COVID-19: What pregnant women in India need to know before getting their vaccine

After months of deliberating on the subject, the Indian government’s advisory group for vaccines has allowed pregnant women to get immunised against Covid-19.

On July 2, the Indian government brought out an operational guideline (pdf) for vaccinating pregnant women, including details on educating them about the risks from the vaccines versus the risks of getting infected with Covid-19. Those eligible will be able to get any of the three vaccines currently authorised in India—Covishield (the local version of the AstraZeneca vaccine), Sputnik V (imported from Russia), or Covaxin (India’s homegrown vaccine).

The decision to open up the vaccines to pregnant women comes on the heels of an ebbing second wave, which overwhelmed healthcare facilities in the country and devastated entire families. Several pregnant nurses and doctors, ineligible to receive the vaccine despite working in high-risk environments, also died because of Covid-19. In May, the government greenlighted the vaccine for women who were lactating or breastfeeding.

Research has shown that pregnant women are at greater risk of severe illness and death from Covid-19. This risk further increases in women who have co-morbidities like diabetes.

But the government’s guidelines remain silent on the overall risk assessment of the vaccines and the timeframe for getting the vaccine.

Should pregnant women get vaccinated?

Most doctors concur that a vaccine is the best armour against fighting Covid-19. There is no known risk to the fetus and, in fact, studies have shown that pregnant women could even pass on their antibodies to their newborn children.

“We must note that we do not have trials for how the vaccine (Covishield and Covaxin) affects pregnant women. However, the data we have based on the other vaccines that are being administered world over indicate that the vaccines are safe,” says Dr Nupur Gupta, director of obstetrics and gynaecology at the Fortis Memorial Research Institute in Gurugram.

Pregnant women also interact heavily with healthcare services throughout the three trimesters, often needed to visit high-risk places like laboratories and hospitals. And with a more transmissible Delta variant, which is believed to have caused havoc during India’s second wave and infected entire families together, and protection becomes more imperative.

“Considering the high mortality that was witnessed in the second wave, one can make an informed choice, especially those pregnant women who have medical comorbidities and pregnant women who go out for work,” she adds.

Gupta also adds that pregnant women who have been infected with Covid-19 should follow the same protocol that exists for others in India—get their vaccines three months after recovery.

When should pregnant women get vaccinated?

According to India’s health ministry, expectant mothers can get vaccinated at any point of time during their pregnancy. But doctors want them to exercise some caution. “I feel you can take it in your second trimester because by then the baby’s organs have also developed,” says Gupta. “Though it is not a live virus, I think the second trimester will be safer overall.”

But since original trials did not include pregnant women, most countries that have opened up vaccinations for this group have created their own guidelines based on the vaccines available and the assessment of risks.

Which vaccines are safe for pregnant women?

This lack of trial data has led countries like the US and the UK to caution against the viral vector vaccines—technology that the Sputnik V and Covishield shots are based on.

Viral vector vaccines, which use a modified and harmless virus to trick the body into producing antibodies, have also had issues with side effects. Several studies have shown that vaccines like AstraZeneca’s and Johnson & Johnson’s single-dose Janssen put people at risk of developing clots.

But this risk is still low, and in a risk-benefit analysis—especially given the high case numbers like during India’s second wave—generally has favoured vaccinating against Covid-19 with whichever vaccines may be available.

For pregnant women with known risks of clotting, though, this might be a risk they would want to discuss at length with their doctors. “We still need data on the risk of clotting in pregnant women. However, my advice is that before you get the jab, connect with your OB and discuss this aspect,” says Gupta of Fortis Memorial hospital.

Countries like the UK do not use AstraZeneca vaccines in pregnant women altogether, while the US has issued an advisory for women under the age of 50 to avoid getting the Janssen shot.

This is also because mRNA vaccines such as Pfizer’s and Moderna’s have seen more studies with respect to side effects and pregnant women. These vaccines are currently not available in India, though Moderna has received an emergency use authorisation in the country and is likely to be available soon.

But till such a time as these are available, a detailed conversation with one’s physician—and the availability of the vaccine—will determine the course for pregnant women in India.