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Pregnant during a pandemic

Pregnant women who have contracted COVID-19 are 20 times more likely to die than those who do not contract the virus, says JAMA Paediatrics, a leading journal by American Medical Association. My heart sinks as I read this, and I turn to my three year old who is blissfully oblivious to everything happening around us. “Why hasn’t Appa come to see me,” she asks. “Because Appa is a police officer, he is helping people outside and Amma has a baby in her belly,” I start explaining. “Oh yeah, corona,” she completes it for me, without really comprehending what it means. Not a great time to be pregnant in India, I think to myself.

Studies say COVID-19 is associated with increased severity, mortality, pre-term deliveries and pre-eclampsia in pregnancy. What is the solution? I try talking to several doctors and get extremely diverse opinions, everything from lock yourself up in a room to get the vaccine at the earliest.

After careful deliberation, I decide that vaccine is the way to go. Little did I know that only half the battle was over. I went to three hospitals only to be turned down by all of them. I was met with a nonchalant “We haven’t received any order from the government” in all the three places. I tried quoting India’s National Technical Advisory Group (NTAGI) and the International Federation of Gynaecology and Obstetrics (FIGO). FIGO, on its website, states that pregnant women should be given the option of vaccination after explaining to them the possible benefits and risks.

“I am a doctor myself, I am willing to sign a consent form taking responsibility for the consequences of the vaccine,” I pleaded, but in vain.

Being part of what is today the most vulnerable group, I am feeling helpless. Tamil Nadu has seen deaths among pregnant doctors in Chennai, Tiruvannamalai and Madurai, to name a few. Several pregnant COVID-19 deaths remain unaccounted for among nurses and other frontline workers such as police and sanitation workers.

Yes, I understand that vaccines are still under trial among pregnant women, if at all. Vaccines have not been found to cause more harm than the disease itself. The benefits of the vaccine definitely outweigh the risks. Other countries have started administering the Moderna and Pfizer vaccines to pregnant women. The Royal College of Obstetrics and Gynaecology, U.K., has stated that the AstraZeneca vaccine, which is manufactured as Covishield in India, has no reported concerns and found to have minor side effects in a small portion of people — nothing that a paracetamol couldn’t cure.

It is also important to highlight that the Joint Committee on Vaccination and Immunisation (JCVI), the nodal agency for vaccination in the U.K., states that the rare side effect of blood clots associated with Covishield was not increased in pregnancy. It also categorically states that pregnant women affected with COVID-19 are two or three times more likely to have their babies early than otherwise, the risk of serious complications increasing multiple times if there are any underlying health conditions. Hence due to a lack of extensive studies with the AstraZeneca vaccine, the JCVI recommends Moderna and Pfizer vaccines for pregnant women. It is the absence of government-sponsored vaccine trials (of available vaccines) in pregnant women that is alarming. In theory, Covaxin should also not cause harm to the mother or the foetus.

Added benefit

There is an added benefit of the babies born to vaccinated women having some amount of protection from this disease as opposed to babies born to unvaccinated women. Pregnant women form 5% of the total population. It doesn’t seem wise to ignore a major chunk of the population when the goal is herd immunity.

The government has not announced trials for Covaxin or Covishield in India. It is the absence of such an initiative that rings fear in our hearts.

It also seems cruel not to give pregnant women the option of vaccination. They should ideally be allowed to take an informed decision. The government could import the Moderna and Pfizer vaccines specifically for pregnant women as they have been tested and administered abroad.

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Printable version | Aug 3, 2021 10:59:10 AM |

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