January 24, 2022

Coronavirus Infection, the disease and vaccination in pregnant and lactating mothers in India.

“It is not the strongest of the species that survives, nor the most intelligent. It is the one that is the most adaptable to change.” – Charles Darwin.

It’s January 2022 and every passing day now brings us a rise in the number of cases of the Coronavirus disease – the pandemic is slowly moving onto its way to become endemic. The pregnant and lactating mothers in our country have for long now encountered enormous amounts of anxiety, confusion, myths and unanswered questions revolving around COVID 19. It’s important to rely on scientific data, rather than hear-say for something as life altering as the vaccine.

A motivational Mithila painting

Here’s a scientific take on the frequently asked questions related to the disease, infection in pregnancy and more importantly the vaccine.

• How does covid infection affect a pregnant mother and her pregnancy?

In the current wave of covid ( omicron variant ) - two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms . Pregnant women with symptoms of cough, fever, myalgia and a stuffy nose – are NOT at an increased risk of SEVERE disease or complications.

Most pregnant women recover from the illness as with the common cold and require only this = temperature control with paracetamol, plenty of fluids, monitoring of temperature pulse and oxygen saturation, isolation from elderly and children and following Covid appropriate behavior (CAP).

Covid infection in any trimester of pregnancy in the current variant has NOT been associated with miscarriages, anomalies or complications in the baby or delivery process.

However pregnant mothers with diabetes, heart disease, morbid obesity, advanced age and vascular disease are at an increased risk of ICU admissions due to lower respiratory tract involvement and hence require critical care and monitoring. There have been isolated reports of preterm labor, sudden onset hypertension or eclampsia, sudden cardiac arrest, still birth and decreased amniotic fluid in a few pregnant patients with COVID 19 most of these towards term. However, most infected patients recover without preterm delivery.

In small proportion of pregnant mothers who contract severe Covid infection and are extremely unwell – there could be preterm labor pains or they may warrant a preterm delivery by the doctor - to reduce the strain on their respiratory system.

One in twenty pregnant women with COVID 19 infection require hospital admission. 95 percent of these mothers are unvaccinated.

• Is it recommended to take the COVID vaccine in pregnancy and post delivery?

The Covid vaccine in pregnancy (as per current data) is safe and is recommended as a preventable measure against severe Covid infection , ICU admission , ventilator requirement and death. Various routine immunizations in pregnancy like tetanus and influenza are given with the intent to protect the mother from severe disease. At the same time these vaccines protect the baby in the womb with antibodies too. (Passive immunization) – hence preferable to take the vaccine within the 36th week. Protective antibodies from the immunized breastfeeding mother to the baby are transferred through breast milk.

The same applies to the Covid vaccine and hence it is recommended by the MOHFW and FOGSI to be taken by all pregnant women and lactating women after their well informed consent, irrespective of their stage of pregnancy.

The WHO recommends that the COVID vaccine should be taken in pregnancy – as pregnant and lactating mothers are at a risk of exposure and are in a physiologically immunosuppressed stage.

• Is there a risk for couples trying for a pregnancy, undergoing infertility treatment or who have just conceived and are in the early pregnancy stages - with the vaccine?

No there is no risk. There is no mandatory pregnancy testing required before the vaccine nor does it affect the outcome of the infertility treatment. The vaccine is deemed safe.

• Is there a category of pregnant patients in whom the vaccine should NOT be taken?

The COVID vaccine is contraindicated in the following cases:

History of allergy or anaphylaxis to previous vaccines.
Active symptoms of COVID and infection.
History of confirmed COVID infection in the last 12 weeks
COVID-19 infection previously treated with anti-COVID-19 monoclonal antibodies or convalescent plasma
Acutely unwell and hospitalized (with or without intensive care) patients due to any medical illness

• Which vaccine brand is the safest – COVAXIN, COVISHIELD and PFIZER?

With the data from the mRNA vaccine PFIZER coming out early – its safety profile has been reassuring in pregnant women and has shown almost negligible adverse outcomes.

However the two vaccines widely available to the pregnant and lactating in India are COVISHIELD and COVAXIN. The major fear revolving around these vaccines is that of thrombosis of forming blood clots. Pregnancy and the days post-delivery are also a natural thrombogenic state.

With the data and studies that are available – it remains unknown whether the risk of thromboembolism increases due to vaccination in pregnancy or in the puerperium – the data is still evolving. However based on extrapolated risk analysis from the general population, it seems the risk of thrombosis in low risk pregnant women after vaccination is extremely rare.

Hence both vaccines are safe and are recommended in pregnant and lactating mothers. In special situations like women with history of hypertension, cardiac disease, anticoagulant medication or epilepsy – COVAXIN is preferred due to a slightly better thrombotic profile. This decision is to be taken after a proper consult and opinion of the health care provider or obstetrician.

• What are the immediate side effects of the Covid vaccine in pregnancy?

Like many vaccines, the COVID vaccine may have side effects which are normally mild. After getting the vaccine injection, one can have mild fever, pain at the injection site or feel unwell for 1-3 days. The fever is harmless to the pregnancy or the foetus.

Unusual symptoms like chest pain, breathlessness, leg cramps, swelling in the body and abdominal pain that appear within 20 days of the vaccine need to be reported promptly.

• Is it true that pregnant women who opt out of the vaccine out of personal choice will not be allowed to deliver in a hospital of their choice or not issued a baby birth certificate?

Pregnant Women are counselled by their health care providers, recommended and empowered to make their own decision, supported by caregivers. However there is no force or repercussions as above should a woman chose not to take the vaccine. The decision lies with the mother alone.

• Even after taking the vaccine can a pregnant mother still get infected with COVID 19?

Pregnant or lactating mothers who receive the vaccine - can be infected even after taking two doses of the vaccine. However there is almost negligible risk of severe disease or ICU admission in vaccinated pregnant mothers.

• Once vaccinated should pregnant and lactating mothers still follow CAP (Covid appropriate behavior)?

Yes, even after vaccination they should follow the standard preventive safety measures like wearing a mask, hand wash and social distancing in public places.

• Does the virus cross the amniotic fluid in the womb or breast milk post-delivery in a mother with an active COVID infection?

The coronavirus is not known to cross the placenta and into the amniotic fluid – if so in near nil amounts. This is why the fetal effects are negligible. It doesn’t transfer in breast milk either. A newborn can be infected only through airborne transmission from the mother and the infected newborns almost always have very mild disease.

The Coronavirus is not Novel anymore and is mutating by the day. Hopefully into strains and waves that will eventually become inconsequential and routine like the common cold.

The Benefits of the vaccine FAR OUTWEIGH the supposed risks.

Receiving two doses of the vaccine is the safest and most effective way of protecting a pregnant mother and her baby from COVID-19 infection. The second dose ensures long lasting protection.

Let’s COVACCINATE our pregnant and breast feeding mums – to ensure a healthy living for them and the little ones of our future.

‘Care is an absolute, prevention is ideal’