KUALA LUMPUR, August 13 — The Ministry of Health (MOH) now recommends Covid-19 vaccination for pregnant women after 12 weeks of pregnancy, while advising informed decision-making for those who want to get inoculated earlier.
In an August 10 update to guidelines on Covid-19 vaccination in pregnancy and breastfeeding — which previously recommended the first dose in pregnant women between 14 and 33 weeks of gestation — MOH cited the v-safe data registry and the New England Journal of Medicine (NEJM) preliminary findings on mRNA vaccine safety that found only a small minority of mothers received their vaccination in the first trimester, while the majority were inoculated in the second trimester.
“Thus, it is optimal to offer the vaccination after 12 weeks of pregnancy, as to ensure organogenesis has completed, while we await long-term safety data among those vaccinated in the first trimester,” MOH said. Organogenesis is the period of time when organs are being formed during the embryonic phase.
“However, pregnant mothers should be encouraged to make informed decisions if they choose to receive the vaccine before 12 weeks of gestation.”
MOH said mRNA vaccines remain the preferred shot for pregnant women due to their best available safety data, but noted that vector-based and inactivated vaccines are not contraindicated in pregnancy. Pfizer-BioNTech is an mRNA vaccine, while AstraZeneca-Oxford and Sinovac are vector-based and inactivated vaccines respectively.
“Balancing the benefits of vaccination against the risks, pregnant mothers should not be denied the benefits of vaccination at any gestation. Vaccination should be offered at any gestation following an informed decision,” said MOH, adding that pregnant women should complete Covid-19 inoculation before their late second and third trimester when they are most vulnerable to coronavirus infection.
MOH also encouraged women to complete their Covid-19 vaccination before getting pregnant.
“Although there is increasing evidence on the benefits of mixing vaccines and boosters among vaccinated adults, it is not yet a standard of practice in pregnancy,” MOH said, referring to heterologous coronavirus vaccination and third booster jabs for two-dose regimens.
The United States’ Centers for Disease Control and Prevention (CDC) said in a statement Wednesday that all pregnant women or women thinking about becoming pregnant are encouraged to get vaccinated against the coronavirus, highlighting severe Covid-19 disease among unvaccinated pregnant women and the spread of the highly transmissible Delta variant.
A new CDC analysis on Covid-19 vaccination early in pregnancy did not find an increased risk of miscarriage among nearly 2,500 pregnant women who received an mRNA vaccine before 20 weeks of pregnancy.
The United Kingdom’s Royal College of Obstetricians & Gynaecologists stated last July 19 that Covid-19 vaccines are considered safe and effective at any stage of pregnancy.
“However, some women may choose to delay their vaccine until after the first 12 weeks (which are most important for the baby’s development) and have the first dose at any time from 13 weeks onwards, but there’s no evidence that delaying is necessary.”
Health director-general Dr Noor Hisham Abdullah said Wednesday that 70 deaths of pregnant women due to Covid-19 complications were recorded in Malaysia as of August 9. The proportion of pregnant women among critical Covid-19 cases increased from 3 per cent on July 10 to 5.3 per cent on August 7.
He noted that based on annual estimates of pregnant women in the country, only 40 per cent of pregnant women have registered on MySejahtera for their Covid-19 shots. Dr Noor Hisham also recommended that pregnant women complete coronavirus inoculation before entering the third trimester.