Pregnancy, Covid-19 and Vaccines: What You Should Know

Too many Covid-19 vaccines and pregnancy-related questions, too little time!  Fear not, as we narrow down the best takeaways from the brilliant doctor-led discussion Sense with Science or Apa Kata Sains?  held earlier this month.

Experts Prof Dato’ Dr Adeeba Kamarulzaman, Tan Sri Dr Jemilah Mahmood and Prof Dr Imelda Balchin joined host Karen-Michaela Tan to answer many questions on topics such as vaccinating during pregnancy to breastfeeding when ill with Covid.

Sense with Science’s Pregnancy in the time of Covid-19 – Question and Answer

Can vaccines pass through the placenta?

Dr Imelda:  There is confusion between the vaccine and the virus. We just have to remember that the vaccine contains no live virus, and it doesn’t matter because what we want is the antibody developing from the vaccine. That’s the one that can transfer through the placenta, to help protect your baby. That also transfers to your breast milk, to protect your baby after birth. 

A study on the Pfizer vaccine shows that for women given the vaccine during pregnancy, the umbilical cord of the baby at birth contains the same antibody that the mother has produced to fight against the Covid virus. Thus, I would like to advise all pregnant mothers not to fear vaccination. It will not give you the virus. It will not give your baby the virus. 

What is the magic number (to take the vaccine)? Why has the 14-33 week period been called the suitable period?

Dr Jemilah:   Fourteen weeks marks the second trimester of pregnancy. Typically, it’s the calm trimester for most pregnant women. They no longer have morning sickness. If you are going to have a miscarriage due to congenital reasons, usually it’s in the first trimester. So it’s just not to complicate things. From 32 weeks onwards, the foetus is viable, hence 33 weeks. We don’t want to complicate things either in case of premature labour. That’s the only reason, which is why it’s not cast in stone. We will look at it on a case-by-case basis. 

Dr Imelda:  I certainly have given vaccines to a pregnant woman beyond 33 weeks because she is a frontliner, and because frontliners have a higher risk of exposure. We have to look at the pros and cons. If you are at risk of exposure and you belong to the vulnerable group (you are pregnant, have diabetes or have medical problems during pregnancy), then you are more at risk from the severe form of Covid illness.  So discuss this with your obstetrician, as there is provision for you to get it because you are in the higher risk group, especially frontliners. 

Vaccination is safe throughout pregnancy

Dr Adeeba:   I just wanted to stress the importance of getting pregnant ladies vaccinated. Those with diabetes, high blood pressure and obesity are more likely to get the severe disease, in Category 4 and 5. But pregnancy itself puts women at higher risk of getting the severe disease.

Dr Jemilah:  The immune system is weakened during pregnancy, compared to those in women who are not pregnant. Hence, it is incredibly important that they receive vaccination, especially those with high risks and are at risk of exposure to Covid, such as frontliners.  Frontliners also include frontline workers in the community, such as those serving at the counters, selling food, and people working in banks. They are serving the public, so we have to take steps to ensure they receive their vaccines too. 

Dr Adeeba:  After millions of doses were given to women in the US, UK, and in Israel, we have not seen adverse reactions. It is now pretty conclusive that vaccination is safe throughout pregnancy and for breastfeeding mothers. 

Should breastfeeding women take the vaccine?

Everyone:  Yes! Definitely!

Is one vaccine better than the other? Is Pfizer still the go-to vaccine for lactating women?

Dr Imelda:  The best vaccine is the one you can get first.  (Other panelists agree with a resounding yes) 

Can a woman state her preference for a vaccine if she is a new mother and lactating?

Dr Jemilah:  Our vaccine portfolio is 70 per cent Pfizer, 10 per cent AstraZeneca and 20 per cent Sinovac and other vaccines, but generally, we have more Pfizer than anything else. So chances are you will be given Pfizer if you are pregnant. But if you are breastfeeding and you didn’t opt-in for AstraZeneca, you will get Pfizer. 

Theoretically speaking, they should all be safe because none of them are live vaccines. But at the moment, we don’t have enough evidence for Sinovac as compared to Pfizer and AstraZeneca. 

Dr Imelda:  Consider which outcome would be worse: getting Covid, or suffering from the side effects of the vaccine? You can’t compare between getting side effects from the vaccine or not getting the vaccine. You have to make a comparison between the side effects of the vaccine and getting the Covid disease.

We have to consider the risk of getting the severe form of Covid disease when compared to suffering from minor side effects from the vaccine. When we make that kind of comparison, prevention is more important.

Is there a safe window for conception when you want to get vaccinated?

Dr Jemilah:   If you are planning to get pregnant, go ahead. If you fall pregnant, we can time your vaccination. The vaccination itself doesn’t affect fertility, or if [you receive it] before you get pregnant, it will not lead to complications. There is no effect. So don’t overthink it. If you are trying to get pregnant, good luck! Hopefully, you will get pregnant quickly. If you fall pregnant, let’s time your vaccine so that you have it between 14 to 33 weeks. 

 If I get Covid while pregnant, will my baby get it too?

Dr Imelda:  If you have the Covid virus, the placenta is a good barrier. With more than 100 million people infected with Covid throughout the world, we have not received any data to say that there is more miscarriage, or congenital abnormalities as a result of this. There is no increase in the rate, so we know that the virus is less likely to affect the baby unless the mother develops severe disease in pregnancy. 

If the mother develops the severe disease or has problems with oxygenation in her body, that will affect the baby. You are more likely to end up with a preterm Caesarean section. So we find that in mothers with severe symptomatic disease, the risk of Caesarean section is increased threefold. And that is when the baby is at risk of requiring premature care in the Intensive Care Unit (ICU).  But if you have asymptomatic disease during your pregnancy, then it is unlikely to cause any problems with the baby, and the likelihood of pre-term birth is the same as those who didn’t have Covid. 

My partner and I are trying to get pregnant. Both of us are recovering from Covid. I’ve heard the virus stays in our bodies. How long should I wait before I can safely try to conceive again?

Dr Imelda:  If you have recovered, you can conceive. You have developed temporary immunity to the virus. The antibodies you have developed to the virus will be passed down to your foetus, through the placenta. And even if you still harbour the virus, the fact that you have recovered means that you have developed immunity. And if you still have the illness, the virus doesn’t pass to the baby through the placenta. 

If a woman is breastfeeding and she finds herself diagnosed with Covid, should she stop breastfeeding? Can the virus pass through breast milk?

Dr Imelda:   No. I believe that mothers who are Covid positive should continue to breastfeed even if it means you pump the milk out, and somebody else gives the bottle to the baby. If not, we would advise mothers to use masks, even indoors. And when you are not breastfeeding, exercise social distancing with the baby – take the baby to another room. Those are [the] options to reduce the risk of transmission. It is not going to be transmitted through breast milk, but through the air that we breathe and the droplets, to the baby. 

*This discussion has been edited for clarity and brevity. 

For many more interesting questions, including those related to women on In-vitro Fertilisation (IVF) treatment, check out the discussion in its entirety here.