I am pregnant during a pandemic. What risks await women in this state, does the virus penetrate the fetus, what happens when a pregnant woman becomes ill with covid? Does passing COVID-19 disease risk miscarriage?
COVID-19 is a new disease that humans encountered late last year-the first cases of coronavirus infection. The disease is caused by the SARS-CoV-2 virus, which can successfully mask itself in the body and spreads rapidly. Its symptoms are not entirely clear, as the virus can have a different set of symptoms in different people, and in some cases develop asymptomatically. Unfortunately, despite intense research into the new disease due to the pandemic it caused earlier this year, little is actually still known. How does the SARS-CoV-2 virus affect pregnancy and are pregnant women more likely to be infected?
Coronavirus and pregnancy - the risks
According to data in the RCOG-Coronavirus (COVID-19) Infection in Pregnancy briefing from June of this year, pregnant women are not at increased risk of contracting the disease. According to observations, COVID-19 is not transmitted via the transplacental route from mother to fetus. However, it is important to note that pregnant women, due to changes in the immune system during pregnancy, may be more susceptible to viral illnesses and undergo them more severely.
People who suffer from chronic diseases, which can also occur in pregnant women, will be in a higher risk group. For this reason, people who suffer from cardiovascular diseases, respiratory diseases, diabetes or obesity should be on their guard and be monitored by the doctor who is conducting the pregnancy. People with these conditions are at increased risk for complications and hospitalization if they become infected with COVID-19
Effects of coronavirus on the fetus
The results of observations and studies performed to date do not support the theory of prenatal or perinatal transmission of infection to children in women infected with SARS-CoV-2. There is no confirmed information on transplacental transmission. However, recent studies have hypothesized the possibility of vertical transmission, but this theory is not fully confirmed. Studies of cord blood, placenta, and amniotic fluid have shown the absence of SARS-COV-2 coronavirus, which means that the period of development and delivery does not pose a threat to the child in women infected with COVID-19. This means that breastfeeding does not pose a risk to infants because the newborn will not be infected this way. However, it should be remembered that the sample in each case is not fully reliable, as the disease is a relatively new case and the number of cases studied is insufficient to draw a definitive conclusion.
There is no confirmed information on the effect of coronavirus on miscarriage issues. However, it is not impossible that the course of the disease may have an effect on premature birth, miscarriage or consequent disorders in the child. The newborn may suffer from kidney failure, disseminated coagulation syndrome, as well as low birth weight. The risk is due to the symptoms that can accompany the development of the infection and lead to complications related to the course of pregnancy. The most common are the condition of elevated temperature and infections. The greatest risk appears to be during the first twelve weeks of pregnancy, when the baby's organs are forming. During this time, any teratogenic agents are at risk, which include but are not limited to viral diseases, biological agents, chemical agents, and particular medications. These can influence the child to develop birth defects and developmental disorders later on. Coronavirus, and more specifically the symptoms it causes, can be a teratogenic factor.
However, all cases of miscarriage and fetal abnormalities in women infected with SARS-CoV-2 should not be linked to the consequences of the disease. The population risk in healthy cases varies between 12-25% (percentage of spontaneous miscarriages). According to the population risk theory, about 2-3% of newborns are born with malformations. Nearly 60% of miscarriages are the result of a chromosomal aberration in the fetus and not the result of a viral disease or other infection. For this reason, it is difficult to determine whether complications during or at termination of pregnancy are directly attributable to SARS-CoV-2. There are data published by Asian countries that indicate that when a pregnant woman is symptomatic for COVID-19, the most severe complication for the newborn is circulatory failure or cardiac arrhythmias.
Childbirth during coronavirus
The management of delivery in the face of COVID-19 disease is determined in each country according to World Health Organization (WHO) guidelines. Women infected with SARS-CoV-2 can deliver by either method, either naturally or by cesarean section. The decision should still be made primarily on the basis of the woman's clinical condition and the baby's condition. According to WHO data, the baby should not be separated from the mother after birth; on the contrary, the contact between the mother and the newborn should be permanent, close. A woman can breastfeed. However, it is recommended that the child of a mother infected with coronavirus be isolated from other children for safety. Above all, proper sanitary-epidemiological precautions should be taken both in the contact of the staff with the child and the mother, and in the bonding between the mother and the infant. Currently, before the planned date of delivery, one should visit the hospital to have a test for the presence of genetic material of the virus or antibodies to SARS-CoV-2. Our hospital is one of the few offering a quick test and results using both the PCR method and the immunochromatographic method. The test will allow to confirm or exclude coronavirus infection, giving information both to the parents-to-be as well as the medical staff on the choice of appropriate sanitary conditions during childbirth and further stay in the hospital.
