➥【孕婦施打mRNA Covid-19疫苗安全性初步報告】:在美國已經有許多孕婦接種mRNA新冠疫苗,但是到目前為止關於安全性的報告很少。本文是由美國疾病管制中心以及食品藥物管理局多位專家學者共同發表的分析報告。
由於在美國接種疫苗的人都會透過 ” V-safe ”手機 APP,在注射後登記自己的健康狀況,並交由「疫苗副作用回報系統」(Vaccine Adverse Event Reporting System,VAER)分析。作者擷取系統中自2020年12月14日到2021年2月28日的孕婦資料進行研究。
結果發現,這段時間裡系統總共收到35691名,年齡分佈在16至54歲之間的孕婦的回報資訊。與一般女性相比,孕婦無論注射的是BNT還是Moderna疫苗,回報注射部位疼痛的比例較高,其他如頭痛、肌肉痠痛、畏寒、發燒等的比例則相對較低。
以上這些症狀都是打完第二劑後更常見。其中,不到1%的孕婦接受第一劑疫苗注射後,發燒超過 38°C;接受第二劑疫苗之後,有將近8%的孕婦發燒超過38°C。另外,孕婦接種第二劑之後相對較容易出現噁心、嘔吐,其他大致上與一般未懷孕者並沒有太大差異。
到今年2月底前,V-safe的孕產委員聯繫了系統中的5230名孕婦,最後符合分析條件的有3958名,其中有3719名(94%)是醫護人員。
將近三成的孕婦是在第一孕期中施打疫苗,在第二孕期接種的佔43%,第三孕期佔26%;這3958名施打疫苗的孕產婦在研究期間有827位結束妊娠,其中順利生產的有712位(86.1%),因自發性流產而結束妊娠的有104位(12.6%),與一般懷孕20週以內的自發性流產發生率10%~ 26%相比,風險並未增加。而順利生產的孕婦幾乎(98.3%)都是在第三孕期施打第一劑疫苗。
接受疫苗注射的孕產婦發生早產的機率約9.4 %、胎兒小於妊娠年齡(small for gestational age,SGA)約3.2%、胎兒有先天性異常的比例為2.2%,這都與過去一般孕產婦的數據接近。而有先天性異常胎兒的孕婦都不是在受孕前後或是第一孕期中施打疫苗。
■因此,在接種 mRNA Covid-19疫苗的孕婦安全性初步分析報告中沒有發現特殊的風險。但是,有必要進行更多的長期縱向追蹤,包括對懷孕早期接種疫苗的孕婦,以了解包括孕婦、產婦和嬰兒的狀況...完整轉譯文章,詳連結:http://forum.nhri.org.tw/covid19/virus/j_translate/j2658/ ( 財團法人國家衛生研究院 齊嘉鈺醫師摘要整理)
📋 The New England Journal of Medicine - 2021-06-17
Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons
■ Author:Tom T. Shimabukuro, Shin Y. Kim, Tanya R. Myers, et al.
■ Link:https://www.nejm.org/doi/full/10.1056/NEJMoa2104983
〈 國家衛生研究院-論壇 〉
➥ COVID-19學術資源-轉譯文章 - 2021/06/29
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
同時也有1部Youtube影片,追蹤數超過3萬的網紅POPA Channel,也在其Youtube影片中提到,之前我們探討了母乳的種種神奇之處,很多媽媽隨即大吐苦水,因為身邊總有人說母乳不夠營養,會令到BB「奀吱吱」,不夠「肥肥白白」;每當BB餓到哭起來,母乳媽媽又會被質疑,「你嘅BB又唔夠飽啦,梗係你唔夠奶水啦!」到底這些有關母乳餵養的迷思是否可信?今集就讓我們一起探討。 參考資料 Ziegler, ...
gestational age 在 Serena C Facebook 的最佳貼文
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gestational age 在 李木生醫師 Facebook 的最佳解答
2019的新型冠狀病毒 (武漢肺炎病毒) 已經發生超過8 個月了,最近出生小嬰兒的孕期也已幾乎全部發生於此新型冠狀病毒流行的時代裡。 在這個新的時代,我們偏好在家吃外送,看網路電視 而比較少出門。身為婦產科醫師的我,也一直在了解它對於產婦的影響。有兩點想與大家分享。
首先,懷孕中感染並不會增加武漢肺炎的死亡率。但感染新型冠狀病毒的媽媽可能會經由胎盤垂直感染給小孩。所以孕婦戴口罩,勤洗手與社交距離的重要性再跟大家提醒。很幸運的,目前在台灣我們並沒有這樣的個案出現。
第二點是我覺得比較少人討論到的:維他命D缺乏。在台灣30歲的婦女普遍有三分之一都有維他命D的缺乏。維他命D由食物吸收,但必須靠肝,腎與(陽光照射)皮膚活化(註)。所以在這個大家因為疫情都比較少出門曬太陽的大環境裡,我覺得維他命D缺乏的比例會更高。
維他命D幫助鈣質的吸收,對於骨骼與肌肉的健康有很大的幫助。對於孕婦它甚至可能減少孕期糖尿病或子癲癇症 的風險。但至於有些報告指出維他命D缺乏可能是武漢肺炎死亡率的危險因子,英國國家衛生機構NICE 已經釋疑,認為維他命D缺乏與武漢肺炎死亡率並無因果關聯。
(註) 維他命D3是目前比較被廣泛使用的口服維他命,因其不需要經由身體活化。
==============================
謝謝熱心讀者的詢問,這是本篇文章所採用的醫學文獻。
懷孕與武漢肺炎的死亡率關聯
Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775.
