As per new guidelines of the Government of India, all pregnant females are also eligible for covid vaccination, irrespective of the term of pregnancy. Pregnant females should be informed about all the benefits and possible side effects of vaccination. They should be given a choice to get vaccinated.
Why is vaccination important for pregnant females?
Pregnancy as such doesn’t increase the risk to covid infection but pregnancy may affect the severity of covid illness compared to non pregnant females. So covid vaccination is being included in the precautions to prevent covid infection for pregnant females as well.
Pregnant females should be included in the decision. After explaining all the risks associated with covid infection, benefits and undescribed risks of being vaccinated, pregnant females can decide for themselves.
Pregnancy is a hypercoagulable state, meaning it makes the blood thicker and so is covid. A combination of both may prove fatal sometimes, if not taken care of.
In high risk groups, pregnant females are more likely to get affected by covid infection which may further affect their pregnancy outcome. So these females should be vaccinated at the earliest after informed consent.
Is it mandatory for all pregnant females?
Covid vaccination is not mandatory for anyone but its highly recommended for all above 18 years in India, including pregnant females. Females should be informed about all the benefits and risks associated with covid vaccination. They should as well be informed about the risks of getting covid infection and its complications. Every case has to be dealt on individual basis weighing risks and benefits associated with vaccination. Pregnant woman is free to take an informed decision after evaluating all the risks of infection and undescribed risk of being vaccinated during pregnancy.
Food for thought: If you are not getting covid vaccination during pregnancy, then your baby may not get the chance to get vaccination for next 12 years in present scenario. As the minimum age for vaccination presently is 12 years in many countries. But fetus can get antibodies even before birth, if mother is vaccinated as proven in many studies.
What WHO recommends about covid vaccination in pregnancy?
WHO recommends covid vaccination in pregnant women, when the benefits of vaccination outweighs the potential risks. This includes vaccination in high risk females like frontline workers, females with comorbidities, where there are high chances of getting exposed to covid infection.
Which females are at higher risk of getting infected?
- Health care workers or frontline workers.
- High rate of exposure to people outside the household.
- Living in a place where social distancing can’t be followed.
- Community with high risk of covid infection.
- Close contact with frontline workers.
- Females with other comorbidities like diabetes, hypertension, being overweight, immunocompromised state like AIDS.
- Pregnancy related complications, where frequent visits to hospital are needed, increasing your exposure risk.
Which females are at increased risk of getting complications, if infected with covid?
- Pregnant females with risk factors like high body mass index, advanced age.
- Females with existing comorbidities like diabetes, hypertension, asthma or other lung diseases, immunocompromised state like HIV/ AIDS, on immunomodulators.
- Pregnant females with kidney diseases, heart diseases or history of any thromboembolism.
Effects of getting covid in pregnancy:
On Mother:
Though most pregnant females recover from covid infection without much intervention, there’s a rapid deterioration in few. Pregnant females with symptomatic infection are at increased risk of hospitalization and complications.
Pregnancy outcome is also affected in these females leading to increased chances of hospitalization, premature labor, pre eclampsia, c-section and even death.
On fetus:
Most newborns are normal without any effects due to covid, and are in good health.
Few may be born prematurely, with low birth weight, some may require hospitalization or other interventions, and there may be intrauterine death in some cases.
Effects of getting covid vaccination in pregnancy or lactation:
In a study published in the American Journal of Obstetrics and Gynecology(AJOG) looked at 131 women of reproductive age group receiving one or two doses of mRNA vaccine. Its demonstrated that vaccine is highly effective in producing antibodies against the SARS COV 2 virus in pregnancy and lactating women.
The study also demonstrated that vaccine confer protective immunity to newborns through breastmilk and the placenta.
What if the pregnant female has already been infected with covid?
In case the female has been infected with covid in the current pregnancy, she can be vaccinated immediately after childbirth.
In case infection was in very early pregnancy or there’s high risk of exposure like in frontline workers, vaccination can be done for 6-8 weeks from recovery or 12 weeks from onset of infection.
Absolute contraindications for vaccination:
Contraindications in pregnancy are the same as in the general population. These include
- Anaphylactic or allergic reaction to previous dose of covid vaccine.
- Anaphylaxis or allergic reaction to any other vaccine or drugs especially injectable.
- Active covid 19 infection
- Any other acute illness going for which patient is undergoing treatment or hospitalization.
What’s recommended in other countries:
Many countries like the USA, UK, Australia, Canada, Singapore and Israel are vaccinating all pregnant females. In most countries pregnant females are being given the choice to decide after evaluating all the risks and benefits of vaccination or covid infection. Vaccination is being done by informed decision.
WHO also recommends vaccination of pregnant females provided the benefits of vaccination outweighs the potential risk.
It also recommends that pregnancy can’t be deferred due to vaccination. Pregnancy test prior to vaccination is not recommended, in females who are planning for pregnancy or are unaware of their status.
The Federation of Obstetrics and Gynecological Societies of India (FOGSI) recommends real benefits of vaccinating pregnant and lactating women seems to far outweigh any theoretical and remote risk of vaccination.
American College of Obstetricians and Gynecologists (ACOG) recommends covid vaccination of all pregnant and not pregnant females. Vaccines can be administered to females who are planning for pregnancy and no pregnancy test is required prior to vaccination.
The Royal College of Obstetricians and Gynecologists (RCOG) recommends offering vaccination to all pregnant females like the general population. Females are given informed choices after discussing every aspect.
International Federation of Gynaecology and Obstetrics (FIGO) recommends that there are no risks, actual or theoretical, that would outweigh the potential benefits of vaccination for pregnant women. FIGO also recommends that all other vaccines like Tdap or tetanus toxoid vaccine should be deferred for 14 days after completing covid vaccination series.
Any side effects of covid vaccination in pregnant women?
Based on all the studies till date, covid 19 vaccinations are unlikely to pose any risk to pregnant females or fetus.
Covid 19 vaccinations available are safe and there is no reason to defer pregnant women from vaccination in case of no absolute contraindication. As all vaccines available are attenuated or killed and not live so it doesn’t pose any threat of covid infection passing to the fetus.
Covid vaccination may have some side effects in pregnant females which are generally mild and are common for all persons like mild fever, headache, bodyache, pain at injection site, diarrhea for 1-3 days.
Very rarely some females may experience symptoms like
- Shortness of breath
- Pain, weakness or swelling in limbs
- Small pin sized reddish spots over the body or bruises
- Severe and persistent headache( without previous history)
- Pain in eyes or sudden change in vision
- Severe abdominal pain
- Persistent vomiting
If any of these symptoms occur within 20 days of receiving the vaccine, you should consult a doctor immediately.
Covid vaccination during lactation or menstruation:
Covid vaccination is safe and is recommended for women who are breastfeeding irrespective of the age of baby. Its advisable to continue breastfeeding like regular routine on the day of vaccination as well.
During menstruation, females can get covid vaccination like normal days. There is no scientific evidence to link menstrual cycle with any adverse effect due to covid vaccine. Females can get covid vaccine during any phase of their menstrual cycle.
So in general covid vaccination is safe and effective during pregnancy and should be taken, if you are an eligible candidate.
Other standard precautions like wearing mask, handwashing frequently, maintaining physical distance, should all be followed even after vaccination, till recommended by the authorities.
