Pregnancy during a pandemic: What are the risks?

Experts are investigating the potential impact of the coronavirus on pregnancy. In this report, SADE OGUNTOLA, writes that while many of these researches are in their early stages, they underscore the wisdom of following guidance on avoiding the coronavirus in pregnancy based on past experience with other viral infections, like rubella or influenza.

Many months into the coronavirus pandemic, experts are giving more details about how the virus is disrupting the health and wellbeing of pregnant women. Yet for pregnant women and their unborn children, protecting them from contracting the virus is very important.

Pregnant women may be at a higher risk for severe illness from COVID-19 compared with women who are not expecting. Researchers, at the United States of America Center for Disease Control and Prevention (CDC) stated that “pregnant women were 50 per cent more likely to be admitted to the intensive care unit.”

The study, in the CDC’s new report, included information on 326,335 women, ages 15 to 44 who tested positive for the coronavirus. This is the largest U.S. cohort of pregnant women with lab-confirmed SARS-CoV-2 infection.

Data on the women were reported to the CDC between January 22 and June 7 either electronically using a case report form or through the National Notifiable Diseases Surveillance System as part of nationwide COVID-19 surveillance efforts.

What is not clear is whether pregnant women were hospitalised because of complications related to their coronavirus infections or if they were hospitalised for pregnancy-related reasons but just happened to also have coronavirus.

When it came to COVID-19 symptoms, the experiences were similar among the pregnant and non-pregnant women (cough and shortness of breath) but pregnant women less frequently reported headache, muscle aches, fever, chills and diarrhea than did non-pregnant women.

However, the reports found that more than 31 per cent of the pregnant women who caught coronavirus were hospitalised, compared to 5.8 per cent of non-pregnant women.

“Really a pregnant woman’s risk of contracting COVID-19 is not too different from that of another who is not pregnant; both need to take the expected precautions to be protected from this droplet infection,” said Dr Oladipupo Adefuye, the Chief Medical Director (CMD) of the Olabisi Onabanjo Teaching Hospital, Sagamu, Ogun State.

Adefuye, a consultant obstetric and gynecologist, stated that pregnancy can alter the way the body is able to handle severe viral infections for a small proportion of women and as such pregnant women need to take precautions such as regular washing of hands, intake of water, eating healthy, plenty of rest, taking their prescribed iron tablets, practice social distancing and steer clear of anyone who is sick.

Dr Adefuye said in ensuring physical distancing, antenatal clinic is devoid now of dancing and singing; the women are attended to immediately to prevent crowding.

He stated that although pregnant women are now given longer appointments for antenatal care, they should feel free to call the hospital with the phone numbers they are provided to seek help in an emergency.

However, since medical experts still have much to learn about how COVID-19 could cause problems during pregnancy and in new babies, he said even during delivery, steps are taken to protect both the mother and her unborn baby from contracting the virus.

“They can go through labour normally, but we try to prevent the viral particles coming out from their throat or any unsuspecting medical teams infecting the new baby by making everyone wear a face mask,” he added.

According to Dr Adefuye, although studies are yet to show that the amniotic fluid could also be contaminated with the virus, still precautions are also taken to ensure that the newborn is protected from contracting the virus in its passage through the birth canal.

CDC in its report said specifically, pregnant women were admitted more frequently to the intensive care unit, at 1.5 per cent, than non-pregnant women, at 0.9 per cent. Equally, 0.5 per cent of pregnant women required mechanical ventilation compared with 0.3 per cent of non-pregnant women. Among both pregnant and non-pregnant women, about 0.2 per cent died.

The data also showed racial disparities among the pregnant women with coronavirus infection: 46 per cent were Hispanic, 22 per cent were black and 23 per cent were white. The researchers noted that those proportions differ from pregnancy data from 2019, showing that among women who gave birth last year, 24 per cent were Hispanic, 15 per cent were black and 51 per cent were white.

No studies to date have shown that being pregnant increases the risk of COVID-19 infection or, once infected, severe symptoms. But if a woman contracts coronavirus in advanced pregnancy there is high probability that she may experience difficulty in breathing, as her respiratory capacity is already reduced due to the pregnant uterus pressing the diaphragm.

Some reports have painted a more troubling picture. A case study published by JAMA in late April described a COVID-19 patient who had a spontaneous miscarriage in her second trimester. The placenta tested positive for the COVID-19 virus, prompting the question of whether the infection had a role to play in inducing the adverse outcome.

In addition, evidence has been growing that the coronavirus in some rare situations can cross the placenta and infect a fetus in the womb.

Researchers in Italy studied 31 women with COVID-19 who delivered babies in March and April and found signs of the virus in several samples of the umbilical cord blood, the placenta and, in one case, breast milk.

In one case, there was strong evidence suggesting the newborn had the virus at birth because signs of it were found in the umbilical cord blood and in the placenta.

In another report from France, researchers gave even stronger evidence of in-the-womb infection and that newborn was very ill at birth.

Still, pregnancy weakens the immune system, making pregnant women more susceptible to respiratory infections more broadly, not just those caused by the coronavirus. According to another Lancet study, pregnant women developed severe pneumonia and deteriorated to the point of needing mechanical ventilation at higher rates than non-pregnant women.

Even high fever, a common symptom of COVID-19, can be dangerous in pregnancy, and something pregnant women need to be wary of. Developed in too early a stage of pregnancy, high fever can lead to birth defects.

The American College of Obstetricians and Gynecologists in a release said it is reviewing its clinical materials and resources for patients related to COVID-19. It, however, urges its members to encourage pregnant patients who test positive for COVID-19 to consider enrolling in an appropriate COVID-19 registry, such as the COVID-19 Priority Registry, to help the medical community better understand the impact of COVID-19 on pregnancy outcomes.

Specific actions pregnant women can take include not skipping prenatal care appointments, taking precautions to prevent getting COVID-19 when interacting with others, having at least a 30-day supply of medicines, and talking to their health care provider about how to stay healthy during the COVID-19 pandemic.

They also need to test as soon as possible if they feel they may have come into contact with someone who is infected as well as look after their health much more than before by eating well and drinking lots of liquids.

A pregnant woman should not don jewelry as these can often be difficult to be kept clean; she should not to delay getting emergency care due to COVID-19.

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