COVID-19 Vaccination in Pregnant Women and Lactating Moms

Vaccination in Pregnant Women: A lot of questions and speculations are hovering around in the minds of the masses regarding the safety of COVID 19 vaccination in pregnant women and Lactating mothers.

Pregnant women, especially are considered to be a ‘High-risk group’ for COVID-19 infection. Not because a pregnant mom is more prone to the infection but because if they get infected, they are at a higher risk of developing severe illness, hospitalisation and complications. Breastfeeding mothers are also considered a special group because of the speculation whether a COVID-19 infected mother can give the infection to the newborn directly or indirectly

The vaccination against COVID-19 in India has been on since January 2021 and is phased into different groups. So far the vaccine is being given safely to masses mainly in the age group of above 45 years of age. Recently, the vaccine has been started to be given in the age group of 18-44 years. Obviously, the discussion of vaccination in Pregnancy and lactation comes in question mainly in the most recent drive.

According to the latest updates, Vaccination has started with permission from MOHGov for Breastfeeding mothers. For pregnancy, one can take it provided she is ok with the fact that not enough studies are out regarding the safety profile. Animal studies have been found to be safe. One would need a certificate from the doctor saying that she is pregnant and that she is willing to take the vaccination at her own will
Logically, the Vaccination should not cause any major side effects in pregnancy either to the mother or to the fetus. And the benefits of being protected against COVID 19 is definitely desirable during pregnancy

Why does one need to take vaccinations against COVID-19?

• To reduce the risk of infection as it is a public health problem
• To reduce the risk of severe illness and death from the infection
• To prevent long-term effects of infection
• To prevent transmission to other individuals

Studies have shown that various vaccines have a 70 to 90% protection rate. All vaccines available all over the world has been almost equal in terms of efficacy and safety profile with statistically insignificant differences.

Individuals should take the COVID-19 vaccine that is available to them at the earliest opportunity.

However, the Ministry of Health, Govt. of INDIA has clearly categorised pregnant and lactating mothers as ‘a CONTRAINDICATED” group for COVID-19 vaccination. Which means the GOI has not allowed this vaccination yet to be used by pregnant and lactating women.

Other countries like UK, USA and Australia have allowed certain vaccines in pregnant women believing that it will confer significant benefits to this group. The international bodies have also clearly mentioned the need of follow up for these women to find out about the long-term safety and dissemination of the proven benefits. Most of the vaccinations that are being given are the mRNA vaccines such as Pfizer/ Moderna and J&J in view of the maximum trials done with them in pregnancy and lactation.

Indian regulating bodies taking care of women’s health also believes that the benefit might be enormous in saving a mother’s and newborn’s life. But the vaccination drive is on hold for this group only because of lack of substantial data in form of robust trials and studies regarding the two vaccines available in India. Though it has been found to be safe in animal experiments, the safety profile is yet to be sufficiently backed up by human data for the current vaccines available in India.

“With new data from across the world, this may be due for a revision to broaden the vaccine drive and include pregnant and lactating women based on the emerging global data. At the present time, it is emphasized that individual practitioners cannot advise vaccination to pregnant and lactating women in India until there is a change in recommendations from the MOHFW, GOI.”

(Position  Statement by the federation of Obstetrics and Gynaecology of India)

The regulating bodies are putting all the efforts to come up with sufficient data to make it available as a recommendation from the Government of India. Women in this group are, therefore, advised not to take the vaccination till government recommendations come in.

Some key points

1. Though vaccination against COVID-19 has largely been found to be safe in pregnancy and lactation, the Indian Government and regulating bodies are advising against it due to the lack of studies and sufficient evidence around the two vaccines available in India.
2. India might soon come up with a positive recommendation especially with the advent of Pfizer and other mRNA vaccines in India.
3. If someone has taken the vaccination in pregnancy or during breastfeeding, it should be considered safe and hence abortion or cessation of breastfeeding is not recommended. It also has no evidence of causing miscarriages or to cause any congenital abnormality in the baby.
4. Vaccination against COVID- 19 does not affect fertility.
5. Women undergoing treatment for fertility or planning a pregnancy can safely take this “Women should take the vaccine at any point of time before a 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”.
6. Vaccination can be done at any time of a woman’s cycle including during periods.
7. No pregnancy testing is needed before vaccination.
8. Vaccination is advised  to women infected with COVID 19 in the past. As for the general population, vaccination can be deferred for 4 to 12 weeks from recovery.

Dr Sudeshna Ray is a senior Gynecologist and Obstetrician attached to Jaslok and H N Reliance hospitals, Mumbai. The views expressed are the author’s own.