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Impact of COVID-19 on Pregnant Women

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Sunanda Kulshrestha:

Impact of COVID-19 on Pregnant Women: 

The entire world is busy dealing with an unprecedented and monstrous pandemic in the face of novel coronavirus (SARS-CoV-2), and the disease got its name as COVID-19. The news of reported cases arose from Wuhan, China in December 2019, which soon engulfed the whole world in its claws, spreading over 213 countries.(1) After United States, India has now become the second largest hotspot of coronavirus in the world with a large number of cases reported on a daily basis.

In the race of management, treatment of COVID-19 and discovery of vaccine, other underlying ailments and issues have been neglected and overlooked. One of them is the care for pregnant women at times of COVID-19. A strategical lockdown has been adopted in countries worldwide to deal with the spread of the disease, which guided people to stay home and avoid any contact and spread. Post-lockdown, a surge has been seen in cases of pregnancies including planned, unplanned and even those out of sexual abuse by the intimate partners. About 20 million pregnancies will be there as reported by UNICEF between March 2020 and December 2020, giving it a name of baby boon with India being the leading one in the race. However, the question is, is the time safe for babies? What will happen if the mother is one of the positive head counts and how will it affect the baby in turn? Such questions have been discussed in the curated literature after reviewing related articles and papers.(2)

Data for vertical transmission of COVID-19 to the new born are scarce; however, other issues have been observed that are directly or indirectly linked to SARS-CoV-2 infection in mother, including preterm labour, miscarriage and even death of the new born. All this could also be related to other underlying diseases.(3) Khan et al. suggest that COVID-19 increases the risk of neonatal pneumonia and preterm delivery.(4) Pregnant mothers have always been a vulnerable group even at the normal times and are likely to develop more problems if infected with SARS-CoV-2. Approximately 85% of pregnant women experienced mild disease, 10% severe and 5% critical with fever, cough, shortness of breath being the most common symptom. Reports from seven pregnant women with COVID-19 in China showed fever (86%), cough (14%), shortness of breath (4%) and diarrhoea (14%) as the symptoms. Chen et al., conducted a similar study in 112 women and found relatable results.(5,6)

Transmission of infection from mother to baby has not been linked with the type of delivery, vaginal or caesarean. However, premature miscarriages mainly in 2nd or 3rd trimester in COVID-19 positive women, still birth and even death of new born babies have also been reported in many cases.(7,8) This could be linked to the weak physical condition of the mother. The physiological needs of increased maternal oxygen demand, fastened metabolism, anaemia and increased need of foetal oxygen consumption can be the factors behind the reported cases of foetal mortality.(9) Also, Rafael et al. reported that elevated serum CRP at admission may help identify women at-risk of severe COVID-19 pneumonia.(11)

Some daily newspapers and media coverage have reported cases of  children recovering from COVID-19 after intensive care and treatment; however, no confirmed results have been reported for the recovery of new born child after the infection. Furthermore, if a child does not get infection from mother in due path of mature birth, several other problems even arise in terms of post-natal child care. Breastfeeding, which is the most beautiful part of motherhood and even the most important one for the well-being of the child itself, also gets hindered due to the fear of transmission. Although data supporting viral transmission through breast milk are lacking, holding the child during feeding increases the susceptibility to infection. Therefore, mothers are advised to follow proper guidelines and instructions and wear mask while feeding the baby.(10) Other related factors include post-partum depression, which is a common scenario in mothers and the feeling of fear of this disease adds up in it.

Due to the absence of proper evidence related to foetal mortality and COVID-19, the fact that expecting mothers are vulnerable to the disease can’t be ignored at once. The study in field related to COVID-19 is a new emerging one which comes up with new researches every day. Expecting mothers are advised to follow proper safety measures and guidelines issued by FIGO and WHO.(11) Proper hygiene should be maintained, telemedicine and regular advice from the gynaecologist should be practiced, taking selfcare and calming the minds down to avoid any state of panic for the safety of child and oneself is crucial to deal with such issues related to child and mother in the times of COVID-19.

Author:

Sunanda Kulshrestha, M.Sc (Biosciences), Banasthali University, Rajasthan, India.

October 15, 2020

Edited by:

Dr. Kalika Mathur, Ph.D (Scientific editor at Bio-Services). https://www.bio-services.org/dr-kalika-mathur-ph-d-2/

References:

  1. 1. Wang C, Horby PW, Hayden FG, and Gao, G.F. (2020). A novel coronavirus outbreak of global health concern. Doi:https://doi.org/10.1016/S0140-6736(20)30185-9.
  2. 2. https://timesofindia.indiatimes.com/life-style/parenting/pregnancy/covid-19-baby-boom-india-expected-to-have-the-highest-number-of-births-this-year/articleshow/75602754.cms
  3. 3. Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. doi: 10.1016/j.ajog.2020. 04.014.
  4. 4. Khan, S. et al. Association of COVID-19 with pregnancy outcomes in health-care workers and general women. Clin Microbiol Infect (2020).
  5. 5. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. 2020. Outcome of Coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysisis. Am J Obstet Gynecol.
  6. 6. Chen L, Li Q, Zheng D et al. 2020. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med. NEJMc2009226. https://doi.org/10.1056/ NEJMc2009226.
  7. 7. Marta L, Martinez-Portillaa T. 2020. Coronavirus Disease 2019 in Pregnancy: A Clinical Management Protocol and Considerations for Practice. Fetal Diagn Ther 2020; 47:519–528
  8. 8. Gillian AR, Purandare NC, McAuliffe FM, Hod M and Purandare CN. 2020. Clinical update on COVID-19 in pregnancy: A review article. J. Obstet. Gynaecol. Res. 46, 8:1235–1245
  9. 9. Rafael San-Juana et al., Research Paper Incidence and clinical profiles of COVID-19 pneumonia in pregnant women: A single-centre cohort study from Spain. https://doi.org/10.1016/j.eclinm.2020.100407
  10. 10. Davanzo R, Moro G, Sandri F, Agosti M, Moretti C, Mosca F. 2020. Breast feeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr. e13010. https://doi.org/10.1111/ mcn.13010
  11. 11. Pascarella G, Strumia A, Piliego C et al. 2020. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020. https://doi.org/10.1111/joim.13091

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