Pregnancy is a time of mixed emotions for any family. While looking forward to carrying their bundle of joy, there is always some anxiety about something going wrong. The current pandemic has added another uncertainty to this otherwise rewarding journey.
When a woman is pregnant, her risk of contracting a severe Covid-19 infection is higher than a woman who is not pregnant. Having said that, most Covid-19 infections in pregnancy are mild; however, women who are pregnant and suffer from illnesses like asthma, heart disease and diabetes mellitus, or who are obese, are at greater risk of infection and severe illness which means there is an increased risk of admission into intensive care, requiring breathing assistance and possibly even dying.
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 still birth. 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.
Luckily though, medical advancements in virology and vaccines have allowed 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, to avoid the first 12 weeks when major organs systems form in the developing foetus. The general rule of thumb is to avoid medication 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) vaccines are preferred because the safety profile of such vaccines has been best studied with over 130,000 vaccinations given to pregnant women in the US without safety concerns. The available evidence is that the vaccine will reduce the risk of infection and severe disease in pregnancy. Vaccinations may also provide protection to the baby, as antibodies to the virus 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 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 the vaccine in pregnancy is clear, there will be those who may opt out or who may not be able to take the vaccine. This, and the fact that the disease is evolving with mutations, means that everyone will need to continue to exercise caution – physical distancing, using masks and maintaining a high level of hygiene – 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.
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 these circumstances. As such, the risks of withholding the vaccination must be weighed and discussed with the patient and her parents to allow an informed decision.
In summary, the 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 Covid-19, but for now the general principle would be “Safe Vaccine, Saved Lives”.
Dr Ganesh Ramachandran is an obstetrician and gynaecologist.
The views expressed in this article are those of the author(s) and do not necessarily reflect the position of MalaysiaNow.