Benefits of opening COVID-19 vaccination for pregnant women outweigh theoretical risks, here's why

Expectant mothers in India can now opt for a COVID-19 jab after the Centre revised its position this week regarding vaccinations for pregnant women.

The lack of sufficient data has been seen as a key factor that discouraged health authorities from rolling out vaccines for women during pregnancy, but it is now widely agreed that this group is among the most vulnerable when it comes to developing serious symptoms from the disease.

Are pregnant women at increased risk of getting COVID-19?

No. A factsheet released by the Union Ministry of Health on vaccination for pregnant women notes that "pregnancy does not increase the risk of COVID-19 infection and most pregnant women will be asymptomatic or have a mild disease".

More than 90 percent of pregnant women who do get infected "recover without any need for hospitalisation", the ministry added.

But a very small percentage of pregnant women who catch COVID-19 may experience a "rapid deterioration in health". The ministry said that symptomatic pregnant women appear to be at an increased risk of severe disease and death. Pregnant women who are aged above 35 years or have underlying medical conditions like high blood pressure, diabetes or obesity, or have a history of clotting in the limbs are at a higher risk of contracting severe illness due to COVID-19.

How can vaccination protect pregnant women, newborns?

Given the risk profile, pregnant women should adopt the same precautions as the rest of the population to ward off COVID-19, and that includes getting vaccinated, the ministry said.

Vaccination is crucial for the health of the child, too. The ministry notes that over 95 percent of babies born to COVID-19 positive mothers "have been in good condition at birth" though in some cases, COVID-19 in pregnancy "may increase the possibility of premature delivery".

That is, "the baby's weight might be less than 2.5 kg and in rare situations, the baby might die before birth", the ministry said.

The recommendation for pregnant women to get vaccinated assumes importance at a time when experts have warned of a third wave of COVID-19. A study by the Indian Council of Medical Research (ICMR) found that symptomatic cases among pregnant and post-partum women during the second wave were significantly higher at 28.7 percent as against 14.2 percent in the first wave.

The fatality rate, too, was higher at 5.7 percent in the second wave compared with 0.7 per cent in the first wave.

Noting how a "vaccine is the best and long-term solution" against future waves, the Federation of Obstetric and Gynaecological Societies of India (FOGSI), said that "the very real benefits of vaccinating pregnant and lactating women seem to far outweigh any theoretical and remote risks of vaccination".

That is a position taken by the World Health Organisation (WHO) as well.

 

Its chief scientist Soumya Swaminathan said, "In situations where there is a lot of COVID transmission in the country and a woman is exposed to it, or if she's in a profession like a healthcare worker or a frontline worker where she's at especially high risk of acquiring the infection, the benefits of getting the vaccine definitely outweigh the risks".

Why have authorities waited till now to allow vaccines for pregnant women?

If some countries have been slower in rolling out vaccination for pregnant women than the general population it is because most trials of the  COVID-19 vaccines included pregnant or lactating women.

According to the COVID-19 Maternal Immunisation Tracker, or COMIT, maintained by the Johns Hopkins University, "The variability in policy positions is in part a consequence of the absence of evidence on vaccines in pregnancy, because pregnant and lactating people are excluded from the vast majority of clinical trials."

However, FOGSI refers to a study in the US on vaccination in pregnant and lactating women — which it says is the first of its kind — that showed "COVID vaccination generates a robust immune response in pregnant and lactating women, which is equivalent to the general population".

It noted that "protective antibodies were also isolated in umbilical cord blood and breast milk, implying protection to the foetus and newborn". The study of 131 women involved those who had received an mRNA vaccine, two of which — Pfizer-BioNTech and Moderna — are the chief shots being used in the US.

What is the advice on side-effects?

The health ministry factsheet says that "the vaccines available are safe and vaccination protects pregnant women against COVID-19 like other individuals".

It points out that pregnant women, thus, can develop normal side effects like any other person.

"Like any medicine, a vaccine may have side effects which are normally mild. After getting the vaccine injection, a pregnant woman can get a mild fever, pain at the injection site or feel unwell for 1-3 days," the ministry said, adding that "long-term adverse effects and safety of the vaccine for foetus and child is not established yet".

But it notes that "very rarely", a pregnant woman may experience specific symptoms such as shortness of breath, chest pain, persistent abdominal pain, etc. within 20 days of getting a dose. The frequency of such cases may be 1 in 1-5 lakh persons, the ministry said, adding that such cases "require immediate attention".

Are there any specific vaccines for pregnant women?

FOGSI notes that the US study on vaccination among pregnant woman did not cover any of the vaccines being used at present in India — Covishield, Covaxin, or Sputnik V — but experts are of the view that all the vaccines available now can be equally recommended for pregnant women.

Experts do consider live attenuated vaccines — which contain a weakened version of the whole pathogen and, while providing excellent immune response, carries the risk of multiplying too much within the body and causing disease — may be inadvisable for pregnant women. But none of the vaccines currently in use against COVID-19 use this platform.

According to WHO's Dr Swaminathan, the vaccines in use are based either on the mRNA, inactivated virus, protein subunit platforms and none has "a live virus that can multiply within the body and that could potentially create a problem".

While there may not be studies specifically covering the use of the vaccines okayed in India among pregnant women, at least when it comes to the Oxford-AstraZeneca vaccine, the UK's Royal College of Obstetricians and Gynaecologists (RCOG) says there "are no reported concerns with the AstraZeneca vaccine in pregnancy".

The Oxford-AstraZeneca vaccine, of course, is the same as the Covishield shot that is being made under licence in India by the Serum Institute.

The UK may be prioritising the mRNA vaccines for pregnant women, but RCOG notes that it is because there is "less experience in pregnancy with (AstraZeneca), than with the Pfizer and Moderna vaccines".

All the same UK authorities maintain that "all those who have received a first dose of the AstraZeneca vaccine should continue to be offered a second dose of AstraZeneca vaccine, irrespective of age".

How many countries are vaccinating pregnant women?

The COMIT database says that currently 17 countries, not including India, make an "explicit recommendation that some or all pregnant people should receive vaccination".

A further 57 countries have either permitted vaccinations for pregnant women or are extending jabs to "only certain groups of pregnant people" like health workers and those with underlying conditions.

Of these, 34 countries, excluding India, are such that are using the Oxford-AstraZeneca shot in their vaccination drives.