Issues confronting pregnant mothers during COVID

Dr Richa Sharma, Dr Amit Basnotra
Issues faced by Pregnant women –
There have been a sensitive segment of society that is pregnant mothers who have to face the Issues during COVID times and more so when either they are carrying a new life or have just given birth to new life in current situation which definitely creates a panic and stressful situation among them and the whole family as there are many aspects which still search for an answer
What cannot be done is not current motto but aim is to focus on what all can be done and what all necessary precautions etc need to be taken
Precautions During Pregnancy-
If you catch infection, definitely avoid panic and seek urgent care of physician and keep yourself and family members protected with synptomatic management and without any self treatment and taking all due corona preacutions
Precautions During Delivery- During your delivery also doctors and staff will take due precautions and as patient you also have to abide by the rules for your safety, your baby safety and also safety of other patients and staff as we all know we are fighting an invisible enemy
What all care needed to handle the new born baby- When the baby is delivered, due corona precuations to be taken and Covid test to be done as per Doctors instructions.You can continue with breast feeding with mask on with hand hygeine so that cross contamination can be avoided
Role Of Vaccination and how safe it is and with lots of unsolved questions-
COVID Vaccination-
Good part was discovery of COVID Vaccine at a very fast speed which had lots of concerns in the minds of general public to begin with but now slowly everybody accepting and taking it especially those above 18 years age
There are various kinds of Covid vaccines both Indian and International brands.
What are various current statements issued by India and Internationally at various platforms
As Per Govt Of India (MoHFW)
Interchangeability of Covid-19 vaccines is not permitted and pregnant and lactating women should not be administered the shots as they have not been part of any anti-coronavirus vaccine clinical trial so far, the health ministry said on Thursday.
In a letter to all states and Union territories, the ministry highlighted that under the emergency use authorisation, coronavirus vaccination is indicated only for 18 years and above. If required, the Covid-19 vaccine and other vaccines should be separated by an interval of at least 14 days. The second dose should also be of the same Covid-19 vaccine which was administered as the first dose
At International Platform, various statements have been issued related to COVD-19 Vaccines,future fertility,pregnancy and breastfeeding(Lactation)-
The latest advice from the Joint Committee on Vaccination and Immunisation (JCVI) is that COVID-19 vaccines should be offered to pregnant women at the same time as the rest of the population, based on their age and clinical risk group. Women should discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances.
There is no need to stop breastfeeding in order to be vaccinated against COVID-19.
Women trying to become pregnant do not need to avoid pregnancy after vaccination and there is no evidence to suggest that COVID-19 vaccines will affect fertility.
As of 16 April, COVID-19 vaccination is offered to the following groups of pregnant women:
Those with high risk medical conditions who have a greater risk of severe illness from COVID-19
Health or social care workers – who are at very high risk of catching COVID-19
Individuals considered at high risk of COVID-19 because of health and personal factors that include age, ethnicity, BMI and underlying health conditions
Women diagnosed with gestational diabetes in pregnancy or pregnant women with a BMI of more than 40
Individuals aged 45 or over
Risks of Vaccination –
The benefits and risks of COVID-19 vaccination in pregnancy should be discussed on an individual basis. The discussion should include acknowledgement that, while there is no known risk associated with giving other non-live vaccines to pregnant women, there are no specific data as yet about the safety of COVID-19 vaccination in pregnancy but definitely even in countries in which its permitted ,its still more of an individaul choice
What Does Clinical Trials say ?
The large clinical trials which showed that COVID-19 vaccines are safe and effective did not include pregnant women. This means there is limited information about the effects of COVID-19 vaccination in pregnancy. A very small number of women became pregnant after they received the vaccine in a trial. There was no sign of problems, but the numbers are too small to be certain.
As the COVID-19 vaccines were not tested in pregnant women, we cannot say for sure that they work as well in pregnant women as they do in other adults. However, there is no reason to think that the vaccines will not protect pregnant women effectively against COVID-19. Similarly, there is no reason to think that the vaccine will have worse side-effects in pregnant women.
One dose of COVID-19 vaccination gives you good protection against infection, but it is thought that this is not long-lasting and may not protect you for the whole of pregnancy. If possible, we recommend that you complete the course of vaccination before you become pregnant.
COVID-19 vaccine and fertility-
There is no evidence to suggest that COVID-19 vaccines will affect fertility.
There is no biologically plausible mechanism by which current vaccines would cause any impact on women’s fertility. Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.
Likewise, the theory that immunity to the spike protein could lead to fertility problems is not supported by evidence. Most people who contract COVID-19 will develop antibody to the spike and there is no evidence of fertility problems in people who have already had COVID-19.
COVID -19 Vaccine and IVF-
It’s a very challenging situation actually as what should an infertile couple and we are as if stuck as same stage. Definitely now we have vaccine in place but with lots of unsolved queries
Vaccination programs exclude all women trying to achieve a pregnancy, being pregnant, or breastfeeding, and the reason for this is fairly simple as there is no significant evidence yet that guarantees the vaccine’s safety to the above-mentioned populations.
Here we will mention various points of each group-
As Per European Society of Human Reproduction and Embryology (ESHRE) :
For women and men attempting conception, due to the limiting data on the possible effect of the vaccine on a future pregnancy, ESHRE cannot make any recommendations on with the vaccine should be performed. Vaccination could be considered in women that the benefits could outweigh any potential risks.
Women that have received the vaccine it is advisable to postpone conception to allow time for immunization.
For pregnant women vaccination should be performed after evaluating the risk and the benefits of performing the vaccine.
Moreover in a joint IFFS (International Federation of Fertility Societies and ESHRE statement), it is stated that the women that are planning to conceive have different options to women that are already pregnant. In more detail:
Women that are planning to conceive:
Either postpone pregnancy until effective measures to reduce the risk of contracting the virus have been implemented, such as lower infection rates or vaccination availability.
To not postpone conception, follow the safety guidelines and seek vaccination.
The first option, understandably, may not be the optimal solution for women of order reproductive age or shorter reproductive horizon. On the other hand, the second option is suggested in cases where the benefits of vaccination would outweigh any potential risks.
Women that are pregnant:
Follow all safety guidelines for COVID and postpone vaccination until after pregnancy
Proceed with vaccination as soon as possible while continuing to follow the already imposed safety guidelines.
Again, the discussion to proceed with the vaccination should be made after evaluation of each individual case and confirmation that this would be the most beneficial route.
CDC Statement-
The Centers for Disease Control and Prevention (CDC) states that women that are pregnant and lactating belong to the population eligible to receive the vaccine. Receiving the vaccine for each individual is a personal choice.
What women who are planning to get pregnant, are pregnant or lactating need to consider before finalizing their decision:
* Chances of exposure to the virus
* Health risk of a COVID-19 infection to the woman and the fetus.
* Vaccines’ potential risks
Patients who decide to proceed with the vaccination should still follow the imposed guidelines for COVID prevention.
What should we do as pateint and doctor?
That is the main question what should we do as patient and as doctor so the best approach is to follow your home-country’s guidelines along with your doctor’s recommendations with more of the individualized approach always taking into consideration medical history and current imposed guidelines
This article we hope will help you keep updated and we will continue the same as new information pours in.Till then stay safe and stay healthy
(The authors are Senior IVF Consultant Delhi NCR and Senior Gastroentrologist)