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COVID-19 and Pregnancy

P SamjiCoronavirus Disease (COVID-19) and Pregnancy:

Dr. Priyanka Samji, Ph.D.

Background: Coronavirus (CoV) is a large family of viruses that cause mild common cold but sometimes cause more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV) (Lai et al., 2001). Coronavirus disease (COVID-19) is caused by a new strain of coronavirus designated as SARS-CoV-2 that was discovered in 2019 in Wuhan, China and has not been previously identified in humans (Xu et al., 2020). Coronaviruses are zoonotic, that means they are transmitted between animals and humans (Lee et al., 2020). The COVID-19 virus spreads mainly through respiratory droplets when an infected person coughs or sneezes. People are assumed to be most contagious when they are most symptomatic (Chan et al., 2020).

Various studies have shown that respiratory viral infections during pregnancy have been associated with problems such as low birth weight and preterm birth. Further, high fever early in pregnancy might increase the risk of certain birth defects (Siston et al., 2010). During SARS epidemic, 12 pregnant females got infected with the SARS virus and out of 12; 3 died during pregnancy, 4 had miscarriages, 2 had intrauterine growth restrictions, 4 had successful deliveries (Wong et al., 2004). During MERS-CoV epidemic, 11 pregnant females got infected; 10 of them (91%) had adverse clinical outcomes such as premature delivery, intensive care treatment for newborns, maternal and perinatal death. Similar to SARS epidemic, there was no case suggesting the vertical transmission of the MERS virus (Alfaraj et al., 2019). Till now, no study has shown that SARS-CoV-2 infection during pregnancy increases the chance of miscarriage, however, it was observed during SARS coronavirus epidemic in 2002-2003, that women with the SARS-CoV infection were at a slightly higher risk of miscarriage, but only in those who were severely ill (Wong et al., 2004).

Risk to Pregnant Women: As SARS-CoV-2 is a novel virus, not much is known about its effect on pregnant women. Currently, medical experts believe that pregnant women are just as likely, or may be more likely, than non-pregnant women to develop symptoms if infected with the new coronavirus. It is suggested that symptoms are likely to be mild to moderate for both pregnant and non-pregnant women in the same age range. According to the American College of Obstetricians and Gynecologists, the data on COVID-19 does not suggest that pregnant women are at higher risk of getting the virus as compared to non-pregnant women. However, the literature suggests that pregnant women are at greater risk of harm if they get respiratory infections (Siston et al., 2010). During pregnancy, the mother’s body experiences various immunological changes that allow her to tolerate an antigenically different fetus and any further changes in respiratory or cardiovascular systems such as increased heart rate, reduced lung capacity might increase the risk of severe respiratory issues (Warning et al., 2011).

Symptoms: COVID-19 is a respiratory disease in which the infected patients develop mild to moderate symptoms and recover without requiring special treatment. Some people don’t even show any symptoms but are carriers of this virus. Common symptoms of COVID-19 are fever, cough and fatigue. In some cases, people experience shortness of breath, aches, pains, sore throat, nausea, running nose or diarrhea. Rarely, it leads to pneumonia, severe acute respiratory syndrome, heart failure, kidney failure and even death (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html). If a pregnant woman has an underlying situation such as asthma or diabetes, it can lead to more severe symptoms with significant chest infection that requires immediate enhanced care and hospital admission (Luo et al., 2020).

Diagnosis: Routine confirmation of cases of COVID-19 uses nasopharyngeal, oropharyngeal swab or sputum (if produced) and endotracheal aspirate or bronchoalveolar lavage in patients with more severe respiratory disease. It detects the presence of SARS-CoV-2 by using real time RT-PCR with confirmation using nucleic acid sequencing. (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technicalguidance/laboratory-guidance).

If one develop symptoms of COVID-19 such as persistent fever and cough and had close contact with anyone who has been diagnosed with COVID-19 or you think you have been exposed to virus or you have a travel history of going to places with ongoing community spread of COVID-19 in the last 14 days, then first wear a mask to avoid infection to others and then consult the doctor in the hospitals approved by ICMR to detect and treat the COVID-19 infection (https://covid.icmr.org.in/index.php/testing-facilities).

