Doctors root for jabs from second trimester of pregnancy
The ministry of health and family welfare has approved Covid-19 vaccination for pregnant women underlining that the benefits of vaccination outweigh their potential risks. The only condition that the ministry has put forward is that the pregnant women should be informed about the risks of exposure to Covid-19 along with the risks and benefits associated with the three vaccines – Covishield, Covaxin and Sputnik V – available in India.
Mumbai is set to roll out vaccinations for pregnant women this week. Brihanmumbai Municipal Corporation’s (BMC) executive health officer Dr Mangala Gomare said they are in the process of training the staff and are likely to start the vaccinations from Thursday. While the Centre’s guidelines allow women to get vaccinated at any point during the pregnancy, some doctors said it is advisable to take the jab after the first trimester – from conception to 12 weeks of pregnancy.
The first trimester is when the process of organogenesis or formation of organs takes place. Medical experts do not prescribe any drug or vaccines during this period to avoid any interference in organ development. “The Covid-19 vaccines are completely safe, but I would be reluctant to prescribe them during the first trimester,” said Dr Kiran Coelho, gynaecologist, from Lilavati Hospital. “I would prefer that my patients take it after 12 weeks when the organogenesis is complete and the baby is simply growing in size,” she said.
The mechanism used by the three available vaccines is such that there is no possibility of viral infection crossing the placental barrier in pregnant women. Covishield and Sputnik V are ‘viral vector vaccines’ that use a harmless adenovirus to deliver the genetic material from the Covid-19 virus to the host and induce immunity.
Covaxin is a ‘killed virus vaccine’ which uses inactivated or killed genetic material of Covid-19 to induce immunity in the host. “The vaccines we currently have produce antibodies in the host and few studies have also found that these antibodies could be passed on from the mother to the baby, which would shield them from the infection,” said Dr Arun Nayak, head of gynaecology at the civic-run LTMG Hospital in Sion. “Live virus vaccines are a contraindication for pregnant women as there would be a risk of the viral infection crossing the placental barrier. But none of the vaccines available in India are live virus vaccines,” he said.
Nayak too said it would be advisable for pregnant women to take the vaccines after the first trimester. “It is a universally known precaution followed by all gynaecologists. We don’t prefer prescribing anything to pregnant women during the first 12 weeks,” he said.
VACCINES ARE SAFE
The Federation of Obstetrics and Gynaecological Societies of India (FOGSI) was the first body to push for vaccination for pregnant women. A position statement issued by FOGSI in April said there is no available evidence about any teratogenic effects caused by the vaccines. In medical terms, a teratogen is an agent that can disturb the development of the embryo or foetus. FOGSI, however, said women who get vaccinated in early pregnancy should not panic or should not be advised to terminate their pregnancies. They should be counselled that the risk of congenital anomalies does not rise above the baseline risk. At that time, FOGSI’s statement also said that “it would be prudent to defer vaccination in the first trimester as there is no substantial available data to establish the absence of teratogenicity.”
“Other countries that have opened vaccinations for pregnant women are allowing the jabs at any point during the pregnancy. We are also of the same opinion,” said Dr Alpesh Gandhi, the immediate past president of FOGSI. “We have been actively involved with the centre before it came out with the guidelines for pregnant women and there is consensus that women can take the jab at any point during the pregnancy,” he said.
Higher ICU admissions, fatality, among pregnant women in the second wave: study
There was eight-fold rise in the case fatality rate of pregnant women with Covid-19 during the second wave, a study carried out by doctors from civic-run BYL Nair Hospital and the National Institute for Research in Reproductive Health (NIRRH) has found. Published in the American Journal of Obstetricians and Gynaecologists, the study analysed outcomes of 1,143 pregnant women with Covid-19 who came to BYL Nair between April 1, 2020 to January 31, 2021 (considered as the period of first-wave by the researchers) and 387 pregnant women with Covid-19 who sought treatment at the hospital between February 1 to May 14, 2021 (second wave).
The case fatality rate among pregnant women jumped from 0.7% in the first wave to 5.7% in the second wave, an eight-fold rise. “The rates of severe Covid-19, admission to the intensive care unit or high dependency unit, case fatality rate, and maternal mortality ratio was higher during the second wave. The preterm birth rate and stillbirth rate were not statistically different,” the study said, adding that nearly 93% of maternal deaths were due to Covid-19 pneumonia and respiratory failure. The study noted a higher frequency of severe Covid-19, intensive care unit or high dependency unit admission, and maternal deaths during the second wave. Researchers said the highly virulent B.1.167 variant could have a role to play and underlined the importance of vaccination for pregnant and lactating women.