2019的新型冠狀病毒由胎盤垂直感染的證據
Vivanti, A.J., Vauloup-Fellous, C., Prevot, S. et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun 11, 3572 (2020). https://doi.org/10.1038/s41467-020-17436-6
維他命D 降低子癲癇症與孕期糖尿病風險的證據
Palacios C, Kostiuk LK, Peña-Rosas JP. Vitamin D supplementation for women during
pregnancy. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD008873.
DOI: 10.1002/14651858.CD008873.pub4
台灣北部人口維他命D缺乏的證據
Lee MJ, Hsu HJ, Wu IW, Sun CY, Ting MK, Lee CC. Vitamin D deficiency in northern Taiwan: a community-based cohort study. BMC Public Health. 2019;19(1):337. Published 2019 Mar 22. doi:10.1186/s12889-019-6657-9
英國國家衛生機構 (國家臨床卓越協會, National Institute of Clincal Excellence, NICE) 對於維他命D與武漢肺炎關聯的看法
https://www.nice.org.uk/advice/es28/chapter/Key-messages Accessed August 23rd, 2020
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It has been more than 8 months since the start of the global pandemic of COVID-19. We are now seeing the ripple reflected in the way we live, even in Taiwan. People prefer to stay home now: they order delivery food instead of going to restaurants, and watch video streaming at home instead of going out. As an obstetrician and gynaecologist, I wondered about its effect on women.
First of all, pregnancy does not increase mortality of SARS-CoV2 virus infection. But it can transmit from mother to child via their placental connection. The virus has recently been found in the placenta of a mother and newborn with COVID-19: proving vertical transmission other than routes such as breastfeeding and/or air droplet transmission. So it is worth reiterating the importance of masking at public spaces and hand hygiene for pregnant women. Luckily, in Taiwan thus far, there has not yet been any cases of vertical transmission.
The second point is less well discussed but may well affect more women. And that is Vitamin D deficiency, which is already common in Taiwan pre-COVID-19 era. Its prevalence is about one third in 30 year-olds. In the COVID-19 era, I suspect the prevalence will increase even further because people prefer staying home. Vitamin D deficiency has also been found to be more common in patients who succumb to COVID-19, although it merely reflects the association between vitamin D deficiency and multiple-comorbidities rather than a causal relationship. However, we already know that vitamin D deficiency in pregnancy can be related to a number of birth-related complications such as gestational diabetes and pre-eclampsia. So it is worthwhile testing for vitamin D levels at the beginning of pregnancy. Vitamin D3 is widely used as a supplement in patients with deficiency, because it does not require activation by sunlight.
gestational age 在 POPA Channel Youtube 的最佳解答
之前我們探討了母乳的種種神奇之處,很多媽媽隨即大吐苦水,因為身邊總有人說母乳不夠營養,會令到BB「奀吱吱」,不夠「肥肥白白」;每當BB餓到哭起來,母乳媽媽又會被質疑,「你嘅BB又唔夠飽啦,梗係你唔夠奶水啦!」到底這些有關母乳餵養的迷思是否可信?今集就讓我們一起探討。
參考資料
Ziegler, E. E. (2006). Growth of Breast-Fed and Formula-Fed Infants. Protein and Energy Requirements in Infancy and Childhood Nestlé Nutrition Workshop Series: Pediatric Program, 51-64. doi:10.1159/000095010
Donma, M. M., & Donma, O. (1997). The influence of feeding patterns on head circumference among Turkish infants during the first 6 months of life. Brain and Development, 19(6), 393-397. doi:10.1016/s0387-7604(97)00041-7
Mayer-Davis, E. J., Rifas-Shiman, S. L., Zhou, L., Hu, F. B., Colditz, G. A., & Gillman, M. W. (2006). Breast-Feeding and Risk for Childhood Obesity: Does maternal diabetes or obesity status matter? Diabetes Care, 29(10), 2231-2237. doi:10.2337/dc06-0974
Karaolis-Danckert, N., Buyken, A. E., Bolzenius, K., Perim, C., Lentze, M. J., & Kroke, A. (2006, December). Rapid growth among term children whose birth weight was appropriate for gestational age has a longer lasting effect on body fat percentage than on body mass index.
Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breast-feeding Increases Sleep Duration of New Parents. The Journal of Perinatal & Neonatal Nursing, 21(3), 200-206. doi:10.1097/01.jpn.0000285809.36398.1b
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