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Covid-19 has been a cause of special concern for those who are pregnant, breastfeeding, or have just delivered a baby. And, understandably so. There are new studies to show that pregnant women may be at a higher risk from Covid.
A study by the Centers for Disease Control and Prevention (CDC), that analysed 400,000 women aged 15–44 years with symptomatic COVID-19, found that pregnant women were more likely to need intensive care unit (ICU) admission, invasive ventilation, and extracorporeal membrane oxygenation compared to nonpregnant women.
Femoai spoke to obstetrician and gynaecologist Dr. Vanita Vaishnav (consultant with Practo) about the risk factors for pregnant women, and the precautions they should take to protect themselves and their child. Edited excerpts:
- What are the risks for pregnant women from COVID?
- What are the precautions that pregnant women should be taking to protect themselves during this time?
- Tell us about the precautions for breastfeeding mothers?
- What if a new mother has to quarantine herself because of Covid? Can she have her child with her? What are the precautions they should take?
- Can pregnant women who have tested positive for Covid pass it on to their babies? What about pregnancy complications from Covid?
- How should women who are in the third trimester prepare a birth plan? What are the things they should know and precautions they should take?
- Are there any specific precautions for women who are less than 12 weeks pregnant?
What are the risks for pregnant women from COVID?
There is a lot of change in how Covid is presenting itself now, compared to last year. Last year, the population that was getting impacted severely was mostly the elderly age group or people with comorbidities. However, that isn’t the case anymore. With the mutated strains, younger people are equally impacted as well, and some are succumbing to it or falling gravely ill even without comorbidities.
Pregnant women are all in the younger age group and we don’t have enough data on how badly the mutant virus can impact them. A woman’s immune system changes throughout their pregnancy. Therefore, the risk may be slightly higher for them compared to the general population. A new study by the University of Oxford has indicated a consistent association between pregnant people with a Covid-19 diagnosis and higher rates of adverse outcomes like maternal mortality, preterm delivery, or preeclampsia.
It is still unclear whether pregnant women are more at risk of long Covid or a post Covid condition. But there are patients who are pregnant, who have recovered from Covid and had a healthy delivery.
What are the precautions that pregnant women should be taking to protect themselves during this time?
It’s largely the same as everyone else. They should maintain social distancing, wear a mask or double mask, wear a face shield when required, and maintain hand hygiene. They should stay hydrated, active, eat a healthy and balanced diet, and take their supplements as directed by their doctor. They shouldn’t miss their antenatal appointments, and if their doctor believes it’s okay for them to make some of their appointments online, that can be done. In case they notice any of the symptoms of covid like high fever, a sore throat, cough, or a loss of taste or smell, they should contact their doctor immediately.
The government doesn’t yet have a clear guideline on whether pregnant women should be getting the vaccine, they should consult their healthcare provider and decide whether they should be inoculated.
The Indian government doesn’t yet have a clear guideline on whether pregnant women should be getting the vaccine, they should consult their healthcare provider and decide whether they should be inoculated.
Tell us about the precautions for breastfeeding mothers?
They should get themselves vaccinated. There are various stages of breastfeeding. If a new mother has Covid, and the baby is only a few months old, they can continue to breastfeed. There is no evidence to suggest that the virus is transferred through breast milk and the benefits of breastmilk are well recognised. They should take precautions like wearing a mask and a face shield. If the baby is nine months or older and has started eating other solid foods, and isn’t completely dependent on breast milk, the mother can avoid breastfeeding for a few days if necessary. If the woman chooses to use formula or expressed milk, they need to maintain proper hand hygiene while using a breast pump or a bottle. The bottle should be properly sterilised after feeding.
What if a new mother has to quarantine herself because of Covid? Can she have her child with her? What are the precautions they should take?
They can have the child with them and can breastfeed as long as they are wearing a mask, or a double mask, maintaining hand hygiene, or using a face shield. If the mother is well enough to take care of the baby, she can do so with adequate precautions. However, if there are other people taking care of the baby, special precautions need to be followed so as to not spread it to them.
Can pregnant women who have tested positive for Covid pass it on to their babies? What about pregnancy complications from Covid?
So far there isn’t enough research to show that Covid can spread to the baby during pregnancy. It is uncommon in newborns with Covid-positive mothers. As far as preterm labour is concerned, it depends on the severity of the infection. Even the Oxford study found that the risks in asymptomatic infected women and non-infected women were similar.
If Covid affects the mother gravely and makes them seriously ill, the risk of complications is higher. The severity of Covid varies, for some people it may be just like a regular flu, and is easily taken care of with regular medication. But if it starts to impact someone’s lungs badly or the fever doesn’t go even after 10 days, it impacts a person’s health severely. That can impact pregnancy. Just being infected by Covid doesn’t mean it will cause pregnancy complications, it depends on the severity of the disease.
How should women who are in the third trimester prepare a birth plan? What are the things they should know and precautions they should take?
As the due date approaches, the number and frequency of visits in a normal scenario are more. That may be a concern in the current situation. If everything is fine, they can consider some video consultations if their doctor allows that.
It is also very important to consult your doctor about your birth plan and ask them to help you understand the Covid protocol that is being followed regarding hygiene and other things. Hospitals are asking women to get a Covid test about 10 to 12 days before the due date. They can consider getting the test once or twice on their own before the due date as well, to know that everything is fine. And if they test positive, then necessary steps can be taken.
There is also a lot of paranoia amongst pregnant women about contracting Covid. They need to remember to be very careful and take all necessary precautions. They should also be careful when they go for their appointments or scans and remember to be masked at all times.
Lastly, it is important that they clarify everything with their doctor, including things like how many attendants are allowed in the hospital or whether home-cooked food is allowed etc.
Are there any specific precautions for women who are less than 12 weeks pregnant?
The universal precautions for COVID won’t change at all. Whether a woman is in the first, second, or third trimester, the pregnancy instructions will change but Covid instructions remain the same. We don’t have much data on Covid in early pregnancy. About 80% of miscarriages occur in the first trimester. If a pregnant woman gets Covid and has a miscarriage, we can’t say whether it happened because of Covid.
For Indian Council Medical Research (ICMR) guidelines on Covid and pregnancy, click here
Dr. Vanita Vaishnav
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