COVID-19 vaccine for pregnant women: How to register, side effects and precautions

New Delhi, July 03: In a major move, the government announced that pregnant women are not eligible to take the COVID-19 vaccine at any time during pregnancy.

The Ministry of Health released guidelines in which it detailed the risks from the infection in pregnancy and also explained the benefits of the vaccination. The Ministry said that the experts are of the view that the benefits of vaccination for pregnant women outweigh the risks.

Counselling:

Household visits by frontline workers;

Antenatal checkup at health facility, outreach immunization sessions, Village Health and

Nutrition Days (VHNDs) and Urban Health and Nutrition Days (UHNDs).

• Facility visits by pregnant women for other reasons;
• Any other site where there is interaction with the pregnant woman
• COVID-19 Vaccination Centers (CVCs);

During the counselling, the FLW or vaccinator (if the women reaches the CVC directly and has questions related to COVID 19 vaccination) should explain to the pregnant women the potential risks of COVID-19 on their health or that of the baby, benefits of vaccination, potential side effects and precautions they need to take following vaccination.

How to register:

• Register/Sign in yourself on the CoWin portal
• Enter the mobile number linked with your Aadhaar number
• Click on get OTP
• Enter the OTP
• Register yourself
• Enter details such as name, photo ID proof and number, age and gender
• Click on register at the bottom right
• You will receive a confirmation message upon successful registration

Adverse events following vaccination:

The full impact of COVID-19 disease on pregnancy outcomes for mother and fetus as well as for new-born is still unclear. Therefore, pregnant women require special considerations and systematic reporting of adverse events following immunization (AEFI).

National AEFI surveillance operational guidelines and Covid-19 vaccination operational guidelines will be followed for AEFI surveillance related to Covid-19 vaccination of pregnant women.

Following are the additional specific activities and action points under this:

• Obstetrician and gynecologist, pediatrician or neonatologist to be included in AEFI committees and be sensitized on Covid-19 vaccination of pregnant women
• Members of local FOGSI chapter and IAP should be oriented on Covid-19 vaccination of pregnant women
• All the medical officers, private practitioners and frontline health workers to be trained on their role in AEFI surveillance related to Covid-19 vaccination of pregnant women.

During vaccination:

The vaccinator or medical officer must consider the fact that women in reproductive age group might be unaware of the pregnancy at the time of vaccination.

Therefore, the vaccinator must inform her for immediate reporting of AEFI, if any, following Covid-19 vaccination. In such cases, women will need to report immediately to the vaccinator or nearest health facility.

Reporting:

The pregnancy status of women should be recorded into the AEFI notification form while reporting AEFI cases.

All Adverse Event following vaccination of pregnant women should be reported immediately into Co-WIN.

All serious and severe adverse events following vaccination of pregnant women should be reported immediately to concerned Medical Officer / District Immunization Officer.

Investigation of cases:

Obstetrician and gynecologist, pediatrician or neonatologist should be part of District AEFI Committee investigating all serious and severe AEFI cases following vaccination of pregnant women.
The investigation of all such cases to be expedited. Cytopathological examination of aborted/ perinatal death if any occurring in vaccinated women may be done.

The adverse event and the pregnancy outcome must be noted on the ANC/MCH card. Pregnancy registry can be used to track such cases and to determine pregnancy outcome.

All antenatal, post-natal and other relevant clinical records must be sought for and collected during investigation and gathered from the treating physician.

Why is COVID-19 vaccination 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 outcomes1 including higher chances of neonatal morbidity2
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 hospitalisation, 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 COVID-19 are at increased risk of adverse pregnancy outcomes, including admission to the ICU, iatrogenic preterm birth, pre-eclampsia-like symptoms, Caesarean section and death 3.

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 hospitalisation 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