The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines.

INTRODUCTION: Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS: As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES: The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

Alignment of national COVID-19 vaccine recommendations for pregnant and lactating women.

The rapid development and roll-out of coronavirus disease 2019 (COVID-19) vaccines is providing hope for a way to control the pandemic. As pregnant and lactating women are generally excluded from clinical trials, the vaccination programme was launched without adequate safety and efficacy data for pregnant women. Yet many professional organizations have recognized the need for administration of COVID-19 vaccines in pregnancy and have issued their own set of recommendations. The lack of evidence, however, has often led to confused messaging, inconsistent language and differing recommendations across organizations, potentially contributing to delay or refusal to accept vaccination by pregnant women. We summarize those differences and recommend that leaders collaborate at a country level to produce joint recommendations. We use the example of Australia, where two professional authorities along with the government and partners in New Zealand worked towards one message, consistent language and a unified recommendation. The aim was to help health professionals and women who are planning pregnancy or who are currently pregnant or breastfeeding to make an informed decision about COVID-19 vaccination. National advisory groups for immunization, professional obstetric organizations and government bodies should be encouraged to coordinate their statements on COVID-19 vaccination for pregnant and lactating women and to use similar language and phrasing for greater clarity.

La rapidité de développement et de déploiement des vaccins contre la maladie à coronavirus 2019 (COVID-19) entretient l'espoir d'un jour pouvoir contrôler la pandémie. Étant donné que les femmes enceintes et allaitantes sont généralement exclues des essais cliniques, le programme de vaccination a été lancé en l'absence de données adéquates sur l'efficacité et l'innocuité du vaccin au sein de cette catégorie. Pourtant, de nombreuses associations professionnelles ont reconnu la nécessité de vacciner contre la COVID-19 durant la grossesse, et ont émis leurs propres recommandations. L'absence de preuves a toutefois souvent donné lieu à une communication incohérente, à un discours contradictoire et à des recommandations divergentes d'une organisation à l'autre, ce qui pourrait avoir conduit certaines femmes enceintes à retarder ou refuser la vaccination. Dans le présent document, nous exposons ces différences et exhortons les dirigeants à collaborer au niveau national pour formuler des recommandations communes. Nous utilisons l'exemple de l'Australie, où deux autorités professionnelles ont travaillé avec le gouvernement et des partenaires en Nouvelle-Zélande afin de transmettre un message unique, d'adopter un langage cohérent et de fournir des directives homogènes. L'objectif était d'aider les soignants et les femmes enceintes, allaitantes ou planifiant une grossesse à prendre une décision éclairée en matière de vaccination contre la COVID-19. Les organes consultatifs nationaux sur la vaccination, les associations professionnelles d'obstétrique et les pouvoirs publics devraient être encouragés à aligner leurs déclarations concernant la vaccination contre la COVID-19 chez les femmes enceintes et allaitantes, ainsi qu'à employer des termes et énoncés similaires pour davantage de clarté.

El rápido desarrollo y puesta en marcha de las vacunas contra el coronavirus de la enfermedad por coronavirus (COVID-19) está dando esperanzas sobre una forma de controlar la pandemia. Como las mujeres embarazadas y lactantes suelen estar excluidas de los ensayos clínicos, el programa de vacunación se puso en marcha sin datos adecuados de seguridad y eficacia para las mujeres embarazadas. Sin embargo, muchas organizaciones profesionales han reconocido la necesidad de administrar las vacunas contra la COVID-19 durante el embarazo y han emitido su propio conjunto de recomendaciones. Sin embargo, la falta de pruebas a menudo ha ocasionado mensajes confusos, un lenguaje incoherente y recomendaciones diferentes en las distintas organizaciones, lo que puede contribuir a retrasar o rechazar la vacunación de las mujeres embarazadas. Resumimos esas diferencias y recomendamos que los líderes colaboren a nivel de país para elaborar recomendaciones conjuntas. Utilizamos el ejemplo de Australia, donde dos autoridades profesionales, junto con el gobierno y los socios de Nueva Zelanda, trabajaron para lograr transmitir un único mensaje con un lenguaje coherente y una recomendación unificada. El objetivo era ayudar a los profesionales sanitarios y a las mujeres que planean un embarazo o embarazadas o en periodo de lactancia a tomar una decisión informada sobre la vacunación contra la COVID-19. Hay que animar a los grupos consultivos nacionales de inmunización, a las organizaciones profesionales de obstetricia y a los organismos gubernamentales a que coordinen sus declaraciones sobre la vacunación contra la COVID-19 para las mujeres embarazadas y lactantes y a que utilicen un lenguaje y una redacción similares para mayor claridad.

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.