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COVID-19 and pregnancy

COVID-19, a disease unknown a year ago, today has changed almost all areas of our social and even home life. No matter what we do: work, study, shop, enjoy leisure, travel, visit doctors, meet family and friends – now we are always on guard how not to catch the dangerous coronavirus. And for pregnant women, this warning is twofold, because they need to save two lives.

After analyzing authoritative foreign information resources, including the portal of the Mayo Clinic (USA), the recommendations of the Royal College of Obstetricians and Gynecologists, the Royal College of Midwives and the Royal College of Pediatrics and Child Health, the Royal College of Anesthesiologists and the Association of Obstetric Anesthesiologists), the public health services of England and the public health services of Scotland, the recommendations of national experts and even the blogs of individual practitioners, we have prepared answers to the most common questions of pregnant women about COVID-19.

Are pregnant women at higher risk for COVID-19?

Pregnant women are not at higher risk of catching SARS-CoV-2 than other populations. But given reports of a more severe course of COVID-19 during pregnancy, the risk of preterm birth and responsibility for both lives, doctors recommend that pregnant women be especially careful during the COVID-19 pandemic, especially in the third trimester of pregnancy.

Do pregnant women have a higher risk of COVID-19 complications?

 

Opinions of experts on this issue are ambiguous. The above-mentioned British medical organizations do not believe that healthy pregnant women are at higher risk of complications of COVID-19, but still include pregnant women in the group with a moderate risk of severe coronavirus infection as an additional precaution.

According to the Mayo Clinic, pregnant women with COVID-19 are more likely to develop respiratory disorders that require treatment in the intensive care unit.

Pregnant women are also at higher risk of needing artificial lung ventilation.

Black women, Asians, Hispanics, and some ethnic minorities are at higher risk for COVID-19 complications. It is also determined that pregnant women over the age of 35, with a body mass index over 30, have a higher risk of developing severe pneumonia, also the ones with other medical problems, in particular, on the background of high blood pressure and diabetes.

There are no data on an increased risk of miscarriage for pregnant women with COVID-19. Although observed by some doctors, COVID-19 in the first trimester of pregnancy can lead to miscarriage.

It is believed that pneumonia in women with COVID-19 may be more severe if the gestation period is more than 30 weeks, when the uterus presses on the lungs and diaphragm, and the patient cannot accept the recommended position for pneumonia – on the abdomen.

Does coronavirus cause premature birth?

To date, there is no unequivocal evidence that coronavirus causes preterm birth. Despite statistics on the higher incidence of preterm birth in women with coronavirus, it is thought that their cause may not be coronavirus. Physicians were also able to deliver women infected with SARS-CoV-2 more quickly to maintain their health and to enable mothers to recover more quickly from COVID-19.

Although, according to the Mayo Clinic (USA), women with COVID-19 are more likely to give birth prematurely, as newborns from COVID-19 mothers may need inpatient care. According to an analysis of 427 pregnant women with a severe form of COVID-19, which required hospitalization, it was found that 1 in 5 babies were born prematurely, and less than 20 babies were born very prematurely (before 32 weeks of pregnancy).

 

How does the coronavirus SARS-CoV-2 affect the fetus?

To date, there are no data on the negative effects of coronavirus SARS-CoV-2 on fetal development. But COVID-19 in pregnant women leads to increased blood clotting – thrombosis. In turn, thrombosis of the vessels of the umbilical cord and placenta can be dangerous for mother and child. In general, the number of children born from full-term pregnancies (37 weeks or more) in women with a positive coronavirus test who needed treatment after birth was the same as among women not affected by the coronavirus, ie 1 in 10 babies.

What are the approaches to the treatment of COVID-19 in pregnant women?

In general, approaches to the treatment of COVID-19 in pregnant and non-pregnant women do not differ significantly. A pregnant woman needs special attention from medical professionals, and drugs should be prescribed strictly according to the indications, because through the placenta they enter the baby’s body. Treatment of COVID-19 in pregnant women is aimed at relieving symptoms, including fever and cough relief, and adequate drinking is important. According to the indications, antibiotics, anticoagulants and other drugs are prescribed.

