Vaccination for Pregnant Women

 Synopsis: There is need for urgent vaccination for mother’s to-be to minimise the impact of the coronavirus infection. 

Why there is need to vaccinate mother-to-be? 

• Firstly, India’s demographic dividend is largely dependent on its high birth rate.
  • According to a recent publication in the Journal of the American Medical Association, maternal mortality is several-fold higher in COVID-19 positive pregnant mothers than in non-COVID-19 pregnant women. 
• Secondly, the recent reports from Kerala have showed many serious medical problems faced by pregnant women who contract COVID-19. 
• Thirdly, maternal and neonatal complications increase with maternal obesity and diabetes in pregnancy which is common in India. But pandemic has worsened the situation by increasing complications such as: 
  • Pre-eclampsia, pre-term labour maternal infections. 
  • Increased caesarean section rates. 
  • Fetal growth restriction due to placental insufficiency and still births,  
  • Neonatal infections and respiratory distress.  

Measures need to be taken to protect mother-to-be: 

• Firstly, vaccination should be taken up on a war footing. 
  • Alert women in the reproductive age group and the medical profession. 
  • Advise all women to postpone pregnancy till both partners are vaccinated and offer vaccination to all un-vaccinated pregnant women. 
• Secondly, decrease the number of women who would seek antenatal advice to avoid risk exposure to infection. 
  • Temporary and reversible contraception is a simple and effective way to postpone pregnancies. 
• Thirdly, dedicated and safe ultrasound scan centers for pregnant women and unvaccinated health-care workers should be quickly vaccinated. 
  • Pregnant women with fever should be considered to have COVID-19 unless proven otherwise. 
• Fourth, pregnant women should be vaccinated with inactivated vaccines. Pregnancy and the immediate postpartum period are pro-thrombotic states. It promotes the formation of blood clots in veins.  
  • The vectored vaccine (Covishield) is found to be associated with rare serious side effects pertaining to thrombosis of the veins draining critical areas such as the brain and intra-abdominal organs. 
  • World Health Organization has given a nod to the use of the inactivated Synovac vaccine. 
  • Therefore, the inactivated vaccine available in India (Covaxin) has advantages over the vectored vaccines (Covishield and Sputnik) for pregnant women. 
• Lastly, segregation is required to protect non-COVID-19 infected mothers. 
  • COVID-19 and non-COVID-19 pregnant women coming for delivery should be strictly segregated. 

Best practice: 

• The United Kingdom and the United States have approved vaccination of all pregnant women with mRNA vaccines due to the benefits involved. Benefits of vaccines are: 
• Produce a good immune response. 
• Maternal antibodies cross the placenta and enter the fetus. 
• Antibodies give protection against maternal to the fetal transmission of the virus. 

  Way forward: 

• Vaccination should be offered to pregnant women after providing adequate information and counseling. 
• Provide resources to healthcare professionals involved in their care. 
• Awareness regarding the availability and advantages of the vaccine for pregnant women should be publicised. 
• Enhance vaccination coverage of couples planning pregnancy and pregnant women on a priority basis. 

India needs a multidimensional approach including information, education, effective communication to enhance vaccination coverage and address vaccine hesitancy in mothers-to-be. 

Source: The Hindu