*Covid Update -204*

*Covid vaccination in Pregnancy*

*Government of India on 25 June 21 approved covid-19 vaccination for pregnant women*.

The Ministry of Health has issued guidelines that covid-19 vaccine can be given to the *pregnant women*.

Note : MoHFW had already recommended vaccine for lactating women in second Half of May 21

*Is it just permission or recommendation?*⁉️

In its latest statement, the Union Health Ministry said pregnant women “can and should” get the COVID vaccine.

*What are precautions before vaccination during pregnancy?*

🌹◆Pregnant women should be fully informed that “the long-term adverse reactions and the safety of the vaccine for foetus and child are not yet established.”

🌹◆They should follow the 30 minutes of in-hospital observation rule post-vaccination.

*When should Vaccine be given during pregnancy?*⁉️

COVID-19 vaccine can be provided *any time during pregnancy*.

*Why do Pregnant women need Covid vaccine more than non-pregnant women*?

Yes because:

💦◆Higher risk of *severe disease* after infection, resulting in ICU admission, mechanical ventilation, and death in pregnant woman than non pregnant

💦◆ Risk us even higher in Pregnant women with *coexisting illnesses such as diabetes, hypertension, and obesity*

💦◆ Higher risk of *pregnancy complications — preterm birth, cesarean delivery, and preeclampsia* — associated with Covid-19 during pregnancy.

💦◆Even Indian study from ICMR showed that

Second wave of pandemic hit pregnant and postpartum women more severely compared to the first. *Case fatality rate (CFR) among pregnant women and postpartum women was 5.7% (22/387) during the second wave, in comparision to 0.7% in first wave*. Overall CFR~2%

*What is the vaccine safety data during pregnancy so far?*

🔰◆Robust Safety *data of as high as 35,691 pregnant woman* of 16 to 54 years of age from.USA

🔰◆Of these ladies 86.5% had a known pregnancy at the time of vaccination, and 13.5% reported a positive pregnancy test after vaccination.

🔰◆ *29% received vaccine in the Ist Tm, 43% in the second trimester, and 26% in the 3rd Tm*.

◆Data pertains to mRNA Vaccines being used in USA

🔰◆Delivery after vaccination: Among live-born infants, the incidences of preterm birth (9.4%), small size for gestational age (3.2%), and congenital anomalies (2.2%) were consistent with those expected on the basis of published literature in pre-pandemic period

🔰◆There were no neonatal deaths.

*What about Efficacy of vaccines in pregnancy?*⁉️

Antibody levels were measured in maternal blood as well as Fetal Cord Blood after vaccination in a

prospective study of of 131 vaccine recipients (84 pregnant, 31 lactating, and 16 nonpregnant women).

‼️ *It is noteworthy to read results*:‼️

🔰◆Vaccines generated *robust humoral immunity in pregnant and lactating women*, similar to nonpregnant women.

🔰◆ *Vaccine-induced immune responses were greater than seen after natural infection*.

🔰◆ *Immune transfer to neonates occurred via placenta and breast milk*.

(Results with m RNA vaccines)

*Can the Pregnancy safety and efficacy data of mRNA vaccines be extrapolated to vaccines available in India*?⁉️

🔰◆Yes: In such an precedented situations like covid pandemic we need to rely upon science.

🔰◆Data from Other Vaccines in pregnancy

So far, other non-live, inactivated vaccines and toxoids (recombinant or killed organism) tdap have not reported to cause adverse effects in pregnant woman .

🔰◆None of the clinical trials of the vaccine available so far (including Covishield and COVAXIN) have included pregnant and lactating women as study subjects for obvious risks and compensation issues.

🔰◆But now with thousands of doses of mRNA vaccines having been used in pregnancy and Covishield and Covaxin having been tried tested in Crores of people we can exercise in favour of these vaccines with possibility of little risk even in pregnant woman

🔰◆None of the vaccines – Covishield and COVAXIN – that are being administered in India, are live-virus vaccines.

🔰◆Covishield codes for spike protein like mRNA vaccines (but using different technology)

🔰◆ COVAXIN is being made using time-tested age-old technologies of killed virus.

Since there is no live Virus to cause any harm.

*I am still concerned*‼️

◆Before the vaccine rollout clinicians relied on developmental and reproductive animal and started trials in larger public interest and same principals are to be applied in case of vaccines being used in India.

◆ *Various Organization have also advocated for use of vaccines in Pregnancy*

🔰●(FOGSI)The Federation of Obstetricians and Gynaecologists Society of India recommends Covid-19 vaccines to pregnant and breastfeeding women in India

🔰◆CDC USA says – “If you are pregnant, you can receive a COVID-19 vaccine”

*What does WHO say about Covid vaccination during pregnancy?*📢

WHO strongly *advocates vaccination of pregnant woman with currently available covid vaccines*

“..the benefits of getting the vaccine definitely outweigh the risks, particularly since the platforms that we used currently for vaccines are the mRNA platform, inactivated viruses or the viral vectored platforms or subunit proteins. None of them have a live virus that can multiply within the body and that could potentially create a problem. So, I think it’s important that pregnant women in every country be explained the benefits…” -Dr Soumya Swaminathan Chief Scientist WHO

*Getting vaccinated during pregnancy* pays dividends.

*One Vaccine Saves Two Lives*

drskgupta@gmail.com