Impact of COVID-19 on Pregnant Women and Their Babies

Introduction 

The first wave of COVID-19 majorly affects people with advanced age and underlying medical conditions. However, the second wave had affected young people, adults and the elderly with the same force. The researchers are performing studies to determine the impact of covid 19 on pregnancy.

COVID-19 and Pregnancy 

COVID-19 affects individuals irrespective of their age, sex, gender, and underlying medical conditions. The severity and progression of COVID-19 depend upon various factors. Several researchers had studied the effect of COVID-19 on a pregnant woman. Some studies indicate that in most pregnant women, the COVID-19 infection is mild, and there is no urgent need for delivery. The majority of the pregnant women have cough and fever, while several pregnant women are asymptomatic. 

The World Health Organization, in a large cohort study of 147 pregnant women with COVID-19, reported that only 8% were severely ill and 1% were critically ill. According to the Centers for Disease Control and Prevention (CDC), pregnant women with COVID-19 are at increased risk of developing severe respiratory illness than non-pregnant women and may require a ventilator. The severity is also increased in pregnant women suffering from underlying medical conditions, such as diabetes. 

Mechanism of COVID-19 Impact on Pregnancy Outcomes

There is no high-quality evidence to conclude the impact of COVID-19 on pregnancy outcomes. However, some inference can be taken from the studies describing the effect of SARS on pregnancy outcomes. COVID-19 seems to be less lethal as compared to SARS and MERS. However, the risk of spontaneous miscarriage and preterm delivery due to COVID-19 may not be ruled out.

Although at least a study indicates no increased risk of spontaneous preterm birth and spontaneous abortion in COVID-19 women, there are reports of preterm birth in women infected with COVID-19.

Data on the pathophysiology of COVID-19 in pregnant women is limited. However, the pathophysiology of related Middle Eastern Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV-1) in pregnant women may provide valuable insight. There is currently no evidence to conclude that COVID-19 is teratogenic and is not an indication for medical termination of pregnancy. 

Pregnancy may result in immunosuppression to prevent the rejection of a semi-allogeneic fetus. There is an increased estriol level that suppresses inflammatory cytokine production and promotes anti-inflammatory cytokines release. These changes may expose pregnant individuals to a more severe respiratory infection.

Managing Pregnant Women with COVID-19

Apart from the high risk of poor pregnancy outcomes in some women with COVID-19, there is an increased risk of perinatal anxiety and domestic violence during the COVID-19 pandemic. Once the COVID-19 is suspected in pregnant women, the doctor must take all the relevant information such as medical history, travel history, residing at the hot-spot area and immunocompromised condition. The doctor also advise the patient to undergo a COVID-19 test. There should not be any delay in obstetric management while waiting for the test report. The woman should be managed as if she has been tested positive for COVID-19. 

The use of elective procedures, growth scans, and routine investigation must be minimized according to the discretion of the healthcare provider. Appointments should be deferred by seven days after the COVID-19 symptoms start unless the symptoms are severe. If there is anyone with COVID-19 symptoms in the house, the appointment for antenatal care should be deferred by 14 days. The women should have intrapartum care at a tertiary care centre. 

Pregnancy and COVID-19 Vaccination

There is no study of the COVID-19 vaccine on pregnant and breastfeeding women or the effects of the COVID-19 vaccine in pregnancy. Due to a lack of data, the health ministry in India has advised pregnant and lactating women to avoid the COVID-19 vaccine. However, in some countries like the US, women are opting for vaccination.  

FAQs

Is it safe for pregnant women to undergo the COVID-19 test?

As the testing for COVID-19 requires the collection and testing of the nasal swab, there is no side effect of the COVID-19 test on the fetus or mother. The World Health Organization recommends that the pregnant women suspected of COVID-19 should be given priority for testing. 

What is the impact of HRCT on pregnant women?

High-Resolution Computed Tomography (HRCT) is a necessary tool in diagnosing and determining the impact of COVID-19 on the lungs. In the HRCT done for COVID-19, the target organ is the lungs. The procedure did not pose any risk for developing a fetus. However, ask your gynaecologist before undergoing HRCT.

Can COVID-19 get transmitted to the unborn or newborn baby from the mother?

There are certain instances when the fetus got infected with COVID-19 from the mother. However, these incidences are rare. Another research indicates that although women with COVID-19 make antibodies, these are not transferred to the fetus in sufficient quantity through the placenta. Further, the quantity depends upon the gestational age. There is also a risk of transmission of COVID-19 to the newborn baby from infected parents.

Is caesarean section safe for childbirth in pregnant women with COVID-19?

C-section is not usually recommended in pregnant women with COVID-19 unless it is medically justified. There should not be any effect on the preferred mode of delivery in women with COVID-19 in absence of fetal distress or urgent respiratory intervention.

What precautions should be taken while breastfeeding when the mother has COVID-19?

There is no sufficient evidence to prove that COVID-19 passes through breast milk. However, there are chances that the transmission of infection may be through respiratory droplets. It is necessary to follow all the universal COVID-19 protocols to minimize the chances of spreading COVID-19 to the newborn. 

As a pregnant woman, what precautions should I take to avoid COVID-19?

As COVID-19 may affect pregnancy outcomes, you must take extra care to avoid contracting COVID-19. Stay at home. If there is a need to go outside, never forget to wear a mask (preferably a double mask). Avoid crowded places and maintain a distance of 6 feet from others. Wash your hands frequently. 

 

Dr. T P Rekha

Consultant – Obstetrics & Gynaecology

Manipal Hospitals Bangalore – Old Airport Road

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