Vaccinating Covid-Recovering Pregnant, Lactating Women: All You Need To Know

Mothers are instinctively very protective of their children and more so for lactating moms. They are very sensitive due to the hormonal milieu of that stage of life – full of love and affection but equally anxious for safety of their child.

The SARS COv-2 (COVID) pandemic raised many issues in the minds of moms and doctors as well. Initially, there was no data on safety of mother-child physical contact including breastfeeding.

There always remained a possibility that just as other viruses like HIV or CMV can pass from infected mother to child, this novel virus could also infect the child. Added to that was the scare from sporadic reports of finding the virus in breastmilk.

Thanks to modern science, data collection and communication, it was soon established that risk-benefit ratio of continuing breastfeeding by COVID-infected lactating women was in favor of continuing breastfeeding.

The risk of not breastfeeding and separation of mother and nursing child are higher. Thus, the WHO has declared breastfeeding by infected lactating women as safe for the nursing child.

Though breastmilk of few infected lactating women may show some viral particles of SARS Cov-2, the risk of transmission of disease to the nursing child is extremely low. That’s also because the breastmilk contains the antibodies to the virus passing from the infected mother.

Another dilemma was airborne and contact transmission to the nursing child from the infected mother. Hence, initially, due to lack of data, some health bodies recommended separation of mother and nursing child.

But now, this is demystified and infected lactating mother is permitted to take care of her child including KMC (Kangaroo Mother Care) where child is kept in skin-to-skin contact with the mother.

When the mother has mild illness, she can continue breastfeeding as usual with hand hygiene and wearing a mask. Mothers unable to directly breastfeed can express their milk which can be fed to infants. Only seriously ill mothers or those on certain drugs cannot do it due to their condition.

All mothers suffering from COVID and their families should be supported with proper breastfeeding counseling by trained lactation counselors. Mothers recovering from illness should be supported to do relactation if her milk supply is reduced or stopped due to her severe illness.

No study to date has specifically evaluated the coronavirus vaccine in pregnant and lactating women.

Preliminary developmental and reproductive toxicity studies do not indicate any adverse effects on reproduction or fetal development.

Based on the recommendations from National Technical Advisory Group on Immunization (NTAGI) that benefits of vaccination to the pregnant women outweigh its potential risks, MoHFW has approved vaccination of pregnant women against COVID-19 with the condition that the pregnant women be informed about the risks of exposure to COVID-19 infection along with the risks and benefits associated with the COVID-19 vaccines available in the country.

Accordingly, a pregnant woman will have the choice to take the vaccination, provided no contraindication is there. Contraindications are allergy or anaphylaxis type of responses to previous doses of vaccines or its contents.

COVID vaccines (Covishield, Covaxin and Sputnik V) are approved for restricted use in emergency situations for prevention of severe COVID illness and deaths.

Pregnancy itself does not increase the risk to COVID infection. More than 90 percent infected pregnant women have uneventful illness but few may experience a rapid deterioration in health.

Pregnant women with symptoms appear to be at increased risk of pregnancy complications, severe COVID disease and death especially those with underlying medical conditions like high blood pressure, diabetes, obesity, age over 35 years, history of clotting in the limbs, etc.

More than 95 percent of newborns of COVID-infected mothers have been in good condition at birth. In some rare cases, there is a chance of premature delivery, low birth weight baby and death in the womb. It is therefore advised that a pregnant woman should take COVID-19 vaccine, especially those at higher risk of getting infection or its complications.

A pregnant woman can be vaccinated at any time of her pregnancy. There is no need for pregnancy testing for women in reproductive age taking vaccines. A woman infected with COVID during pregnancy can be vaccinated soon after delivery.

Current data shows that COVID -19 vaccines are unlikely to pose a risk to the pregnant women or fetus. The long-term adverse effects and safety of vaccines for fetus and child is not yet established.

However, the approved vaccines do not contain live virus nor is m-RNA of other vaccines transmitted in breastmilk.

So, there is no risk posed to the nursing infant. There is also no need to restrict or modify breastfeeding schedules before or after vaccination and even during mild common adverse effects like fever and feeling unwell. In fact, there may be a possible advantage of the vaccinated mother passing her vaccine-induced antibodies through her breastmilk to the nursing infant.

(Dr Ketan Bharadva MD, DCH, FIAP. Consultant Pediatrician, Surat. Chairperson of IYCF (Infant and Young Child Feeding) Chapter of Indian Academy of Pediatrics and Human Milk Banking Association.)