With over 18.4 million coronavirus cases in India currently, the pandemic’s second wave has impacted lives and healthcare services like never before. Around 147 million vaccines have been given in phases already and 24.5 million people are fully vaccinated.
During these unprecedented times, it is natural for countless doubts to arise regarding the Covid-19 vaccine’s safety and efficacy especially when it comes to pregnant women.
Dr Hrishikesh Pai, gynecologist and infertility specialist, says, “According to MOHFW, GOI’s current recommendations, Covid-19 vaccines cannot be administered to pregnant and lactating women in India. UK’s Royal College of Obstetricians and Gynaecologists has approved administration of Covid-19 vaccine to pregnant and breastfeeding women.”
Dr Pai says, “For non-pregnant women, and women who are not planning pregnancy, the vaccine can be taken anytime, on any day of the menstrual cycle and even during menstruation. They can take two shots at 4 – 6 weeks’ interval and wait for a minimum of 15 days after the second shot to have maximum protection.”
ALREADY PREGNANT WOMEN
Pregnant women and lactating mothers need to be given more attention because they are not only the more vulnerable population of the society but also, they are reported to have more severity and complications of this infection.
In the case of Covishield and Covaxin, the clinical trials had no involvement of pregnant and lactating women. The manufactures of the vaccine in India have not recommended these vaccines in pregnant and lactating women. At present there is no scientific data available on immunization of these women. Currently, it is recommended not to take these vaccines by pregnant and lactating women, until we get the final reports of the clinical trials regarding this matter. Doctors say that we are in an emergent need for clinical trials in different cohorts of vulnerable groups of individuals for these vaccines.
Dr Pai adds, “For women who are already pregnant, there are not many studies about safety of vaccines in pregnancy. However, there is a huge study from the United States where they have given vaccines to a lot of pregnant healthcare workers and there are minimal side effects. FOGSI (Federation of Obstetric and Gynaecological Societies of India) has issued a statement: This protection should extend to pregnant and lactating women. The very real benefits of vaccinating pregnant and lactating women seem to far outweigh any theoretical and remote risks of vaccination. Based on the FOGSI statement of April 2021, it would be appropriate if the Ministry of Health, Government of India modifies its advisory so that the pregnant and breastfeeding women can be vaccinated.”
Generally, pregnant women must register early with a tertiary hospital for delivery which has all facilities for ultrasound, laboratory, neonatal intensive care unit, and multispeciality team of doctors. Minimum of four to five physical visits including sonography with doctor and remaining tele/ video consultation throughout nine months is required. Follow a healthy diet, exercise preferably at home, take antenatal vitamins and supplements regularly.
WOMEN PLANNING PREGNANCY
There is a third group of women who want to become pregnant soon – either they are planning to conceive naturally, or are trying for fertility and IVF treatments.
In case of planned conception or IVF treatment, the current situation of pandemic dictates the postponing of the pregnancy. I would recommend that, in this pandemic, one should prioritise to take both the doses of vaccine, wait for the subsequent ovulation, and then plan the pregnancy. In IVF treatment there are indications like poor ovarian reserve which needs immediate actions to be taken for conception. In such a scenario, one can collect the eggs and freeze them and can be transferred after taking the vaccine.
BREASTFEEDING AND VACCINATION
It has been reported that the viral molecule is not expressed in breast milk. Breast feeding new-born is recommended in healthy women as well as she can take the vaccine. However, breast feeding the new born is not recommended in virus positive women. The vertical transmission of COVID-19 from mother to child has been reported. However, the clinical trial data is not enough to comment on the transmission due to lactation to the new-born, the severity of the disease and its complications.
Vaccination of lactating mothers is strongly advised. It will protect the mother hence the baby will not be infected by the mother. Protective antibodies produced by the vaccine can pass through mother’s milk to child and provide extra protection.
PREGNANT WOMEN TESTING POSITIVE AND PROXIMITY TO POSITIVE PATIENTS:
If a family member of a pregnant woman gets symptoms or tests positive, one must isolate them.The woman should quarantine herself and get tested, wear a mask at home and should not be the caregiver for the patient. If the woman herself gets symptoms or tests positive, seek tele consultation with both obstetrician and physician preferably a joint consultation. Don’t panic, check oxygen saturation levels four times daily, do a three-minute walk test, check baby movements and start medications only on the advice of your doctor. If you feel sick, breathless or fever doesn’t subside inform your doctor who may advise admission early as pregnant women fall in the high risk group for infection as their immunity is compromised. If you are close to your expected date of delivery and you or your family members are exposed to Covid infection inform your obstetrician who can plan your delivery better.
MUST KEEP IN MIND…
Covid19 virus is a new disease. Knowledge about the course, immediate, short term and long term effects of the disease is limited but fast accumulating. The mutants of the virus are changing and hence the presenting symptoms, infectivity, severity, morbidity and mortality are also changing. We don’t have medicine to cure the disease or stop its spread. Only thing we have is, preventing the disease and treating its effect on the body. Vaccines are not full-proof prevention but certainly reduce the possibilities of acquiring the infection, reduce the severity of infection and hence reduce the complications and death chances.
COVID-19 VACCINE DOES NOT CAUSE INFERTILITY!
Dr Pai feels that because we do not have much data about the safety of the vaccine, it is better to wait for two months after taking the second shot of the vaccine before you start the fertility treatments. He adds, “Please note that the Covid-19 vaccine does not cause infertility. There is no connection between vaccine and infertility.”