COVID19 Vaccination

Here are some key things to consider when deciding if you should get vaccinated when pregnant

Should I get vaccinated against COVID19 if I’m pregnant?

This article contains excerpts from a commentary piece by Professor David Bruce Matchar that appeared in CNA on the 27th March 2021. Read the full article here: https://www.channelnewsasia.com/news/commentary/covid-19-coronavirus-pregnant-vaccine-pfizer-modernasafe-effect-14487506

The nine months of a pregnancy are often a period of great joy, anticipation, and a fair share of trepidation. On top of all the worries and anxieties about becoming new parents, welcoming another life into the family, we also worry about the health of both the mother and foetus.

 The pandemic has only heightened these worries, especially given that pregnant women are at higher risk of severe COVID-19 than non-pregnant women, and COVID-19 has been associated with an increased risk of pre-term birth, according to the World Health Organization.

While vaccination remains the best defence against COVID-19, as of now, health authorities around the world remain cautious and recommend those who are pregnant to defer vaccination until more data becomes available. This is due to the exclusion of pregnant women in the safety and efficacy trials of the new COVID-19 vaccines. As of February 2021, Pfizer and BioNTech have launched their first vaccine trial for pregnant women to evaluate the safety and effectiveness of their COVID-19 vaccine in healthy pregnant women. International and local policy changes or recommendations on the vaccination are also likely to change accordingly when more clinical data is available and conclusive that COVID-19 vaccines are safe for pregnant women.

Should the COVID-19 vaccinations for pregnant mothers be approved, what then are the risks involved for an expectant mother to get a shot? Can one still be safe without it?

Here are two things to consider when deciding if you should get vaccinated when pregnant:

1)      NO SUCH THING AS ZERO RISK

No amount of research can guarantee absolute safety. What studies can do is to increase the confidence about the level of risk.

Scientifically speaking, pregnant women should not receive live-virus vaccines, which may present a hypothetical risk to the foetus. Neither the Pfizer-BioNTech nor Moderna vaccine contains a live virus. Although the data on the risk of vaccination of pregnant women is much less compelling than that for other adults, current data should give us high confidence that the vaccine will do no immediate harm. There was no evident signal of harm from more than 51,000 pregnant women participating in the v-safe Pregnancy Registry launched by US’ Center for Disease Control and Prevention.

Also, should a pregnant woman develop severe COVID-19 infections, which are much more serious than a bad cold (with symptoms including life-threatening pneumonia, damage to multiple organs, and prolonged complications lasting years), studies suggest that they are more likely to need intensive care than non-pregnant women.

2)      BALANCING RISKS AND BENEFITS

The critical question to ask is, therefore, what the balance between the risk (major side effect of the vaccine) and benefit (avoidance of severe COVID-19) is.

Based on currently accumulated data released in a CDC weekly report, of the more than 4 million people who have received the first dose of Moderna's COVID-19 vaccine, 0.03 per cent experienced adverse events. The chances of having severe adverse symptoms is under 0.003 per cent.

The benefit can also be higher if a surge of infections is active or is likely in the future.

 Risk estimates from Mathematica show that in the midst of a three-month COVID-19 surge, a pregnant woman has a greater than 1 per cent chance of both becoming infected and requiring hospitalisation. Effective vaccination has the benefit of avoiding the majority of those severe infections.

One additional benefit of vaccinating expectant mothers is the passing of protection to their babies, just like the flu shot or the tetanus, diphtheria and whooping cough vaccine (Tdap) which are actively recommended during pregnancy. While further data is needed to confirm this, a recent study of 20 women in Israel who received both doses of the Pfizer-BioNTech vaccine during their third trimester showed that antibodies were detected in their new-borns through placental transfer.

Presuming vaccine studies confirm that vaccine is safe broadly, policy constraints for vaccination will decrease and more people will feel more confident with the choice to be vaccinated. For pregnant mums who might find themselves with this newfound choice in the near future, by considering the possible consequences of the decision and the likelihood of those consequences, one should be assured that no matter the outcome, you made the most well-informed decision you could at that point of time. In the meantime, keep yourself safe by continuing to wear a mask, follow social distancing recommendations, and avoid crowds.

Professor David Bruce Matchar is Professor of Health Service and Systems Research at the Duke-NUS Medical School. Source: CNA/e

References
World Health Organization. (2 September, 2020). Coronavirus disease (COVID-19): Pregnancy and childbirth. Retrieved from World Health Organization: https://www.who.int/news-room/q-adetail/coronavirus-disease-covid-19-pregnancy-and-childbirth