As coronavirus vaccines are distributed across the country, many people are still trying to decide whether the shot is right for them. There are still a lot of questions when it comes to vaccinations for pregnant women and nursing mothers, but there are few answers at this time.
However, studies looking at how the Covid-19 vaccine will affect women and their babies are underway right now. So what do we know about the safety and efficacy of the various Covid-19 vaccines in pregnant and lactating women?
Dr Alaa Youness Mohammed, Specialist Obstetrician and Gynaecologist, Fakeeh University Hospital, Dubai and Dr Bariah Dardari, HOD - Child Health Department, Fakeeh University Hospital, Dubai, provided information on this topic and many other issues plaguing would-be mums, dads and new parents, at the recent webinar, ‘My child and me: Living a healthy life’, conducted by Gulf News.
“The Royal College of Obstetricians and Gynaecologists in London and the Society of Obstetricians and Gynaecologists of Canada advise that if the woman has the risk of getting Covid, for example, those who are immunocompromised, healthcare workers, social workers and those working in long-term care can take the vaccine because the risks of getting Covid during the pregnancy are more than the side effects,” says Dr Mohammed. “The reason pregnant woman are advised to avoid it is because they weren’t included in the trials.”
Even men looking to start a family are sceptical about taking the Covid-19 vaccine as it might affect their fertility, but Dr Mohammed puts these fears to rest. "There are no contraindications so men looking to have children can safely take the vaccine,” she said.
Dr Mohammed strongly recommends preconception counselling as it can help identify possible factors that may complicate conception, gestation, delivery, and even the time period after birth.
“The goal of pre-pregnancy care is to reduce the risk of adverse health effects for the woman, and the baby by working with the woman to optimise health, address modifiable risk factors, and provide education about healthy pregnancy, ” says Dr Mohammed.
Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and need to be optimally managed before pregnancy. “You also need to avoid any intake of alcohol, nicotine products, and any medications and herbal products that could affect the reproduction and pregnancy,” she says. “It’s good to start folic acid at least three months prior to get pregnant to reduce the risk of neural tube defects.”
Women of reproductive age should have their immunisation status assessed for various infections such as diphtheria toxoid, and acellular pertussis, measles, mumps, rubella, hepatitis B and varicella. “Women should be screened regarding their diet and vitamin supplements to confirm they are meeting recommended daily allowances for calcium, iron, vitamin A, vitamin B12, vitamin B, vitamin D, and other nutrients,” says Dr Mohammed. “Patients should be encouraged to try to attain a body mass index (BMI) in the normal range before attempting pregnancy.”
However, Dr Mohammed does not recommend ovulation tracking as a way to help couples trying to conceive as this can add unnecessary stress, which in turn can impair fertility.
First few hours in the life of a newborn
The first day of your new baby’s life is thrilling and exhausting for both – mother and baby. The first 24 hours of a baby's life are crucial to a positive experience and while procedures vary by hospital, Dr Dardari gives you a sense of how the hours typically unfold, starting with the minute the baby is born.
“The first few moments are crucial as it affects their development in later stages of their life,” she says. “It's smooth for most babies and they need minimal support such as drying, keeping warm and suctioning the secretions.”
However, about 10 per cent of babies may need support. “The early skin to skin is very important,” says Dr Dardari. “We recommend early initiation of breastfeeding soon after delivery. We monitor the baby's breathing, the colour of the baby as it's an indication that the baby is well, sometimes we also check the sugar levels and weight.”
Weight gain and nutrition during pregnancy
As you probably know, the body goes through lots of physical and hormonal changes during pregnancy. To fuel yourself and your growing baby, you’ll need to make great food choices from a variety of sources. You will also need to maintain a healthy weight. How much weight should a woman expect to gain during pregnancy?
“A woman who was average weight before getting pregnant should gain 25 to 35 pounds after becoming pregnant,” says Dr Mohammed. “Underweight women should gain 28 to 40 pounds. And overweight women may need to gain only 15 to 25 pounds during pregnancy.”
There are also certain foods that are off limits during pregnancy such as junk foods, canned stuff and the other food that contains preservatives and artificial colouring agents.
Dr Mohammed says pregnant women should reduce the intake of certain foods that may increase the risk of certain infections such as reduce the risk of listeriosis by drinking only pasteurised or UHT milk. They should avoid eating ripened soft cheese like blue-veined cheese (there is no risk with hard cheeses, such as Cheddar, or cottage cheese and processed cheese). They should not eat pâté (of any sort, including vegetable). Completely avoid eating uncooked or undercooked ready-prepared meals.
“Pregnant women also need to avoid the foods that increase the risk of salmonella infection by avoiding raw or partially cooked eggs or food that may contain them (such as mayonnaise) and also raw or partially cooked meat, especially poultry,” she says.
How to know if the baby is sick or hungry
“The initial signs can be subtle in the first few months of life – so that’s why we educate the parents on the subtle signs,” said Dr Dardari. “The most common sign is a high-pitched cry, which tends to be much higher in pitch than the hunger cry, as well as if the baby is not being consoled by eating or being carried.”
Also if your baby becomes very lethargic and quiet this can be a reason for concern too. “When baby becomes less active and refuses to feed, this could also be a sign something is wrong. It’s very important to take action on these early signs because if you wait for other signs like fever or vomiting it can be a bit late by then. We encourage parents to seek medical advice if any of these subtle signs happen.”
As far as understanding is the child is hungry, Dr Dardari says crying is one of the indications. “A hungry cry is mostly a highly pitched cry, or a whining sort of a sound. Babies are smart and have primary reflexes such as trying to suck on their hands, or when they turn their face to look for the breast; these are signs that the baby is ready to feed. Sometimes babies can oversleep especially the first few weeks and we advise parents to feed on demand but not go beyond two to three hours without feed as that can cause the production of milk to decrease. We also ask parents to observe how long the baby was actively sucking on the breast.”
High risk pregnancies
Most of the time having a baby is a natural process. After a full-term pregnancy, women go into labor on or near their due date and give birth to a healthy baby. But not all pregnancies go smoothly. Some women experience what doctors refer to as a high-risk pregnancy. When does a pregnancy become a high-risk one?
“Patient with preexisting medical conditions such as diabetes, and hypertension,” says Dr Mohammed. “Women with past history like previous surgery of uterus including caesarean sections, myomectomies. Also those having high BMI, age more than 40 years, short or prolonged interval between pregnancies.”
Importance of childhood immunisations
Childhood vaccines or immunisations can seem overwhelming when you are a new parent. “Your child’s immunisations are very important - not only for the child alone, but for the community as a whole,” says Dr Dardari. “Vaccine-preventable diseases are still around us and some can be deadly for children, such as measles and tuberculosis.”
Although immunisation schedules are flexible, it is important to follow the schedule of the country in which you live as the plans in each country are based on disease activity in that area.
“We will do what works for the parents, but ultimately we need to protect the child,” said Dr Dardari. “There is a lot of misinformation surrounding vaccination in general. This can cause confusion, so it is important for parents to get info from a trusted resource and always discuss it with you paediatrician.”