Pregnancy safety in the era of coronavirus
For pregnant women who are not infected with coronavirus, it is important to stay safe and exercise caution. Adhering to the restrictions associated with the outbreak, such as keeping a social distance and covering your mouth and nose in public spaces, will help here. If possible, it is advisable to keep public spaces to a minimum for the duration of the pregnancy, preferably until the outbreak is over, or at least until the pregnancy is successfully terminated. Both healthy and infected women should be under the constant care of the doctor in charge of the pregnancy. Beyond physical health, however, it is also important for pregnant women to stay calm and try to think positively. Stress in pregnancy is not good for a pregnant woman's mood and psyche and can have a negative impact on the pregnancy itself. For pregnant women who have been confirmed to be infected with coronavirus, the main thing to do is to prevent a state of elevated body temperature from persisting. This is especially important for women in the first trimester of pregnancy.
Women who have a suspicion of being infected or who have had contact with a person suffering from COVID-19 should immediately contact the doctor in charge of their pregnancy or the NFZ helpline, which will provide them with the necessary information and methods of action in their particular case. This is especially important for pregnant women who have alarming symptoms that may indicate the presence of SARS-CoV-2 in the body. A quick response is a guarantee of an appropriate path on the way to preventing the development and appearance of complications for the course of pregnancy. A woman should inform the doctor in charge of the pregnancy of any abnormalities and alarming symptoms she notices and follow the recommendations strictly. It is worth remembering that direct contact is not always required, and sometimes only telephone or e-mail contact is sufficient. The doctor will be able to assess the need for a visit for the condition of the woman so as to minimize the risk.
However, it is not only the pregnant woman who should be self-aware of her condition and the need for caution, but also her surroundings and loved ones. This means that co-habitators should not put the pregnant woman at risk for infection. If possible, both the pregnant woman, the household members or the medical professionals caring for her should be tested for SARS-CoV-2.
The SARS-CoV-2 coronavirus is a new strain of virus to deal with and still requires research to understand its nature. Unfortunately, the findings to date are more like circumstantial evidence and recommendations than definitive conclusions about the disease. This is especially true when considering the impact of coronavirus on pregnancy development. The number of investigated cases of pregnant women infected with COVID-19 is not yet a sufficient sample to make a definite conclusion. However, studies continue to be conducted to develop appropriate standards of management and prevention over time.
Source:
- A. Lamouroux, T. Attie-Bitach, J. Martinovic, M. Leruez-Ville, Y. Ville, „Evidence for and against vertical transmission for severe acute respiratory syndrome coronavirus 2”.
- Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK –seventh update 25March 2020.
- Huijun Chen, Juanjuan Guo, Chen Wang et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records Lancet 2020; 395 (10226): 809-815.
- J. Tulimowski , „COVID-19 w ciąży zalecenia”.
- Rasmussen S.A., Smulian J.C., Lednicky J.A. et al. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know ACOJ 2020 in press.
- Rekomendacje Sekcji Ultrasonografii Polskiego Towarzystwa Ginekologów i Położników, dotyczącymi badań ultrasonograficznych w zakresie położnictwa i ginekologii w obecnej sytuacji epidemiologicznej, publikowane w celu minimalizacji ryzyka transmisji infekcji COVID-19.
- WHO „Coronavirus (COVID-19) Infection in Pregnancy” – Royal College of Obstetricians & Gynaecologists.
- Zalecenia Konsultanta Krajowego w dziedzinie perinatologii oraz Konsultanta Krajowego w dziedzinie położnictwa i ginekologii odnośnie organizacji pracy oddziałów położniczo-ginekologicznych w sytuacji epidemiologicznej związanej z ryzykiem zakażenia wirusem SARS-CoV-2.
