COVID-19 in pregnancy

As COVID-19 has been spreading all over the world, it might be an anxious time for those who are pregnant or those expecting to get pregnant. Should you be worried? What precautions should be taken against COVID-19 during pregnancy?

The effect of COVID-19 on pregnancy is not completely known because it is a relatively new disease, and thus, there is a lack of reliable data. The WHO and CDC have released temporary guidelines for the prevention and management of COVID-19, including guidelines for pregnant women. However, these are not permanent guidelines as little is known about the state of COVID-19 infection in pregnancy thus far. The general idea is to treat COVID-19 like other viral infections and take necessary precautions to prevent the transmission of the disease to pregnant women.

?As a pregnant woman, am I more likely to be infected of COVID-19?

?Pregnancy is a period during which the body’s immunity is slightly lesser than that of a non-pregnant state. Thus, it is possible that any disease occurring during pregnancy might manifest more severely than during other times. The severity of the disease and the risk of suffering from disease complications might also be more in the case of pregnant women than others. Pregnant women with pre-existing conditions such as asthma, diabetes mellitus or SLE are more likely to suffer from severe manifestations of viral diseases such as COVID-19.

?If a pregnant woman gets COVID-19 infection, will it get transmitted to the newborn?

?There have not been any reports of COVID-19 being transmitted from mother-to-baby. However, some infections, if contracted during the first trimester of pregnancy, are known to affect the foetus as well. Some case studies have shown that COVID-19 infected mothers have had complications during pregnancy (Intrauterine growth retardation, pre-term delivery). Fortunately, no maternal deaths after being infected with COVID-19 have been reported.

?If the mother gets infected with COVID-19 during pregnancy, will it result in long-term consequences for the baby?

?As COVID-19 is a relatively new infection, there has not been any evidence regarding this. As mentioned above, the baby might have low birth weight or might be delivered prematurely. Even these complications can be safely managed in hospitals with modern facilities and experienced doctors.

?Can the mother transmit the infection to the baby during delivery?

?Vertical transmission from mother to baby during delivery has not been reported from existing data, but the available data is very little. The virus particles could also not be found in breast milk, amniotic fluid, cord blood, and neonatal throat swab. We don’t yet know if the virus is being shredded in vaginal fluids.

?Can COVID-19 spread from an infected mother to a newborn baby?

?As mentioned above, the presence of the virus in breastmilk has not yet been found. Thus, the current recommendation is to continue breastfeeding. However, the mother and baby are likely to be in close contact, so it is possible that COVID-19 spreads from the mother to the baby via droplets during coughing or sneezing. Based on current understanding, the risk of transmission between mother and baby is the same as the risk between any two people in close contact.

?What precautions should I take during breastfeeding?

?CDC recommends COVID-19 positive mothers to continue breastfeeding babies. Breastmilk has high nutritional value and babies should not be deprived of breastmilk because of the infection.
However, some precautions should be taken:

?Wear a mask during breastfeeding.

?Avoid sneezing or coughing during breastfeeding.

?If you are using a breast pump, clean the pump thoroughly before and after use. Reserve a breast pump for your own use.

?Wash your hands thoroughly before touching the baby, breast pump or feeding bottle.

?If you are giving formula feeds, you should sterilize the bottles and wash hands before preparing the feeds and feeding the baby.

?Can I lie next to my child after delivery?

?If your child has no conditions that require admission to a newborn nursery, the child can stay next to you. You can also feed the baby. If you don’t, it might affect the emotional bonding between the mother and the child. Discuss with your doctor regarding this before making a decision.

?What precautions should I take as a pregnant woman?

?No vaccines or drugs are available for COVID-19.

?Avoid traveling as much as possible.

?Practice social distancing.

?Don’t visit crowded places, even if the crowd is small.

?Avoid traveling in public transport.

?Avoid close contact with sick people, even if the sick person has a condition other than COVID-19.

?Wash your hands soon after visiting any public place.

?Consult a doctor if you have cough, fever, fatigue, body aches, sore throat or breathlessness.

?If you have travelled to disease-affected areas, isolate yourself from others and perform screening tests if necessary.

?Pregnant women showing signs of anxiety or depression should be given medical care.

?Should pregnant women employed in healthcare professions take any extra precautions?

?Definitely. There is more risk of disease exposure to healthcare professionals than other individuals. They should reduce contact with infected people as much as possible. It is imperative to avoid interacting with patients who have developed complications of the disease.

?How is COVID-19 tested in pregnant women?

?COVID-19 testing in pregnant women is done in the same way as in others. Swabs are taken from nose and throat and sent for lab analysis. Regular blood tests can also give some pointers towards the disease, although they are not confirmatory for COVID-19. Sputum, endotracheal aspirate, bronchoalveolar lavage, urine and faeces can also be tested for COVID-19. If lab tests show that SARS-CoV-2 nucleic acid is not present in any of the aspirates from nose and throat in samples taken between 24 hours interval, the person can be confirmed to not have the infection.

?How to treat pregnant women with confirmed COVID-19 infection?

?Pregnant women need to be isolated and be subjected to tests for confirming the disease. Confirmed individuals should be admitted to a negative pressure isolation ward. It is imperative to treat them at a tertiary care centre or at a centres with HDUs and multispeciality care. This is done for ensuring quick management of potential complications. All healthcare professionals and caregivers interacting with a COVID-19 positive individual should use personal protective equipment.