Vaccination in Pregnancy

Maternal immunisation has the potential to protect the mother and/ or the infant from mortality and morbidity from certain infectious diseases. Three vaccines are recommended during pregnancy in Australia (influenza, pertussis and COVID-19). Influenza vaccine is given to prevent severe disease in the mother but also protect infants in the first 6 months of life. There is emerging evidence that COVID-19 vaccines are also effective in protecting the infant against hospitalisation along with the well-established protection afforded to the mother. In contrast, pertussis vaccination during pregnancy is mainly given to protect the newborn from pertussis disease. This presentation will review the latest evidence for safety and efficacy of maternal immunisations including an overview of new vaccines on the horizon, including RSV and GBS vaccines.

Widespread implementation of telehealth in the delivery of antenatal care during the COVID-19 pandemic: An observational cohort study

Introduction: Driven by the COVID-19 pandemic, our maternity service developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. Given limited evidence to inform this clinical initiative we evaluated the safety of telehealth in antenatal care. Methods: We undertook a population-based cohort study using interrupted time series analysis to evaluate the impact of telehealth integration into antenatal care from 23rd March 2020. Allowing a one-month implementation period, we compared the first three months of telehealth integrated care (20th April to 2nd August 2020) to previously delivered conventional care (1st January 2018 to 22nd March 2020). Main pregnancy outcomes measured were detection and outcomes of fetal growth restriction, pre-eclampsia and gestational diabetes, as well as stillbirth. Results: The outcomes of 2,977 births during the telehealth integrated period were compared to 20,031 births prior to its implementation. Following telehealth integration, 10,928 of the 20,517 (53.3%) antenatal consultations provided were delivered via telehealth. No significant change during integrated compared to conventional care periods in the rate of fetal growth restriction <3rd centile (2.9% vs 2.6%), stillbirth (1% vs 1%), or pregnancies complicated by pre-eclampsia (4.2% vs 3.9%) or gestational diabetes (23.6% vs 22.9%) was seen. A reduction in preterm birth among women in high-risk models (ITS-0.71 (-1.4 to-0.036);p = 0.04), but no change in other outcome measures were observed for low or high-risk care models. Discussion: Telehealth integrated into antenatal care was able to reduce in-person consultations by 50% without compromising pregnancy outcomes.