I'm pregnant. Should I get the Covid-19 vaccine?

On April 17 last year when the HealthyNation team visited the Kenyatta National Hospital Covid-19 isolation wards, we met *Anita in one of the wards.

She knew that respiratory viruses were especially dangerous to pregnant women and the distressed 31-year-old had just been brought to the isolation ward from a quarantine facility after she was confirmed to have the coronavirus.

The young woman, who had earphones plugged into her phone, was one of the two patients admitted at the facility at the time.

She had just concluded a consultation with her gynaecologist through the window since he could not get near her without wearing proper personal protective equipment .

A year later the country is experiencing the third wave of Covid-19 and pregnant women like Anita are still in danger of getting the virus even though there is a Covid-19 vaccine.

The danger is something Ann Kiboh, a resident of Kakamega County, knows all too well. Ann, who is three months pregnant, says she wanted to get the vaccine but upon inquiry, the antenatal care nurse at the hospital she visits advised her against it.

“I inquired and was advised to hold on until the test is complete to confirm whether the vaccine is safe for me and the child,” she says.

This is why many pregnant women like her have not been able to get the vaccine despite the fact that should they get sick, they are at a higher risk of needing ventilators compared to other women.

The Centers for Disease Control and Prevention considers Covid-19 an acute threat during pregnancy. It states that Covid-19 is uncommon in children born to mothers who had Covid-19 during pregnancy.

Past pandemics

Some newborns have tested positive for the virus shortly after birth but is unknown if they got the virus before, during, or after birth. CDC further reveals that most newborns who tested positive for Covid-19 had mild or no symptoms and recovered.

However, there are a few reports of newborns with severe Covid-19 illness.

In November last year, CDC revealed that pregnant women might be at increased risk for severe illness associated with coronavirus disease. The report, which analysed 400,000 women aged between 15 and 44 years who had Covid-19 symptoms revealed admission in intensive care unit, invasive ventilation, extracorporeal membrane oxygenation, and even death were more likely in pregnant than in non-pregnant women.

This is not just limited to Covid-19. Past pandemics have shown that pregnant women are at great risk of hospitalisation and even death.

The American Journal of Obstetrics and Gynecology (AJOG), which looked into previous influenza pandemics (1918, 1957, and 1989), found out that pregnant women have higher rates of morbidity and mortality.

Respiratory viruses pose great risks to pregnant women because their lungs work harder than usual. When a woman is pregnant, the uterus pushes against the diaphragm reducing lung capacity taxing an oxygen supply divided between mother and foetus.

Pregnancy also lowers that immune system so that the baby is not harmed, making the woman more susceptible to complications from an infection.

Since the pandemic started pregnant women have had a difficult time and the choice to vaccinate or not has been hard for most especially with the misinformation going around.

A Facebook group for pregnant and nursing women where the topic was discussed recently is proof of just how little information is out there in regards to whether they should be vaccinated or not.

Based on how the Covid-19 vaccines work in the body, experts believe they are unlikely to pose a specific risk for pregnant women. However, data about the safety of the  vaccines on these mothers is limited.

In Kenya where the government rolled out vaccination on March 5, health workers, security personnel, clergy, teachers and other staff in learning institutions are on the priority list of getting vaccinated.

Just recently the government added people aged 58 years and above to the priority list. Pregnant women are not part of the list.
Covid-19 vaccine taskforce chairperson, Dr Willis Akhwale, says that the fact that the vaccines have not been tried on pregnant women is enough reason for them to stay away from it for now.

“It is important to note that indications on usage for any pharmaceutical products, including vaccines, depends a lot on what happens during trials. As you know, trials begin with animals before moving to humans and in the first instance, only a handful of individuals participate,” he says.

Lactating women

“From the information we have, the vaccines were not tried on pregnant and lactating women and therefore there was no information available for this demographic by the time we got emergency use authorisation. As a precaution for this group, therefore, vaccination is not advised,” he says.

Dr Akhwale adds that until there is enough information on how the vaccine affects pregnant women, the government will not be offering it to them.

“The data, which was reviewed to grant Emergency Use Authorization, did not include pregnant or lactating women. They will only be used when research among this population is conducted and their safety confirmed,” he says.

A recent study published on March 25 by the American Journal of Obstetrics and Gynecology reveals that the vaccines offer strong immune protection for people who are pregnant, just like their non-pregnant peers.

The new paper joins other early findings that antibodies to Covid-19 generated by pregnant mothers after receiving their vaccines were passed through the placenta to the foetus.

The American College of Obstetricians and Gynecologists (ACOG) supports the vaccination of pregnant women. ACOG states that the vaccine should be offered to pregnant women given the strong evidence that pregnancy elevates the risk for severe Covid-19 and death.

“ACOG recommends that Covid-19 vaccines should not be withheld from pregnant individuals. Covid-19 vaccines should be offered to lactating individuals similar to non-lactating individuals,” says ACOG.

They further recommend that expected side effects should be explained as part of counselling patients, including that they are a normal part of the body’s reaction to the vaccine and developing antibodies to protect against Covid-19 illness.