A critical moment in the course of COVID-19 is the development of a “cytokine storm”, which means the excessive release of numerous pro-inflammatory substances by immunocompetent cells. “Cytokine storm” occurs for 7-10 days in patients with coronavirus pneumonia and coronavirus and is especially dangerous for pregnant women.

 

What are the approaches to screening pregnant women with COVID-19?

Whenever possible, ultrasound of the lungs should be performed to pregnant women instead of X-rays or computed tomography.

 

What are approaches to childbirth in women with COVID-19?

The course of COVID-19 in each pregnant woman may be different and decisions about the type of delivery (natural childbirth or cesarean section) are made individually for each patient. Of course, respiratory failure is a contraindication to physiological childbirth – the mother may not withstand a contraction period.

To avoid stress on the respiratory system, pregnant women give birth under epidural anesthesia, if there are no contraindications.

 

What is the risk of transmitting COVID-19 to a newborn?

 

To date, there are no data on the possibility of transmission of COVID-19 from mother to fetus during pregnancy, as it is a respiratory virus transmitted by airborne droplets.

According to the analysis of 427 pregnant women with a fairly severe form of COVID-19, which required hospitalization, it was found that 1 in 20 newborns was tested positive for coronavirus.

According to the observations of doctors, apart from a possible positive PCR test in infants born to women with COVID-19, no other abnormalities were observed in children.

Can a newborn be with the mother of the ward if she has a positive COVID-19 test?

If the baby is stable, full-term, without any comorbidities or disorders, then such a child can stay with its mother in the ward. Most experts agree that the risk of transmitting COVID-19 from mother to newborn is low, and most children tolerate the disease easily.

If the child is with a mother with COVID-19, it is recommended:

  1. Wash your hands with soap for at least 20 seconds before taking the baby in your arms. In the absence of soap, use solutions with an alcohol content of at least 60%.
  2. When approaching a child closer than 2 m, wear a protective mask.
  3. Keep the baby at a distance of more than 2 m.
  4. When staying with the baby in the hospital, discuss with the medical staff the possibility of establishing a physical barrier between mother and baby.

What are the approaches to breastfeeding by women with COVID-19?

A delivered woman with COVID-19 can stay with and feed her baby if her health allows.

According to the Mayo Clinic (USA), it has not been established to date whether the SARS-CoV-2 coronavirus can be transmitted through breast milk, nor has coronavirus been detected in breast milk.

According to experts, during breastfeeding, the baby can be infected with the coronavirus from the mother not through milk, but through respiratory microdroplets. Therefore, doctors advise mothers to wash their hands before touching the newborn and wear a protective mask during breastfeeding.

If the baby is in different rooms with the mother, breastfeeding can be performed with the help of  breast pumps and with the participation of outsiders. Before using a breast pump, a woman should wash her hands thoroughly with soap and wear a protective mask during the period of expressing milk.

How can pregnant women be protected from the coronavirus?

Pregnant women should follow generally accepted guidelines for protection against SARS-CoV-2 coronavirus infection:

  1. social distance;
  2. wearing protective masks or respirators;
  3. frequent hand washing.

The recommendations of international experts “How to protect yourself from coronavirus” for pregnant women also include the following tips:

  1. Maintain physical activity and adequate drinking (to prevent thrombosis).
  2. Eat a healthy diet and get extra vitamin D and folic acid.
  3. Undergo all medical examinations prescribed during pregnancy.
  4. Tell your doctor immediately if you experience any deterioration in your health or symptoms of COVID-19.

It is also recommended that pregnant women be vaccinated against influenza, as co-infection with influenza virus and coronavirus can be especially dangerous during pregnancy. You can be vaccinated from the first to the last weeks of pregnancy.

Sources: https://life.pravda.com.ua/health/2020/12/9/243320/,

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/,

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/pregnancy-and-covid-19/art-20482639,

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html,

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