“Severe COVID-19 infection can lead to poorer outcomes for mother and baby. Vaccination against COVID-19, which is safe in pregnancy, can reduce the risk of transmission and the risk of severe COVID-19 infection and its complications,” answers Dr Serene Thain, Consultant from the Department of Maternal Fetal Medicine and Lead of the one-STop Obstetric high RisK (STORK) Centre at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group.

If you are thinking of having a baby

Current evidence shows that pregnant women are no more likely to get COVID-19 infection than other non-pregnant women. The virus is also unlikely to affect development of the baby if the mother is infected while pregnant and there have been no reports of COVID-19 causing abnormalities in the baby thus far.

As fertility is time-sensitive and diminishes with age (especially after the age of 35), and as it is uncertain at this point when the current pandemic will be over, waiting indefinitely may reduce one’s chances of pregnancy with increasing maternal age.

It is safe to engage in antenatal care in clinics and hospitals because of all the precautions that are being undertaken in the form of strict screening and preventative policies such as safe distancing and infection control measures.

With regards to COVID-19 vaccination, there is no evidence to suggest that these vaccines can affect fertility, nor is there any scientific basis upon which these vaccines could cause any impact on women's fertility. You can therefore get vaccinated against COVID-19 whilst trying to conceive, and you do not need to avoid pregnancy during or after COVID-19 vaccination.

If you are already pregnant

1. Are there increased risks for mothers with COVID-19 infection?

The virus affects pregnant women in a similar manner to non-pregnant women. The majority (roughly two-thirds) of pregnant women infected with COVID-19 are asymptomatic, and the remainder may only have mild symptoms such as runny nose, sore throat, cough or a fever.

A small percentage of pregnant women may develop more severe COVID-19 disease and complications especially those in their third trimester of pregnancy. Although the overall risk for these severe complications are low, pregnant women have been found to be at significantly higher risk for severe outcomes compared with their non-pregnant counterparts.

These severe outcomes include that of admission to the intensive care unit and need for invasive ventilation (breathing support). Pregnant women at higher risk for severe complications include those who are older (age > 35 years old), obese, or with pre-existing medical conditions such as hypertension (high blood pressure), diabetes, heart disease or chronic lung disease.

If a pregnant woman becomes very ill as a result of COVID-19 infection, the baby may need to be delivered to help improve the mother’s heart and lung functions, possibly at a premature gestation with the accompanying risks of prematurity.

2. Are there increased risks for the fetus / baby if the mother has COVID-19 infection?

Vertical transmission of COVID-19 (transmission from the mother to her baby during pregnancy or delivery) is possible but uncommon. Importantly, in most reported cases of newborns with COVID-19 infection detected soon after birth, the babies remained well and recovered without complications.

There is currently no evidence that COVID-19 infection in pregnancy leads to a higher risk of babies developing abnormalities. COVID-19 infection does not affect the baby’s risk of having a genetic or chromosomal abnormality such as Down syndrome.

However, babies of pregnant women with COVID-19 infection compared to those without the infection have almost twice the risk of preterm birth and almost four times the risk of needing neonatal intensive care unit (NICU) admission.

3. Is there a recommended mode of delivery for mothers with COVID-19 infection?

Current evidence shows that the risk of neonatal COVID-19 infection is not higher with vaginal deliveries compared with caesarean deliveries. Hence, COVID-19 infection is not a specific reason for requiring a caesarean delivery, unless there are other circumstances that necessitate it.

4. Are there increased risks for the baby after delivery in mothers with COVID-19 infection?

Based on existing evidence, babies do not seem to have an increased risk for COVID-19 infection. The risk of neonatal infection also does not seem to be greater even when the baby remains with the mother after delivery or if the baby is breast-fed.

If the usual safety precautions are undertaken, for example, through wearing a mask and maintaining good hand hygiene at all times, mothers with COVID-19 do not routinely need to be separated from their babies and breastfeeding can continue.

5. Should I get vaccinated against COVID-19 during pregnancy?

COVID-19 infection in pregnancy, if severe, can be associated with increased complications to both mother and baby. Aside from maintenance of good hygiene and practising social distancing, the most effective strategy for prevention of COVID-19 infection is vaccination, as this reduces not only the risk of transmission but also the risk of severe COVID-19 infection and its complications. Pregnant women would therefore benefit from COVID-19 vaccination to protect their babies and themselves from the infection. 

6. Which COVID-19 vaccines can be used in pregnancy?

Currently, mRNA Vaccines (Pfizer-BioNTech and Moderna) can be used in pregnant women and women younger than 50 years of age. Real world data from a study in the United States showed that these vaccines are safe for use in pregnancy, and there were no increase in incidence of adverse pregnancy and neonatal outcomes in pregnant women vaccinated against COVID-19 compared to incidences in other studies involving pregnant women before the COVID-19 pandemic.1

 [1] Tom T. Shimabukuro et al. Preliminary findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. NEJM 2021. DOI: 10.1056/NEJMoa2104983

7. Should I get vaccinated against COVID-19 while breastfeeding?

Large clinical trials demonstrating the safety of COVID-19 vaccines did not include breastfeeding women within them. As such, there is limited evidence on the safety of COVID-19 vaccines in breastfeeding women and the effects of vaccination on the breastfed baby. However, there is currently no known risk identified with vaccinating breastfeeding women. There is also no scientific rationale by which vaccine components could be transferred to the baby through breast milk.

It is therefore safe to get vaccinated against COVID-19 even if you are still breastfeeding. In addition to the vaccine being safe, some studies have also found that breastfeeding mothers have antibodies in their breastmilk which could potentially have protective effects on the baby, although the extent of protection is currently unknown.

Precautions you can undertake

The best way to protect yourself from COVID-19 is to avoid being exposed to the virus or limit the effects of COVID-19 even in the event of infection. Steps that you can take to achieve this include:

1. Get vaccinated

Getting the COVID-19 vaccination will protect you and your loved ones. The vaccine is free for all Singaporeans and long-term residents. For more info on the vaccine, visit https://www.gov.sg/features/covid-19-vaccination

2. Wear a mask when around other people

As one can spread COVID-19 infection to others even without the presence of symptoms, wearing a mask protects yourself and others.

3. Ensure safe distancing

Try to keep a distance between you and others at all times (at least 1 metre apart).

4. Practise good personal hygiene

Regular hand washing, avoiding touching your eyes, nose, mouth and cleaning and disinfecting surfaces that are regularly touched are important hygiene measures that you can practise.

5. See a doctor if you are ill

Do not ignore your symptoms, even mild ones, and visit your nearest Polyclinic or general practitioner clinic to see a doctor. Early testing and detection means you can get treated sooner, and protect your loved ones from possible infection.

Ref: K21

Check out other articles on COVID-19 and vaccinations:

COVID-19 Latest Variants: Types and Ways to Stay Safe

COVID-19 Vaccine Myths Busted!

COVID-19 Vaccine: Is It Safe for Pregnancy, Breastfeeding or Starting a Family?

The Truth About Vaccines

Childhood Vaccinations: What You Need to Know