NUWABAINE: What everyone needs to know about Covid 19 jabs in pregnancy

HEALTH & LIFESTYLE: Recently, the Ministry of Health (MoH) Uganda through their twitter account communicated that pregnant women and breastfeeding mothers who are part of the priority groups are now eligible for COVID-19 vaccination.

This is in-line with the recommendations from the World Health Organization (WHO), Centres for Disease Control (CDC), Royal College of Midwives (RCM), Royal College of Obstetricians and Gynaecology (RCOG), American College of Obstetricians and Gynaecology (ACOG) and the International Federation of Gynecologists and Obstetrics (FIGO).

1. Why is COVID-19 vaccine being recommended for pregnant women?

Although the overall risk of severe illness is low, pregnant women are at an increased risk for severe illness from COVID-19 when compared to their counterparts who are not pregnant. This severe COVID 19 illness requires hospitalization, intensive care unit (ICU), use of a ventilator to aid breathing and even death. Additionally, available evidence shows pregnant women with COVID-19 are at increased risk of preterm birth and other adverse pregnancy outcomes compared to their counterparts with no COVID-19. It is therefore important that pregnant women take all precautions to protect themselves from acquiring COVID-19, including taking vaccination against COVID-19. It is also advised that a pregnant woman should take a COVID-19 vaccine after being availed with all information especially about her risk of exposure to COVID-19, the risks of severe illness, the known benefits of vaccination and the limited but growing evidence about the safety of vaccinations during pregnancy.

2. Which pregnant women are at higher risk of getting infected with COIVD-19?

Every pregnant woman can contract COVID 19 however some women are a higher risk of getting infected than others. These include; pregnant women who are health care workers or frontline workers, those living in communities having high or increasing rate of COVID-19 infections, those frequently exposed to people outside their households like in markets and those living in crowded areas where there is difficulty in complying with social distance. Additionally, pregnant women who are aged ≥35 years, obese and have preexisting medical comorbidities such as hypertension, diabetes, kidney, lung and liver diseases among others are at high risk for severe COVID 19 disease and death.

3. How does COVID-19 affect the health of the pregnant woman?

The physiological and anatomical changes in the respiratory system during pregnancy have an impact on the lung function including alterations to the chest shape and elevation of the diaphragm by the pregnant uterus. This then causes a reduction in total lung capacity and inability to clear secretions making these women more susceptible to severe infections. Rapid clinical deterioration occurs, and symptomatic pregnant women are at increased risk of severe COVID 19 disease and death especially those with preexisting medical comorbidities.

3. How does COVID-19 infection in pregnant women affect the baby?

Most (> 95%) of the newborns of COVID-19 positive mothers have been in good condition at birth. In some research studies, COVID-19 infections in pregnancy have been found to increase the possibility of pre-mature delivery, small baby weight <2.5kg and in rare situations, the baby might die before birth.

4. Which pregnant women are at higher risk of developing complications after COVID-19 infection?

Available evidence shows that pregnant women who are > 35 years of age, obese, have underlying medical conditions such as diabetes or high blood pressure, respiratory, kidney and liver disease and those with a history of clotting/coagulation abnormalities among others are at a higher risk of developing COVID 19 complications compared to their counterparts who don’t have COVID 19.

5. If a pregnant woman has already had COVID 19, when should she be vaccinated?

According to the WHO, even if one has already had COVID-19 infection, they should be vaccinated when it is offered to them after they have recovered. This is because the protection that someone gains from having COVID-19 will vary from person to person, and there is no available evidence yet on how long ones’ natural immunity might last.

6. Are there any side effects of the COVID-19 vaccines that can either harm the pregnant woman or her fetus?

COVID-19 vaccines available are safe and vaccination protects pregnant women against COVID 19 illness/disease just like any other individuals. Pregnant women have not reported different side effects from non-pregnant women after vaccination with COVID 19 vaccine. After getting the vaccine injection, the pregnant woman may get side effects such as mild fever, headache, fatigue, chills, pain at the injection site and nausea among others, while others don’t even any side effects.

The scanty available evidence shows that actually COVID 19 vaccination to a pregnant woman might pass antibodies to her fetus. Recent reports have also shown that people who have received a COVID-19 vaccine during pregnancy (mostly during their third trimester) have passed antibodies to their fetuses, which could help protect them even after birth.

7. What precautions should a pregnant woman take after COVID 19 vaccination?

A pregnant woman and her family must be counselled and advised to continue adhering to the COVID19 standard operating procedures (SOPs) such as wearing a mask, frequent handwashing, maintaining physical distance, avoiding crowded areas and proper respiratory etiquette among others.

8. When should the vaccine be given to the pregnant woman?

According to the WHO, CDC, RCOG and ACOG, the COVID-19 vaccination schedule can be started anytime during pregnancy. However, some researchers have also come up and urged that since, there is little evidence/scanty research on COVID 19 vaccine use in pregnancy, it’s better when these pregnant women receive the vaccine > 12 weeks of gestation. This is because the first 12 weeks of pregnancy involve development of fetal organs among many other ongoing processes, hence fear for teratogenesis or congenital fetal abnormalities.

Myth buster: You cannot get COVID-19 infection from COVID 19 vaccination

The author; Lilian Nuwabaine Luyima is a BSc trained Nurse; MSN-Midwife & Women’s Health Specialist; lilian.nuwabaine@aku.edu