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COVID-19 Vaccination in Pregnancy & Breastfeeding

Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.

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COVID-19 Vaccination in Pregnancy & Breastfeeding

  1. 1. Dr G Muniswaran Maternal Fetal Medicine Specialist, Women & Children’s Hospital Kuala Lumpur 4th May 2021 COVID-19 Vaccination In Pregnancy & Breastfeeding
  2. 2. Dedicated to… 1,521 patients who died 411,594 confirmed patients The tireless frontliners
  3. 3. • This slide was prepared for the Webinar Series on COVID-19 session on 4th of May 2021, by Dr G Muniswaran MFM Specialist, Women & Children’s Hospital Kuala Lumpur, Malaysia. • This is intended to share within healthcare professionals, not for public. • Kindly acknowledge “Clinical Updates in COVID-19 http://www.nih.gov.my/covid-19” should you plan to share the information obtained from this slide with your colleagues. Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH Disclaimers
  4. 4. Misinfo-demic Zoom-demic Churnalism Bad science PCR-demic Vaccidemic The Pandemic
  5. 5. COVID-19 & pregnancy Vaccination for pregnant and breastfeeding mother Counseling & shared decision making Overview
  6. 6. Implications of COVID-19 in pregnancy
  7. 7. Pregnant mothers are susceptible (2nd & 3rd Trimester) Influenza Varicella Malaria COVID-19? Pregnancy & infections
  8. 8. Implications of COVID-19 in Pregnancy Most mothers will be asymptomatic ICU admissions Increased Need for ventilation Increased Mortality Increased Preterm delivery & neonatal ICU admissions Increased Caesarean section Increased Stillbirth & neonatal deaths Increased
  9. 9. The COVID-19 vaccination for pregnant & breastfeeding mothers
  10. 10. Priority groups in Phase II (April-August 2021) Aged > 70 Immuno-c ompromis ed HIV Medical illnesses Pregnant mothers with risk factors
  11. 11. Principles of vaccination for pregnancy and breastfeeding mothers in Malaysia • Pregnant mothers are vulnerable • Principle is to reduce maternal and neonatal morbidity • Pregnancy & breastfeeding is not a contraindication for vaccination (the only live attenuated COVID-19 vaccine is COVI-VAC from India) • Personal choice – consent • Risk is highest in the second and third trimester • Only Comirnaty vaccine for pregnant and breastfeeding mothers (two doses) (CDC recommends moderna, Pfizer & J&J. • 14-33 weeks • No neonatal protection from COVID-19 • 14 days interval from other vaccinations • Anti D – as per routine if needed
  12. 12. Who are considered high risk in pregnancy?
  13. 13. Societies who recommend vaccination among pregnant and breastfeeding mothers
  14. 14. Countries who recommend vaccination among high risk pregnant and breastfeeding mothers Israel Belgium Canada Ireland Germany UK, USA Scotland Croatia Malaysia
  15. 15. Counseling & shared decision making
  16. 16. Counseling & shared decision making Pregnant & breastfeeding frontlines • Benefits outweighs the risk High risk pregnant mothers / breastfeeding • Benefits outweighs the risk Pregnant mothers in population with high risk of transmission • Benefits outweigh the risk Low risk mothers with low risk of transmission • Discuss risk & benefits
  17. 17. Already on treatment Continue treatment, vaccinate in pregnancy Not on treatment High risk Get vaccinated first Not on treatment Low risk Delay may be unreasonable
  18. 18. Vaccine and fertility • Can vaccine affect fertility – NO • Interval between vaccine and fertility treatment? – no magic interval • Egg and sperm donation and vaccines – 7 day interval (HFEA) • Recurrent miscarriages & early pregnancy? – Vaccine is not contraindicated
  19. 19. Vaccinated 2 weeks ago, UPT positive today? • Option 1 • Delay vaccination • After 14 weeks • 3-12 weeks interval is acceptable 1 • Option 2 • Only take one dose • >87% protected 2 • Option 3 • Second dose as per routine • ?impact on organogenesis? • Not an absolute contraindication 3
  20. 20. I got COVID 19 vaccine, can I take TDAP? Do I need influenza vaccine? I have allergies, can I be vaccinated? Does vaccination cause fetal anomaly? Can I take Antitetanus jab? Do I need a detail scan after a vaccine? Do I need to check UPT before my vaccine? When can I get pregnant after a vaccine? I’m 40 and I am planning IVF. Should I get vaccinated first? Common questions answered
  21. 21. Health care professionals and high risk pregnant mothers are vulnerable (most will be asymptomatic) Maternal Fetal implications of COVID 19 are significant (ICU admission, mortality, preterm delivery, caesarean section) Do not deny a pregnant / breastfeeding mother a preventive COVID-19 intervention (vaccine, mask, physical distancing, hygiene) Vaccination – significant reduction in hospitalization and death Shared decision making (weigh benefit & risk) Denying a safe intervention is a violation of human rights (pregnant mother and infants are a national priority) Take home message
  22. 22. Clinical Guidelines on COVID-19 Vaccination in Malaysia (2nd Edition)
  23. 23. “Women don’t die because of illness that we cannot treat. They die because society still hasn’t decided that their lives are worth saving.” Prof Mahmoud F. Fathalla
  24. 24. Email – gmuniswaran@yahoo.com •

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