KARACHI: Women who are pregnant or lactating are recommended to go for Covid-19 vaccination as the potential benefits outweigh risks, Special Assistant to the Prime Minister (SAPM) on Health Dr Faisal Sultan said on Monday.

“Viral infections are sometimes seen to be worse in pregnant women. Examples include chickenpox and hepatitis E. From information known at present, pregnant women have a higher risk for severe illness from Covid-19 when compared to non-pregnant women,” he added.

Responding to a query regarding pregnant and lactating women being refused vaccination, he said, “Vaccination centres staff are recommended to update their information from the national guidelines and seek any clarification in case of confusions.”

Over the weekend, the news of the death of two young pregnant women made rounds on social media. The deceased were not vaccinated. Infectious diseases doctors say the complications could have been avoided if the expectant mothers had opted for vaccination.

Women planning their pregnancy can take the Covid-19 vaccine if they choose to do so

In a tweet, former special assistant on health Dr Zafar Mirza said, “These 2 young women lost lives to COVID19. Both were pregnant and not vaccinated as they feared about negative effects on their babies. How tragic! PLEASE NOTE : COVID vaccines are safe in pregnancy. All pregnant should get vaccinated. Not getting vaccinated can be lethal.”

PakVac not advised for pregnant women

Since May 2021, the National Command and Operations Centre (NCOC) has been recommending pregnant women and breastfeeding mothers to get Covid-19 vaccination. In its comprehensive guidelines for Covid-19 vaccines, the NCOC has repeatedly said that both pregnant and breastfeeding/lactating women can receive any of the Covid-19 vaccines available in Pakistan. “The Covid-19 vaccines proved to be safe and effective for them during trials and use in general population.”

Vaccines including Sinopharm, SinoVac, Pfizer, AstraZeneca and Moderna can be given to pregnant or lactating women. Only PakVac is not advised for pregnant women.

Unfortunately, the staff at mass vaccination centres is either unaware of these recommendations or fears violent reaction “in case a woman miscarries” and hence turns away pregnant or breastfeeding women. Many women on contraceptives have been denied Covid-19 vaccination.

Meanwhile, the Society of Obstetrics & Gynaecologists of Pakistan (SOGP) and the Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP) strongly recommend vaccination of pregnant or lactating women as well as those using birth control against Covid-19.

In its position statement, the SOGP recommends Covid-19 vaccination for pregnant and breastfeeding women. “This is in agreement with professional OBGYN organisations like FIGO, ACOG, RCOG, CDC, WHO guidelines based on current evidence. The absolute risk of severe Covid-19 in pregnancy remains low, however it is now established that pregnant women are at increased risk of severe Covid-19-associated illness compared with non-pregnant women.

“Such illness can require hospitalisation, intensive care unit admission, mechanical ventilation and even death. Preventing critical Covid-19 infection is of paramount importance for both the mother and her foetus,” the SOGP statement added.

Clinical trials of Covid-19 vaccines specifically in pregnant women have not yet been conducted (some are under way or planned soon). Limited data from animal studies are reassuring and do not indicate direct or indirect harmful effects on embryo/foetal development or pregnancy. Additional reassuring data comes from a statement, released in the USA in the first week of February that 20,000 pregnant women had been vaccinated with no alarming signs reported.

“SOGP considers there are no risks — actual or theoretical — that would outweigh the potential benefits of vaccination for pregnant women and supports offering Covid-19 vaccination to pregnant and breastfeeding women.”

Call to educate gynaecologists

Talking to Dawn, SOGP chairperson Dr Sadia Pal said that unfortunately many gynaecologists were not aware about the recommendations and there was a need to educate them.

She added that healthcare providers should support pregnant women to make an informed decision regarding Covid-19 vaccination in consultation with their obstetrician. The society added that pregnant women who decline vaccination against Covid-19 should be supported in their decision and should be updated with new evidence when it becomes available.

“Women planning their pregnancy can take the Covid-19 vaccine if they choose to do so. Routine testing for pregnancy before Covid-19 vaccination is not recommended. Women who are trying to become pregnant do not need to postpone pregnancy after receiving a Covid-19 vaccine.”

Dispelling the notion that vaccines may lead to infertility or harm women, MMIDSP said that there is no contraindication to vaccination in women who are pregnant or planning to get pregnant.

“As more and more safety data is emerging, we know that Covid-19 vaccines are safe and effective for people. There is no evidence from animal or human studies and from large number of people who have been vaccinated that vaccine administration affects fertility or pregnancy outcomes. Covid-19 infection may lead to serious disease and death in pregnant women. Covid-19 vaccine prevents serious disease and has no harmful effects on the process of conception and on the developing foetus and is absolutely safe in pregnancy.”

The society stressed that risk of serious disease and death is high in pregnancy and the vaccine offers protection.

Published in Dawn, August 24th, 2021