Fact-Sheet to guide the Medical Officers

Why is COVID 19 vaccine being recommended for pregnant women?

• Pregnancy does not increase the risk to COVID-19 infection, but current evidence indicate that pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women in case they get infected.
• Additionally, pregnant women with COVID-19 are at increased risk for preterm birth and might have an increased risk of other adverse pregnancy outcomes including higher chances of neonatal morbidity
• Most pregnant women will be asymptomatic or have mild disease, BUT their health may deteriorate rapidly and that might affect the foetal outcome.
• It is important that they take all precautions to protect themselves from acquiring COVID-19, including taking vaccination against COVID-19.
• WHO recommends vaccination in pregnant women when the benefits of vaccination to the pregnant woman outweigh the potential risks, such as pregnant women at high risk of exposure to COVID-19andpregnant women with comorbidities that place them in a high-risk group for severe COVID-19 disease.
• It is therefore advised that a pregnant woman should take COVID-19 vaccine.

Who are at Higher Risk of getting infected with COVID-19?

• Someone who is a health care worker or a frontline worker.
• Community having high or increasing rate of COVID-19 infections.
• Frequently exposed to people outside the household.
• Difficulty in complying with social distancing if living in a crowded household.

How does COVID 19 affect the health of the pregnant woman?

• Although most (>90 percent) infected pregnant women recover without need for hospitalization, rapid deterioration in health may occur in a few.
• Symptomatic pregnant women appear to be at increased risk of severe disease & death.
• Compared with pregnant women without COVID-19, those with symptomatic COVID19 are at increased risk of adverse pregnancy outcomes, including admission to the ICU, iatrogenic preterm birth, pre-eclampsia-like symptoms, Caesarean section and death.

How does COVID 19 infection of pregnant women affect the baby?

• Most (over 95 percent) of newborns of COVID-19 positive mothers have been in good condition at birth.
• However, Covid-19 in pregnancy increases the chances of preterm birth, increasing the possibility of hospitalization for the neonate and in some cases even death.

Which pregnant women are at higher risk of developing complication after COVID 19 infection?

Risk factors for developing complication after COVID 19 infection during pregnancy are:

• Pre-existing co-morbidities, advanced maternal age, and high body mass index are risk factors for severe COVID -19 in pregnancy4.
• Pregnant women with certain high-risk conditions have greater risk of severe illness from COVID-19 such as
  
  • Pre-existing medical conditions e.g. Diabetes
  • Organ transplant recipients
  • Chronic respiratory conditions like COPD, Asthma, Cystic Fibrosis
  • Homozygous sickle cell disease
  • Receiving immunosuppression therapies (enough to significantly increase risk of infection)
  • Dialysis or advanced chronic kidney disease
  • Congenital or acquired heart disease

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

- In case a woman has been infected with COVID-19 infection during the current pregnancy, then she should be vaccinated soon after the delivery.

Are there any side effects of the COVID 19 vaccines that can either harm the pregnant women or her foetus?

• COVID 19 vaccines available are safe and vaccination protects pregnant women against COVID 19 illness/disease like other individuals.
• Based on current knowledge, experts believe that COVID -19 vaccines are unlikely to pose a risk to the pregnant person or foetus5.
• Like any medicine a vaccine may have side effects which are normally mild. After getting the vaccine, she can get mild fever, pain at injection site, or feel un-well for 1-3 days.
• The long-term adverse effects and safety of vaccine for foetus and child is not established yet.
• Very rarely, (one in 1-5 lakh persons) the beneficiary may after COVID 19 vaccination, experience some of the following symptoms within 20 days after getting the injection which may need immediate attention 

Symptoms occurring within 20 days after receiving any COVID 19 vaccine

• Shortness of breath (difficulty in breathing)
• Chest Pain
• Pain in limbs / pain on pressing the limbs or swelling in the limbs (arm or calf)
• Small pinpoint haemorrhages (petechial) or bruising of the skin beyond the vaccination site
• Persistent abdominal pain with or without vomiting
• Seizures in the absence of previous history of seizures with or without vomiting
• Severe and persistent headaches with or without vomiting (in the absence of previous history of migraine or chronic headache)
• Weakness/paralysis of limbs or any particular side of the body
• Persistent vomiting without any obvious reason
• Blurred vision/ pain in eyes

Any other symptom or health condition which is of concern to the recipient or the family

Are there any specific contraindications for vaccination in Pregnancy?

As for the general population, pregnant women should avoid vaccination in the following conditions:

• Anaphylactic or allergic reaction to the previous dose of COVID-19 vaccine
• Anaphylaxis or allergic reaction to vaccines or injectable therapies, pharmaceutical products, food-items etc.
• Vaccine is temporarily contraindicated in the following conditions:
  
  • Diagnosed COVID-19 infection – defer for 12 weeks from infection or 4 to 8 weeks from recovery
  • Active COVID-19 infection
  • COVID-19 infection treated with anti-COVID-19 monoclonal antibodies or convalescent plasma

What are the global recommendations and practices on vaccination of pregnancy women in other countries?

Given the potential benefits and risks of the vaccine, International professional bodies have taken a positive stand on the COVID-19 vaccine in pregnancy. These bodies acknowledged lack of data in pregnancy.

• WHO recommends use of recombinant vaccine in pregnant women, provided the benefits of vaccination outweigh the potential risk. Pregnant women may also be exposed to COVID-19 vaccine before the woman knows she is pregnant.
• WHO does not recommend pregnancy testing prior to vaccination and delaying pregnancy or terminating pregnancy because of vaccination.
• International Federation of Gynecology and Obstetrics (FIGO) believes that risk-based approach to immunization might be of disadvantage to the pregnant woman.
• The Royal College of Obstetricians and Gynecologists (RCOG) states that pregnant women should be offered the vaccine as the general population6.
• The American College of Obstetricians and Gynecologists (ACOG) states that pregnancy testing should not be required prior to receiving vaccine and vaccine may be administered to the people who may consider future pregnancy. Women under age 50 including pregnant women can receive any COVID-19 vaccine. However, they should be aware of the rare risk of thrombosis with thrombocytopenia syndrome after receipt of mRNA vaccines.
• Countries such as Australia, Canada, Israel, Singapore, United Kingdom and United State of America are vaccinating pregnant women with COVID-19 vaccines.

Source : Ministry of Health and Family Welfare