Treatment: Because COVID-19 is a novel emerging infectious disease, the optimal treatment for affected individuals is not yet established. Majority of the confirmed cases are given oxygen therapy and treated with antiviral drugs in isolation. In the study carried out by Yu et al.,2020, most of the COVID-19 patients were treated with antiviral drugs, antibiotics and corticosteroids, however, there is no published data of the safety and efficacy of these drugs. Till now, both mothers and infants haven’t shown any complications, but the safety of steroids in treating COVID-19 pregnant females still needs further research to draw conclusions (Yu et al., 2020). During pregnancy, due to alterations in hormone levels and reduced lung volumes caused by an increase in uterus size, COVID-19 pregnant women might have a more rapid clinical deterioration (Siston et al., 2010; Warning et al., 2011). For pregnant women, antibiotics should be used preferably after delivery to prevent secondary bacterial infections and strengthen immune system which can further reduce complications or mortality (Yu et al., 2020). It is highly recommended not to take any medication on your own, please visit a doctor and follow the consultation.

Prevention: According to WHO guidelines, it is recommended to wash hands properly and regularly with soap for 20 seconds or by using an alcohol-based hand sanitizer. Pregnant women should prefer to work from home, avoid large gatherings and maintain social distancing to reduce the spread of the virus. If there are no symptoms, they can attend antenatal care but if there are symptoms of coronavirus infection, they should consult their doctors and follow their advice. A pregnant woman should strictly avoid domestic as well as international travel to the COVID-19 affected countries. If you are pregnant and tested positive for SARS-CoV-2 with very mild to moderate symptoms, you should self-quarantine at your home. You should consult your gynecologist on phone and follow her advice. Don’t go to the hospital for consultation as you can spread infection to others. You should stay inside the home or in any quarantine facility or designated hospitals suggested by doctors and avoid contact with others for 14 days. Further, follow online fitness routines to keep yourself fit and active. After 14 days of isolation, you should get the COVID-19 test done again. If it turns negative, go to your antenatal care provider for the routine checkup followed by an ultrasound scan.

Author:

Dr. Priyanka Samji, Ph.D (Molecular Endocrinology and Reproductive Biology), Indian Institute of Science, Bangalore, India.

April 07, 2020

Edited By:

Dr. Nida Rehmani, Ph.D (Scientific editor at Bio-Services).

 

References:

(1) Alfaraj, S. H., Al-Tawfiq, J. A. and Memish, Z. A. (2019) ‘Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature’, Journal of Microbiology, Immunology and Infection, 52(3), pp. 501–503. doi: 10.1016/j.jmii.2018.04.005.

(2) Chan, F. W. et al. (2020) ‘A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster’, The Lancet. Elsevier Ltd, 395(10223), pp. 514–523. doi: 10.1016/S0140-6736(20)30154-9.

(3) Lai, M. M. . and Holmes, K. . (2001) Fields Virology. Edited by D. . Knipe and P. . Howley. Philadelphia, PA: Lippincott Williams & Wilkins.

(4) Lee, I. and Hsueh, P. R. (2020) ‘Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV’, Journal of Microbiology, Immunology and Infection. Elsevier Taiwan LLC, pp. 2019–2021. doi: 10.1016/j.jmii.2020.02.001.

(5) Luo, Y. and Yin, K. (2020) ‘Management of pregnant women infected with COVID-19’, The Lancet Infectious Diseases. Elsevier Ltd, 0(0), pp. 2019–2020. doi: 10.1016/S1473-3099(20)30191-2.

(6) Siston, A. M. et al. (2010) ‘Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States’, JAMA – Journal of the American Medical Association, 303(15), pp. 1517–1525. doi: 10.1001/jama.2010.479.

(7) Warning, J. C., McCracken, S. A. and Morris, J. M. (2011) ‘A balancing act: Mechanisms by which the fetus avoids rejection by the maternal immune system’, Reproduction, 141(6), pp. 715–724. doi: 10.1530/REP-10-0360.

(8) Wong, S. F. et al. (2004) ‘Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome’, American Journal of Obstetrics and Gynecology, 191(1), pp. 292–297. doi: 10.1016/j.ajog.2003.11.019.

(9) Xu, X. et al. (2020) ‘Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission’, Science China Life Sciences, 63(3), pp. 457–460. doi: 10.1007/s11427-020-1637-5.

(10) Yu, N. et al. (2020) ‘Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan , China : a retrospective , single-centre , descriptive study’, The Lancet Infectious Diseases. Elsevier Ltd, 3099(20), pp. 1–6. doi: 10.1016/S1473-3099(20)30176-6.

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