Pregnancy is deemed one of the most memorable and precious moments for a woman. However, with the current pandemic, many pregnant women find themselves in a vulnerable state.
According to the Centers for Disease Control and Prevention (CDC), pregnant women who have Covid-19 appear more likely to develop respiratory complications requiring intensive care than women who aren’t pregnant. They are also more likely to be placed on a ventilator.
A study published in medical journal JAMA Paediatrics also found that women who contracted Covid-19 had higher risks for death, preterm birth, and preeclampsia.
There are many similar research papers, which has prompted public health officials around the world to recommend Covid-19 vaccines to pregnant women to protect themselves and their babies.
However, despite all these vulnerabilities, some pregnant women — as well as those who are planning to get pregnant — are in two minds when it comes to being vaccinated, since they are unsure if there are any effects on their fertility, pregnancies, and ultimately their babies.
While clinical trials of the Covid-19 vaccines on pregnant women is still ongoing, the current data made available from the mRNA vaccines on Covid-19 vaccination in pregnancy did not point to any safety concerns for the vaccinated women or their babies.
The mRNA Covid-19 vaccine available in Malaysia is Pfizer. “If you get the infection when you’re pregnant, chances are you will get the most severe form of the disease. Reports have shown that if you get infected with Covid-19 during your third trimester, the death rate is also higher. Therefore, I strongly advise you to take the vaccination when you’re pregnant, ” said Prof Nazimah Idris, medical director for IMU Healthcare (IMUH) and Professor of Obstetrics and Gynaecology at the International Medical University (IMU).
“If you are in a high-risk group, I would strongly advise that you get vaccinated,” added Prof Nazimah.
This group includes women over 35, and are obese, diabetic or hypertensive. If your day-to-day activities exposes you to many people, you are considered a high risk too.
If you are not in any of these categories, then there is the option of delaying your vaccination after you have given birth, provided that you have assessed your risks with your doctor.
Regarding the side effects of the vaccination in pregnant women, Prof Nazimah advises that it is no different from a non-pregnant person.
“You will have side effects that are the same as women who are not pregnant — soreness at injection area, you may feel feverish, experience headache and body ache,” she said..
“The vaccine itself does not affect your baby. It does not get transmitted from the mother to the baby during your pregnancy, ” she added. “But if you’re vaccinated, it will affect the baby in a good way. All vaccines work by triggering our own body to produce antibodies. These antibodies can be transmitted to the baby and the baby will have some form of protection.”
It is interesting to note that the antibodies can also be excreted through breast milk, so your baby gets both nutrition and protection.
Prof Nazimah advises those who plan to be vaccinated to first consult with their obstetrician and get an assessment done.
It is advised for pregnant women to be vaccinated between Weeks 14 and 28 of their pregnancies, so they will be best protected against the more severe form of disease in the third trimester.
If you are already in the third trimester, the Ministry of Health has advised that you can still get yourselves vaccinated up to 33 weeks of pregnancy.
For those who are trying to conceive, Prof Nazimah recommended some planning be involved.
“I would suggest that you to complete your vaccination dose first before you try to get pregnant. This way you are already protected. Or even if you’ve taken the first shot and found out that you were pregnant after, you don’t have to worry,” she said.
“Just continue with the pregnancy as usual because we know that vaccination in the first trimester does not increase the miscarriage rate.”
As for whether vaccination affects one’s fertility, a simple biology fact clears the air.
“Your menstrual cycle, your ovulation, your ability to get pregnant depends on your hormonal cycle from your hypothalamus to pituitary to your ovary. The Covid-19 vaccine does not affect this or your chances of getting pregnant in any way,” explained Prof Nazimah.
Currently, there are three vaccinations available in Malaysia — Pfizer, Sinovac, and AstraZeneca. The advisory now is that Pfizer can be given to both pregnant women and lactating mothers, and AstraZeneca for the latter.
To ensure that you are given the most appropriate vaccine, you can provide more information on your status in the MySejahtera app, and your appointment will be based on the vaccine that is suitable for you at a particular vaccination centre.
“For pregnant women, we recommend that you be vaccinated with the Pfizer vaccine as it has been studied the most for pregnancy. So there is safety data to make that recommendation. As for the other two, research is still ongoing,” said Prof Nazimah.
Should one be worried if they took the AstraZeneca vaccine and found out they were pregnant later? Not at all, said Prof Nazimah.
“The vaccine itself does not affect the pregnancy. We have much experience with vaccination and vaccination in pregnancy, and we have knowledge of how it affects you and the pregnancy. So even if you have received another type of vaccine, I wouldn’t worry too much,” she said.
Ultimately, vaccination is a personal choice. But when dealing with Covid-19 and the fact that pregnant women are known to have significantly higher risks for severe coronavirus-related complication, the issue of protection is critical.
Prof Dr Nazimah Idris is a Professor of Obstetrics and Gynaecology at the International Medical University’s School of Medicine and also the Medical Director at IMU Healthcare. She is also a consultant obstetrician and gynaecologist registered under the National Specialist Registry.