Covid-19: Pregnant women face higher risk of serious complications if infected, but some remain hesitant about getting vaccine

• Pregnant and lactating women are rightly concerned about Covid-19 vaccines, medical experts said
• But expectant mothers run a higher risk of developing serious and critical complications if they get infected
• Singapore's expert committee on Covid-19 vaccination said there is no evidence the vaccines cause harm to pregnant women and their unborn child
• Still, a majority of expectant mothers said they are taking a wait-and-see approach

SINGAPORE — The national Covid-19 task force may have deemed it safe for pregnant women and breastfeeding mothers to take the vaccine as a protection against the coronavirus, but some in this group are still lukewarm to getting the jabs due to lingering concerns over its effect on their unborn child.

Only two out of seven pregnant women approached by TODAY said that they will seize the opportunity to get vaccinated when their turn comes.

The Government has opened registration for them to be vaccinated from Friday (June 4), if they fall within the age group being invited to take it as part of the progressive roll-out for the national vaccination exercise.

On Wednesday (June 2), the expert committee on Covid-19 vaccination under the Ministry of Health (MOH) said in response to TODAY's queries that there is no evidence to suggest that the Pfizer-BioNTech or Moderna Covid-19 vaccine cause harm to pregnant women or their babies.

Gynaecologists and infectious diseases experts recognised that pregnant and lactating women are rightly concerned, but they stressed that the risk of getting infected with Covid-19 during pregnancy outweighs other potential risks from vaccination, because the vaccine would greatly reduce the chances of severe diseases and stillbirth.

Associate Professor Tan Lay Kok from KK Women’s and Children’s Hospital (KKH) said there is strong evidence to show that expectant mothers run a higher risk of developing serious and critical complications, which may require invasive ventilation and admission into intensive care units.

The head and senior consultant at KKH’s department of maternal fetal medicine added that this was the case particularly in the second wave of coronavirus infection in the United Kingdom.  

“Moreover, the symptomatic infected pregnant women have twice the risk of delivering premature babies, which increases the risk of neonatal admissions for intensive care,” Assoc Prof Tan said.

MOH's expert committee on Monday gave the go-ahead for expectant and nursing mothers to get the Pfizer-BioNTech and Moderna vaccines — the two Covid-19 vaccines approved for use here.

This is following the committee’s review on real-world clinical data relating to pregnant women in countries with extensive Covid-19 transmission.

The revision came six months after the committee said last December that more data was needed to understand how the vaccine would affect this group of people. 

In its reply to TODAY, the expert committee said that globally, Covid-19 vaccination has now been rolled out to a large number of pregnant and breastfeeding women.

“Studies have been done to monitor women who were pregnant when they were vaccinated and their babies," it added.

"These studies were examined by the committee, and there is no evidence to suggest that the Pfizer-BioNTech or Moderna Covid-19 vaccine cause harm to pregnant women or their babies.”

This included a study of 3,958 women who were at different trimesters of pregnancy and some women who were in the periconception period, which is the period just before and immediately after conception, it added.

The observed outcomes were similar to that of pregnancies before the Covid-19 pandemic, the study showed.

“There is data and a good understanding of how the messenger ribonucleic acid (mRNA) vaccines work," the committee said.

The mRNA technology mimics the surface of the coronavirus and teaches the human body to build a protein component of the virus, thereby enabling the immune system to recognise and neutralise it.

"The mRNA vaccines are not live vaccines, the RNA is degraded rapidly in the body and they are biologically unlikely to adversely affect the breastfed babies,” it added.

In contrast, breast milk of vaccinated mothers may help protect the babies from Covid-19 due to antibodies in the breast milk, although the extent of protection requires further study.

“There has been no vaccine-related side effects reported in the babies who were breastfed by mothers who received the vaccine while breastfeeding, despite the United States and other countries having vaccinated numerous breastfeeding mothers without requiring a pause in breastfeeding.”

RISK OF COMPLICATIONS A TOP CONCERN

While global medical literature has shown no evidence that the vaccine may cause harm to pregnant women and their unborn child, the expectant mothers TODAY interviewed said that they are taking a wait-and-see approach because the risk of complications remains a top concern.

