Pregnancy during Covid-19: How to be safe

As the world reels under the impact of Covid-19, there are various vulnerable groups that are more at risk. The World Health Organisation (WHO) identifies people over 60, and those with comorbidities, or health conditions like lung and heart disease, diabetes or other conditions that impact immunity, as at risk groups. During this crisis, pregnant couples are also concerned about how Covid-19 will impact women and their newborns.

One of the major concerns for pregnant women is whether Covid-19 can be transferred to their newborns if they are infected themselves. There are still studies being conducted to determine this threat. In a study conducted on nine pregnant women infected by Covid-19, none of their newborn babies had the virus. The virus was not found in the amniotic fluid, cord blood, neonatal throat swab or in breast milk, it said. In another study which tested 33 babies born to mothers with covid-19, three babies tested positive.

According to a Morbidity and Mortality Weekly Report (MMWR) report, among adolescents and women aged 15–44 years with COVID-19, “pregnancy is associated with increased risk for ICU admission and receipt of mechanical ventilation, but it is not associated with increased risk for mortality”. It, however, adds that more time may be needed to ascertain some of these outcomes.

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 from Covid.

• Are pregnant women at a higher risk of contracting covid?
• What precautions can pregnant women take during the time of a pandemic?
• Are there any specific questions that pregnant women should be asking their primary healthcare provider?
• What should women do if they have fever or, if they have been in contact with a person who is confirmed to have covid?
• If a pregnant woman gets covid, does this increase their risk of miscarriage or other complication?

Are pregnant women at a higher risk of contracting covid?

As long as the pregnancy is not complicated with any other underlying conditions, the risk of a pregnant woman contracting covid is not higher. It is exactly like anyone else. It depends on the exposure and hygiene measures. However, there is a lot of anxiety all around, women are scared to step out and go to the hospital to meet the doctor. Physical activity and diet is compromised because of covid-related restrictions. All this in general may add to the stress of pregnancy.

What precautions can pregnant women take during the time of a pandemic?

The precautions are the same as the rest of the population: social distancing, hand hygiene, and avoiding large gatherings. Apart from these, what is most important for pregnant women is that they should be in touch with their primary consultant or the obstetrician. Because of covid restrictions, the lockdown, the guidelines, many pregnant women are not able to step out, or sometimes the doctors are not available, but telemedicine is available. The consultation can be done while the pregnant woman is at home.

Pregnant women should keep their supplements and checkups up to date. They shouldn’t skip on their supplements, and if at all they run a fever or have a sore throat, they shouldn’t panic,  and shouldn’t self medicate. My advice to them is to stay calm and consult their primary healthcare provider, who will be able to guide them best. Just follow the healthcare provider’s advice.

Pregnant women should keep their supplements and checkups up to date. They shouldn’t skip on their supplements, and if at all they run a fever or have a sore throat, they shouldn’t panic,  and shouldn’t self medicate. My advice to them is to stay calm and consult their primary healthcare provider, who will be able to guide them best.

Are there any specific questions that pregnant women should be asking their primary healthcare provider?

Generally pregnant women ask questions about what they should include in their diet, and what would help them build their immunity. They could ask about supplements that they can include in their diet to help build immunity.

In the first three months of pregnancy, unnecessary medication should be avoided. Eating a healthy diet, including fruits and vegetables, antioxidants, is important. A lot of patients ask about vitamin c supplements, but if they take citrus fruits, orange juice, lime juice etc, they don’t need supplements.

Apart from diet, get information about what happens when you go into labour, what if you get covid during pregnancy. These are some of the questions that patients should be asking their primary healthcare provider.

What should women do if they have fever or, if they have been in contact with a person who is confirmed to have covid?

If they have fever, or if they suspect that they have been in contact with a covid patient, they should first self -isolate. The first thing should be to ensure that it doesn’t spread to the other family members. So self-isolation is important. Secondly, inform your primary consultant. The guidelines in every state in India are very different. In many places, if you have no symptoms but you have come in contact with a covid positive patient, you have to self-isolate. If your symptoms worsen then you have to get in touch with the doctor.

Also, not every covid patient is experiencing the infection in the same severity, there are mild forms of the infection as well, which will go away on their own. It depends on the symptoms. If the patient has a fever, or even if they are covid positive but the symptoms are mild, the government is asking for self-isolation at home. Medical facilities are getting overloaded and the healthcare staff is overworked. The beds are reserved for patients with severe symptoms. For pregnant women, they should inform the doctor, self-isolate, and keep an eye on their symptoms. If they feel that their condition is worsening, be in touch with the doctor and they will guide you accordingly.

If a pregnant woman gets covid, does this increase their risk of miscarriage or other complication?

It is a very new virus, so the data and the studies and number of cases are limited. The studies that are available are for the second or third trimester of pregnancy. There is very limited data on early pregnancy. More than 90% of the cases that have been researched upon are after the fourth month. And those cases haven’t shown any negative impact on pregnancy. There are hundreds of studies that are being done, but so far these haven’t seen any negative impact on the baby inside. During pregnancy, if the mother has the virus it doesn’t get transferred to the baby via blood. But these are studies on women in their second and third trimester. 

Also, most miscarriages happen in the first trimester, if it is happening in the second and third trimester, the reason isn’t covid. So if there is no underlying condition, it is like any other pregnancy. If you have any underlying condition like diabetes or high blood pressure during pregnancy, then there may be complications. It also depends on the severity of the infection.

But just because you are pregnant , it doesn’t make you more vulnerable to the severity of the covid infection as long as you don’t have any underlying comorbidities.

But just because you are pregnant , it doesn’t make you more vulnerable to the severity of the covid infection as long as you don’t have any underlying comorbidities.

The next part of the interview will talk about birthing plan, breastfeeding and c-sections during the time of a pandemic.

Sources:

1. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Huijun Chen, Juanjuan Guo, Chen Wang, Fan Luo, Xuechen Yu, Wei Zhang, Jiafu Li, Dongchi Zhao, Dan Xu, Qing Gong, Jing Liao, Huixia Yang, Wei Hou, Yuanzhen Zhang
2. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. Lingkong Zeng, MD1; Shiwen Xia, MD2; Wenhao Yuan, MD
3. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020 Weekly / June 26, 2020 / 69(25);769–775. Sascha Ellington, PhD; Penelope Strid, MPH1; Van T. Tong, MPH; Kate Woodworth, MD; Romeo R. Galang, MD; Laura D. Zambrano, PhD; John Nahabedian, MS; Kayla Anderson, PhD1; Suzanne M. Gilboa, PhD

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