o COVID-19 cjepivu i trudnoći i dojenju
ABM ABM Statement: Considerations for COVID-19 Vaccination in Lactation. 2020. https://abm.memberclicks.net/abm-statement-considerations-for-covid-19-vaccination-in-lactation
Allotey, J. et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 370, m3320 (2020).)
CDC Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#pregnant
ClinTrials.gov https://clinicaltrials.gov/ct2/show/NCT04705116?cond=Vaccine+Exposure+During+Pregnancy&draw=2&rank=2
Collin, J, Byström, E, Carnahan, A, Ahrne, M. Public Health Agency of Sweden’s Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand. 2020; 99: 819– 822. https://doi.org/10.1111/aogs.13901
Davanzo R, Agosti M, Cetin I, Chiantera A, Corsello G, Ramenghi LA, Staiano A, Tavio M, Villani A, Viora E, Mosca F. Breastfeeding and COVID-19 vaccination: position statement of the Italian scientific societies. Ital J Pediatr. 2021 Feb 27;47(1):45. doi: 10.1186/s13052-021-00998-6. PMID: 33639998; PMCID: PMC7912459.
EMA European Medicines Agency. Comirnaty. 21 December 2020. https://www.ema.europa.eu/en/news/ema-recommends-first-covid-19-vaccine-…. https://www.ema.europa.eu/en/medicines/human/summaries-opinion/comirnaty
Evans et al. COVID-19 vaccine and infertility: baseless claims and unfounded social media panic. 2021. Fertility and Sterility. Editorial Office, American Society for Reproductive Medicine https://www.fertstertdialog.com/posts/covid-19-vaccine-and-infertility-baseless-claims-and-unfounded-social-media-panic
Male, V. Are COVID-19 vaccines safe in pregnancy?. Nat Rev Immunol 21, 200–201 (2021). https://doi.org/10.1038/s41577-021-00525-y
Pace RM, Williams JE, Järvinen KM, Belfort MB, Pace CDW, Lackey KA, Gogel AC, Nguyen-Contant P, Kanagaiah P, Fitzgerald T, Ferri R, Young B, Rosen-Carole C, Diaz N, Meehan CL, Caffé B, Sangster MY, Topham D, McGuire MA, Seppo A, McGuire MK. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio. 2021 Feb 9;12(1):e03192-20. doi: 10.1128/mBio.03192-20. PMID: 33563823; PMCID: PMC7885115.
Perl SH, Uzan-Yulzari A, Klainer H, et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. Published online April 12, 2021. doi:10.1001/jama.2021.5782
Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, Marquez PL, Olson CK, Liu R, Chang KT, Ellington SR, Burkel VK, Smoots AN, Green CJ, Licata C, Zhang BC, Alimchandani M, Mba-Jonas A, Martin SW, Gee JM, Meaney-Delman DM; CDC v-safe COVID-19 Pregnancy Registry Team. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. 2021 Apr 21. doi: 10.1056/NEJMoa2104983. Epub ahead of print. PMID: 33882218.
Wei, Bilodeau-Bertrand, Liu, Auger. The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis CMAJ Apr 2021, 193 (16) E540-E548; DOI: 10.1503/cmaj.202604 https://www.cmaj.ca/content/193/16/E540
WHO 2021. Pfizer BioNTech COVID-19 vaccine: What you need to knowhttps://www.who.int/news-room/feature-stories/detail/who-can-take-the-pfizer-biontech-covid-19–vaccine
Zambrano LD, Ellington S, Strid P, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641–1647. DOI: http://dx.doi.org/10.15585/mmwr.mm6944e3