As per the guidelines of the health ministry of India, pregnant women are now eligible for COVID-19 vaccination, at any stage of pregnancy. The guidelines, detailing the risks from COVID-19 infection in pregnancy, the benefits of vaccination, and the likely side-effects of vaccination, have been issued in order to help pregnant women make an informed decision. About 100 countries in the world allow some levels of permission regarding vaccination of pregnant women. The Indian government also recommended vaccination of pregnant women in early July 2021, but still concerns persist.
As for the timing for vaccination during pregnancy, it can be started at any time. However, vaccination might be considered later just to avoid any incorrect attribution of congenital anomalies to the vaccine. It must be given as early as possible to protect both mothers and their babies.
Safety Concerns
Generally, pregnant women are not included in vaccine trials for safety purposes. However, vaccinating them without trials may create complications and make it hard for regulators to recommend vaccination for pregnant women. A few women have undergone the efficacy trials of the mRNA vaccines, but no safety issues have been identified. As per an analysis of the real-world use of vaccines in pregnant women, published by Centres for Disease Control and Prevention (CDC) in the New England Journal of Medicine, 36,000 women who were given mRNA vaccines showed a small increase in pain at the injection site, but no other side-effects.
Even as the recommendations are in favour of administering inactivated vaccines or non-live vaccines or their equivalent to pregnant women, the data available so far is mainly based on mRNA vaccines.
As pregnancy increases the risk of venous thromboembolism (blood clot in the vein) four to five times for women, there are concerns as to whether the adenovirus vectored vaccines like Covishield should be given to pregnant women because such vaccines are related to a small risk of thrombosis with thrombocytopenia syndrome (TTS) in young people. But so far, there is no evidence indicating that vectored vaccines increase the risk of the thromboembolism in pregnancy.
Moreover, the claim by anti-vaxxers that the lipid nanoparticles of mRNA vaccines bind to ovaries lack any scientific basis as there are no findings from Development and Reproductive Toxicology (DART) studies that indicate this.
Pressing Need to Vaccinate Pregnant Women
Experts are of the view that the benefits of vaccination for pregnant women outweigh the potential risks. The risk factors for developing complications after COVID-19 infection during pregnancy include pre-existing co-morbidities; advanced maternal age; and high body mass index. Besides, certain categories and conditions like diabetes, organ transplant recipients, chronic respiratory conditions, those receiving immunosuppression therapies, dialysis, and congenital or acquired heart disease, too, can put pregnant women at a greater risk.
The following factors make vaccination quite necessary for pregnant women:
- Pregnant women are at an increased risk of severe illness from COVID-19 as compared to non-pregnant women.
- Pregnant women, infected with COVID-19, are at higher risk for preterm birth and may have a higher risk of other adverse pregnancy outcomes, including neonatal morbidity.
- Even though most pregnant women remain asymptomatic or have mild disease, their health is likely to deteriorate rapidly, which might affect the foetal outcome.
- As per the World Health Organization recommendations, pregnant women are at high risk of exposure to COVID-19. Similarly, pregnant women with co-morbidities are in a high-risk group for severe COVID-19 disease.
Possible Side-Effects of the Vaccination
As per the health ministry, available COVID-19 vaccines are safe and protect pregnant women like other individuals. The operational guidelines state that based on current knowledge, experts believe that COVID-19 vaccines are unlikely to pose a risk to the pregnant person or foetus. However, long-term adverse effects and safety of the vaccines for foetus and child are not established yet. A vaccine may have side-effects like any medicine. They are, however, normally mild—fever, pain at injection site, or feeling unwell for 1–3 days, etc. The possibility of a rare adverse reaction (one in 1–5 lakh) within 20 days after vaccination, needs attention.
Rare Symptoms
Following are some of the rare symptoms which may be traced in pregnant women after vaccination:
- Shortness of breath;
- Chest pain;
- Pain on pressing the limbs or swelling in the limbs;
- Small pinpoint haemorrhages or bruising of the skin beyond the vaccination site;
- Persistent abdominal pain with or without vomiting;
- Seizures in the absence of previous history of seizures, with or without vomiting;
- Weakness/paralysis of limbs or any particular side of the body;
- Persistent vomiting; and
- Blurred vision or pain in eyes.
Who should Avoid Vaccination
The contraindications for pregnant women are similar to those for the general population: allergic reaction to a previous dose; allergic reaction to vaccines or injectable therapies, pharmaceutical products, and food items.
If a woman has already had COVID, she should defer vaccination for 12 weeks from infection or 4 to 8 weeks from recovery. Those who were treated with monoclonal antibodies or convalescent plasma, or have active COVID-19 infection, should also temporarily avoid vaccination. However, if a woman gets COVID-19 infection during pregnancy, she should be vaccinated soon after the delivery.
Effects of COVID-19 on a Pregnant Woman
As per the ministry, although most infected pregnant women (more than 90 per cent) recover without the need for hospitalisation, there maybe rapid deterioration in health in a few cases. “Compared with pregnant women without COVID-19, those with symptomatic COVID-19 are at increased risk of adverse pregnancy outcomes, including admission to the ICU, iatrogenic preterm birth, pre-eclampsia-like symptoms, caesarean section and death.”
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