Coronavirus and Pregnancy: What is Important to Know
Pregnant women are more susceptible to respiratory infections and may be ill during pregnancy and childbirth.
Renato M.E.Sabbatini, PhD, FIAHSI
Leia este artigo em português.
In view of the coronavirus pandemic that is spreading in many countries, it is understandable that all pregnant women, at different stages of pregnancy, are becoming concerned.
These are questions like: If I get the virus, will the fetus develop problems? He/she will he be born sick, too? If my delivery occurs during the epidemic, in a hospital full of people with COVID 19, am I at risk? Do I have a higher risk of pneumonia, of going to the ICU, or of dying during childbirth? Is surgical delivery (cesarean) too risky? Can I choose to have my baby at home? Should I isolate myself during and after pregnancy?
I am not a gynecologist or obstetrician, so I think that it is highly recommended for anyone who is pregnant to get in touch and ask for professional guidance from the attending doctor. But, as a health professional and scientific writer in this area, I will try to pass on some information that is being conveyed in specialized medical publications, based on solid scientific evidence.
There are several ways to try to answer these questions, because despite the fact that we already have hundreds of thousands of cases of COVID 19 in the world, specific data on pregnancy during the epidemic have not yet been published, whether the pregnant woman had the disease or not. At the end of this article I will summarize the experience of Chinese tgynecologists with the few cases they have treated.
From the biological point of view, the maternal organism is subject to a very large number of organic changes throughout pregnancy and, mainly, at the critical points that are childbirth and the postpartum period, which we call the puerperium (from Latin “puerus”, child, and “peri ”, around). Some women are subject to contracting specific illnesses, such as pregnancy diabetes (increased sugar in the blood and tissues), high blood pressure (which can lead to prenatal pre-eclampsia, a sometimes fatal condition), displacements of the placenta, abnormalities in nutrition and blood circulation of the fetus, puerperal infection, among others.
Childbirth, whether normal or surgical, is an experience that tests the mother’s limits, with sudden physiological changes, bleeding, emotional stress, a lot of pain, prolonged duration of labor, or the need to have a cesarean or even minor surgery in the perineum. Therefore, it is recommended to have periodic and detailed prenatal examinations, and to have the childbirth in a hospital, with medical monitoring. In addition, several systemic diseases, such as infections, and the need for surgery, chemotherapy, or taking medications not recommended for pregnant women, may occur.
All of this puts the pregnant woman and her fetus at greater risk than other healthy people, in the case of a coronavirus infection. It is known that pregnant women are more susceptible and react more severely to respiratory infections (5 times more deaths than among non-pregnant women). It is very important, therefore, that the pregnant woman isolate herself socially and protect herself against infections, strictly following the recommended hygiene measures, especially if she is at the end of her pregnancy, and if the PDD (Probable Date of Delivery) is going to fall within the expected duration to the most acute phase of the epidemic.
This also applies to prenatal examinations. Probably, as many obstetricians’ offices are closed during the mandatory quarantine, the pregnant woman will have greater difficulty in performing her periodic ultrasound and physical examinations which are essential to ensure good monitoring and clinical decisions based on this evaluation. However, if this happens, she should still try to keep in touch with the doctor for follow-up via teleconsultation, to avoid having to leave the house and have contact with other patients in the waiting room.
What does the Chinese experience, which has had the most cases reported so far, tell us about it? In an analysis of 35 pregnant women who were infected, all had surgical delivery, except one, without problems. The children were tested at birth and were not positive for the virus. To date, these very limited data from China have shown no greater risk of acquisition or severity of COVID-19 in pregnant women, compared to other adults.
Data from nine women in their third trimester with COVID-19 suggest that a serious infection towards the end of pregnancy can affect the time and route of delivery. In two of the patients the fetuses developed a distress syndrome, and in two cases there was premature rupture of the uterine sac. However, it is not known if this was really due to the Cov2 pneumonia.
Due to the small number of cases, we still do not know whether vaginal delivery involves a greater risk than the surgical one for the mother and baby. Theoretically, avoiding the great maternal effort in vaginal delivery, accompanied by fatigue and exhaustion, would suggest that the best way to this is to resort to surgical delivery, which would avoid all this. However, general airway anesthesia for these pregnant women during delivery is problematic if she has pneumonia.
The transmission of the disease from the mother to the newborn after birth, through contact with infectious respiratory secretions, cough and sneezing, is a concern and occurred in two cases in this Chinese study. In order to reduce the risk of this transmission, the health team may recommend the temporary separation of themother from her baby, if she has suspected or confirmed COVID-19.
How to do it while breastfeeding, can it be done by an infected mother, or is it not recommended? Although there is no evidence that viruses from the infected mother are transmitted through milk, contact during breastfeeding is potentially dangerous for the newborn baby, there have been several cases that have caused breathing difficulties in the child. If she decides to breastfeed, the mother should thoroughly clean her hands, arms, lap, breasts, neck and face and wear a hair cap, a sterile apron and a fresh surgical mask before breastfeeding. The right thing, however, would be to extract the milk with a breast pump after cleaning the nipples and feeding the baby like this, with a bottle.
In my view, I think that maternity wards should be isolated from the rest of the operations to combat the epidemic, and receive only tested and negative pregnant women for the coronavirus; and for the positive ones, in special isolated wards. Attention to pregnant women in general hospitals where there are large numbers of infected patients are being treated, either in outpatient clinics, emergency rooms or in hospitalizations is not recommended.
Finally, although many uninfected mothers are tempted to deliver at home instead of at the hospital, this is clearly not recommended by experts, as the possibility of complications and lack of resources for immediate care is a real danger. However, each case is different, and must be carefully assessed by the team serving the future mother.
Reference
Yang, H. et al. Novel coronavirus infection and pregnancy. Opinion. Ultrasound in Obstetrics & Gicecology. ISUOG: International Society of Ultrassound in Obstetrics and Gynecology, 05 March 2020: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.22006
The author:
Prof. Renato Marcos Endrizzi Sabbatini is a biomedical scientist, graduated and doctorate (Physiology) from the Ribeirão Preto School of Medicine, University of São Paulo, Brazil. He has 51 years of experience as a teacher at this Faculty and also at the Faculty of Medical Sciences of the State University of Campinas (UNICAMP) and at the Bahiana School of Medicine and Public Health. He has received the “José Reis” Award for for Best Scientific Dissemination from the National Research Council (CNPq) in 1994 and has more than 2,000 articles published in many newspapers, magazines, books, websites and other media. Contact: renato@sabbatini.com
Copyright © 2021 by Renato Marcos Endrizzi Sabbatini