Graphic designer Syahidah Sahib, 29, who is five months pregnant with her first child, said although data has shown that vaccination would protect her against the coronavirus, she is held back by concerns about the unknowns of the vaccine, such as long-term effects on her unborn child. 

“At this point, I think most pregnant women will put their baby’s health before theirs. We don’t know what’s going to happen. I don’t want to take the risk.”

Agreeing, part-time music teacher Ashley Tan, 30, who is six-and-a-half months pregnant with her first child, said: “Even healthy people suffer from adverse side effects after getting jabbed, what more pregnant women?

“If there are complications, we are the ones who have to deal with it for the rest of our lives.”

Project manager Elaine Sim, 32, who is six months pregnant with her second child, said: “As much as I want to protect myself and my baby against the virus, I honestly don’t want to be first in line (to be vaccinated), because who can guarantee that it wouldn’t harm my baby?”

On the other hand, recruiter Eileen Low, 30, who is almost seven months pregnant, said that she is keen on getting the vaccine when the opportunity arises.

“I feel that at this point, there is definitely more data and research that has been done regarding vaccination for pregnant women as compared with before.”

Even then, Ms Low added that she would discuss with her gynaecologist before getting vaccinated.

MOH on Monday also said that the Pfizer-BioNTech and Moderna Covid-19 vaccines are safe for breastfeeding mothers and there is no need to suspend breastfeeding to receive the jab.

Five women who are now nursing their babies told TODAY that are happy to know this, but one of them, Ms Siti Sabrina, 33, who has a four-month-old baby, said that she will not breastfeed during that first week after the vaccination, out of caution.

The front-desk manager added that she is still wary about the potential risk the vaccine has on her baby even though she wants to get inoculated to protect herself and her child.

BENEFITS OF GETTING VACCINATED

Medical experts told TODAY that research on vaccine safety for pregnant and lactating women may be limited so far, but findings have been promising and have shown no evidence to suggest that the vaccines pose a risk to them. 

Dr Khoo Chong Kiat, a senior consultant of obstetrics and gynaecology at Mount Elizabeth Novena Hospital, said that with countries such as Australia, England and the US vaccinating pregnant women, there is more data available that supports antenatal and nursing vaccinations. 

He also pointed to data collated by the US’ Centers for Disease Control and Prevention, where more than 100,000 pregnant women have been vaccinated mainly with mRNA vaccines such as Pfizer-BioNTech and Moderna and there have not been any safety concerns raised.

Besides that, there are many benefits for expectant and nursing mothers when they are vaccinated.

Dr Khoo said that it reduces the risk of severe disease for these women and lowers the chances of stillbirth and prematurity for the baby.

It will also reduce transmission to vulnerable household members such as other children or older parents.

Associate Professor Natasha Howard from the Saw Swee Hock School of Public Health at the National University of Singapore said recent findings showed that women who have received the vaccines during pregnancy, mostly in their final trimester, pass antibodies to their unborn child that could help protect them after birth.

Another recent study also found that there was secretion of antibodies in breast milk after vaccination, suggesting potential protection, she added.

Dr Leong Hoe Nam, an infectious diseases specialist from Mount Elizabeth Novena Hospital, said: “This is expected, just like the currently recommended flu vaccine and pertussis vaccine. What is given to the mother translates to antibodies given to the foetus and provides protection after birth.”

Pertussis, also known as whooping cough, is a highly contagious respiratory disease.

Like all medicines, vaccines can cause mild and short-lasting side effects, the doctors said.

Dr Tan Toh Lick, an obstetrician and gynaecologist from Thomson Women’s Clinic in Jurong and Thomson Surgical Centre, said that pregnant women largely reported more pain, but they also reported less fatigue, headache, muscle aches, chills and fever when compared to non-pregnant women having the vaccination.

Assoc Prof Tan from KKH said that side effects such as fever can be managed with standard treatment such as paracetamol, a common painkiller used to treat aches and pain that is safe for use in pregnancy.

“(However), we advise that vaccination of pregnant women should be done after an informed discussion and joint decision reached with their obstetricians or healthcare professionals,” he said.