Pregnancy is a time of mixed emotions for any family, but while parents look forward to carrying their bundle of joy, there is always a fear of something going wrong. The current pandemic has added more uncertainties to this otherwise rewarding journey.
When a woman is pregnant, her risk of contracting severe Covid-19 infection is higher than a woman who is not pregnant. Having said that, most Covid-19 infections during pregnancy are mild; however, women who are pregnant, and suffer from illnesses like asthma, heart disease and diabetes mellitus, or are obese, are at greater risk of infection and severe illness.
This means there is an increased risk of admission into intensive care, requiring breathing assistance, and possibly even resulting in death.
Severe illness is also more likely to occur in the second half of pregnancy as compared to the first half, and risks are also higher in the third trimester.
A pregnant woman who develops Covid-19 is twice as likely to have a premature birth or stillbirth. She is at greater risk of developing hypertension in pregnancy and undergoing an emergency caesarean section.
Clearly, Covid-19 is a condition that can have serious consequences for both mother and baby.
Fortunately, medical advancements in virology have allowed for the development of a vaccine in record time to combat this infection. The vaccination programme in Malaysia has prioritised pregnant women, and it is imperative that all those between 14 and 33 weeks of gestation be vaccinated.
Studies have indicated that the vaccine is safe throughout pregnancy — the vaccine is recommended from Week 14, after the first 12 weeks when major organ systems form in the developing foetus.
The general rule of thumb is to avoid medications and unnecessary interventions during this time. If, however, a woman is found to be pregnant a short time after receiving the vaccination, she should be reassured that this will not adversely affect her pregnancy. There is no increased risk of abnormalities or miscarriage associated with the vaccine.
It bears repeating that the vaccines available for pregnant women in Malaysia do not have the live coronavirus. This means the recipient will not fall sick with Covid-19 because of the vaccination. All the vaccine does is to build immunity against the virus in the recipient.
All vaccines available in Malaysia are safe but the messenger RNA (mRNA) vaccine is preferred – because the safety profile of this vaccine has been extensively studied, with over 130,000 vaccinations given to pregnant women in the United States without safety concerns.
The available evidence shows that the vaccine will reduce the risk of infection and severe disease in pregnancy. Vaccinations may also provide protection for the baby, as antibodies have been found in the blood of the umbilical cord.
Women who are breastfeeding should also receive the vaccination, to serve as protection against contracting the infection. Antibodies in the breastmilk may protect babies against the disease.
However, the exact extent of protection for the baby is still being studied. There are also concerns about menstrual and fertility disorders due to the vaccine, but the evidence does not support these claims.
While the safety of receiving the vaccine during pregnancy is clear, there will be those who may opt out, or may not be able to take the vaccine.
This, and the fact that the disease is evolving means that everyone will need to continue to exercise caution – physical distancing, using masks and maintaining a high level of hygiene – whether they are vaccinated or not.
Another issue that will need consideration is if the vaccination should be offered to pregnant adolescents, especially those below 18 years of age.
The Pfizer mRNA vaccination has been licensed for use from the age of 12 – but the possible risk of myocarditis and pericarditis, which are inflammatory conditions involving the muscles and a layer of tissue that covers the heart, has resulted in a decision not to extend vaccination to those below 18 for the time being in some parts of the world, including Malaysia.
The question that needs to be answered is if a young pregnant teenager should be vaccinated? There is good evidence from the US regarding the safety of this vaccine in such circumstances.
As such, the risks of withholding the vaccination must be weighed and discussed with the patient and her parents to facilitate an informed decision.
To summarise, all available vaccines are safe, and lives have been saved with their rollout. All pregnant women should be vaccinated, unless there are strong reasons not to do so.
We are all on a learning curve with regard to the Covid-19 pandemic, but for now, the general principle is “Safe Vaccine, Saved Lives”.
Assoc Prof Dr Ganesh Ramachandran is the Head of School at the School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.
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