Side effects from the vaccinations were mild and similar to those of non-pregnant women, including soreness at the injection site after the first dose and some muscle aches, headache, fever and chills after the second dose.

The CDC says clinical trials that look at the safety and how well the Covid-19 vaccines work in pregnant women are underway or planned. “Vaccine manufacturers are also monitoring data from people in the clinical trials who received vaccine and became pregnant. Studies in animals receiving a Moderna, Pfizer-BioNTech, or Johnson & Johnson’s Janssen Covid-19 vaccine before or during pregnancy found no safety concerns,” it adds.

High-risk conditions

“CDC and the Federal Drug Administration have safety monitoring systems in place to gather information about vaccination during pregnancy.”

The guidelines on the Covid-19 vaccine rollout have not been consistent around the world.

Some countries and regions believe that the benefits of the vaccine on pregnant women outweigh the risks. It is for this reason that countries like Israel, parts of Canada, and some US states have chosen to offer the vaccine to pregnant women and enlist them among the priority groups.

Washington, D C and more than 40 US states  have added pregnancy to their lists of eligible high-risk conditions. So far 60,000 pregnant women have been vaccinated, says the CDC.

In Uganda, people over 65 years and essential health workers are the only ones listed in the priority group. Other countries like Germany and the UK stand with the World Health Organization (WHO) which recommends that pregnant women should wait.

Health Specialist at Unicef Kenya, Dr Peter Okoth, is in agreement with this and he says that only the attending doctor can waive the risks of the Covid-19 vaccine and the potential effects on the pregnancy. This, he says, is because there is not enough research done on pregnant women so far.

“The clinical trials for the vaccines did not include pregnant women and until now there is no sufficient data from those who have taken the vaccine to show that it is indeed safe for them,” he says.

Dr Okoth refers to the WHO recommendations on the Covid-19 vaccine that says there is “very little data are available to assess vaccine safety in pregnancy”.

“Based on what we know about this kind of vaccine, we do not have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women. For this reason, those pregnant women at high risk of exposure to Sars-Cov-2 (such as health workers) or who have comorbidities which add to their risk of severe disease, maybe vaccinated in consultation with their health care provider,” says the WHO.

When it comes to mothers who breastfeed, however, Dr Okoth says breastfeeding is beneficial to mother and child and that the Covid vaccines are believed to pose minimal to no potential risk to the newborn through breast milk.

Despite the government not including pregnant women in the priority group, doctors like Ahmed Kalebi, founder of Pathologists Lancet Kenya say there is no difference between pregnant women and other people when it comes to the immune reaction to the Covid-19 vaccine.

Lower immunity

“The vaccines, whether the mRNA like Pfizer & Moderna, or modified viral components like AstraZeneca and Sputnik, are meant to induce an immune reaction from the body’s immune cells and antibody production upon being injected in the body, such that in future the body can quickly respond to any exposure to the Sars-Cov-2 virus,” he says.

Dr Kalebi says none of the Covid-19 vaccines use live viruses so they do not cause any infection or any harm to the body, not even in pregnancy. He believes they have no risks to the mother and the foetus.

“Because all these vaccines were developed on an emergency basis to deal with the pandemic, not much studies have been done on their safety and efficacy in pregnancy. For obvious reasons in that no manufacturer would want to delve into that area at this emergent time,” says Dr Kalebi.

Dr Simon Kigondu, a gynaecologist at the Murang’a Level Five Hospital and a member of the Kenya Obstetrical and Gynaecological Society,  says pregnant women with Covid-19 have other risk factors including asthma, obesity, non-pregnancy related diabetes, high blood pressure or heart disease and should be considered in the priority group for the vaccine.

“Women who are pregnant fall into the category of vulnerable groups because when you fall pregnant your immunity goes down. So far we have seen a high mortality rate among pregnant women who have Covid-19, which is why some gynaecologists advise the patients to get the vaccine. This is because the benefits outweigh the risks in most cases,” he says.

Dr Kigondu says the society refers to the International Federation of Gynecology and Obstetrics (Figo) recommendations for Covid-19  vaccination of pregnant and breastfeeding women.

The professional organisation, that brings together obstetrical and gynaecological associations from 132 countries, says that pregnant women are at increased risk of severe Covid-19 associated illness compared to non-pregnant women. It says they require hospitalisation, intensive care unit admission, and mechanical ventilation or may even die.

This they see as a good enough reason to prevent critical Covid-19 infection for both the mother and her foetus. Figo states that no risks outweigh the potential benefits of vaccination for pregnant women and supports offering Covid-19 vaccination to pregnant and breastfeeding women.

No alarming signs

On their site, they say:  “Given that clinical trials of Covid-19 vaccines specifically in pregnant women have not yet been conducted and given the limited data available on their efficacy and safety during pregnancy, there is not sufficient evidence to recommend the routine use of Covid-19 vaccines for pregnant or breastfeeding women.

Figo says the limited data from animal studies has shown that the vaccine causes no harm to the embryo or foetal development or pregnancy and that the data from the US indicates thousands of pregnant women had been vaccinated with no alarming signs reported.