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The COVID Conundrum: Should pregnant & lactating women get their shot of protection?

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This past year and a half have been mind-numbing, and as we get hit with a devastating tsunami of the second wave of COVID, I find myself flooded with queries, doubts, a fear from women and their families on a question that has been plaguing the medical/research and administrative ranks – should pregnant women and lactating mothers be administered the COVID vaccine.
No doubt the pandemic has taken a physical, mental, and economic toll, and I feel the worst hit are women – the most vulnerable section of the society, subject to the emotional and physical labour of households in this state of crisis.
So, when the vaccine against this virus came out, instead of shouting hurray, I found myself amidst another conundrum – should she or should she not get the shot? I have been receiving calls daily – by pregnant women, by the reproductive age group, by those who want to conceive or are at the cusp of their periods, menstruating, or nursing/lactating – on whether they should get their COVID shots.

International professional bodies have taken a uniformly positive stand on the Covid-19 vaccine in pregnancy and lactation. The Federation of Obstetricians and Gynaecologists Society of India (FOGSI) has recommended that obstetricians, gynaecologists and women’s healthcare providers should be allowed to administer Covid-19 vaccines to pregnant and breastfeeding women with preparations to manage adverse events. Due to limited data available on the use of Covid-19 vaccines during pregnancy, especially of the vaccines available in India, FOGSI also added that individual practitioners cannot advise vaccination to pregnant and lactating women in India until there is a change in recommendations from the MOHFW, GOI.

So where do we stand?
Here are some pointers that will help clear the air and facilitate women in taking the right decision, one that hopefully gravitates towards good health –

The Vaccine: Now, the vaccines have been approved by the Central Drugs Standard Control Organisation (CDSCO) India for those above 18 years of age and are being produced in and for India are COVISHEILD (by Serum Institute of India in collaboration with Astra-Zeneca) and COVAXIN (by Bharat Biotech Ltd).COVISHEILD is an adenovirus-based viral vector vaccine, on the other hand, COVAXIN is an indigenous vaccine and is an inactivated (killed) whole virus vaccine.
The vaccine is administered to reduce the risk of infection, reduce the risk of severe acute morbidity and mortality, and prevent transmission to other individuals.
There is no doubt that mass immunization will ease the tremendous burden on the healthcare infrastructure and allow safe resumption of daily life.

Points to Ponder: There are 25 million births every year in India. The numbers are simply mind-blowing. There are concerns about adverse pregnancy outcomes such as miscarriage, low birth weight, preterm births, stillbirth, congenital anomalies.

There is a breather and assurance by the first Study conducted on vaccination in pregnant and lactating women published recently in the USA. The Study shows that COVID vaccination generates a robust immune response in pregnant and lactating women, equivalent to the general population. Additionally, protective antibodies were isolated in the umbilical cord and breast milk which implies protection to the foetus and new born. (10). This data, however, pertains to the 131 women who were given the mRNA vaccine. There is no such data on immunization of pregnant and lactating women with Covidshield or
Covaxin.

On the other hand, data from basic science and animal studies have not shown any teratogenic or adverse fatal or neonatal effects of the vaccine. Data from the American V- Safe registry is reassuring in this regard. There is no increase in maternal side effects with vaccine administration in pregnancy as compared to non-pregnant women. Women who have delivered after receiving the vaccine in pregnancy do not show any increased risk of the above-mentioned events. (14) This data pertains to the use of the mRNA vaccine in over 35000 pregnant women.

Take a Shot:
As matters stand in our country, every individual needs protection from the surging COVID- 19 infections. We are amid the second wave. There is a need to prevent further waves, and the vaccine is the best and long-term solution to this. This protection should extend to pregnant and lactating women. The benefits of vaccinating pregnant and lactating women seem to outweigh any theoretical and remote risks of vaccination.

To answer some of the questions:

* Is there is a specific time during periods to take the vaccine – no, it can be taken at any time. There is no physiological, endocrine, or immunological basis for such a consideration. Women should receive the vaccine on any day of the menstrual cycle, even during menstruation.

* There is also no evidence that the vaccine administration affects fertility or leads to miscarriages. Women should take the vaccine at any point in time before pregnancy is confirmed, as and when they have an opportunity to do so. There is no basis for deferring pregnancy or treatments for taking the vaccine.

* If someone conceives after getting one of the vaccine doses, there is no need to panic, fear, or terminate the pregnancy.

* One can avoid the second dose or defer it. Although there is substantial data yet to be collated and collected, there is no evidence of congenital malformations to date. Infections during pregnancy can lead to more complications, so we must empower women to discuss vaccination with their gynecologists/doctors freely and make an informed choice. Go ahead, take a shot to good health.

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