Pregnancy In The Times Of A Pandemic: What Impact Can COVID-19 Have On Moms-To-Be And Babies

New Delhi: Pregnancy can be stressful even under normal circumstances but during a pandemic, the anxiety can increase exponentially. In an open webinar on pregnancies conducted by doctors of the All India Institute of Medical Sciences (AIIMS), New Delhi, a senior gynaecologist-obstetrician said that they are preparing for the possibility that the number of pregnant women infected with Covid-19 would increase. Since pregnancy comes with significant changes in the body including the immune system, it is important to take extra precautions to avoid catching the infection. There are also concerns on how risky the pregnancy would be and if the mother can transmit the infection to the baby in the womb. However, experts say that there is no need to panic because as of now there only have been cases of COVID-19 positive pregnant women delivering babies who have tested negative. For example, recently a COVID-19 positive woman in Aurangabad Civil Hospital gave birth to a baby who did not get the coronavirus from its mother but is being kept in a separate ward to avoid the risk of catching the virus through aerosols.

Maharashtra: Staff at Aurangabad Civil Hospital arrange a video call between a #COVID19 positive mother&her newborn baby who have been kept in separate wards. "On April 18, the baby was born by cesarean section&tested negative," says Aurangabad Civil Surgeon Dr. Sunder Kulkarni. pic.twitter.com/hJmWvqztFe

— ANI (@ANI) April 23, 2020

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Here is what medical experts have to tell many mothers-to-be who are worried about looking after themselves and their babies during the Covid-19 pandemic.

Talking about the challenges of being pregnant during COVID-19 outbreak, Dr. Shweta Khandelwal, an expert at Public Health Foundation of India (PHFI), a not for profit public-private initiative working towards strengthening health in India said that only a small number of studies reporting a limited number of cases are available for reference till now. She said,

Pregnancy itself is a vulnerable stage as we nurture another life within us thus in a state of partial immune suppression which makes pregnant women more vulnerable to viral infections, and the morbidity is higher even with seasonal influenza. So yes, pregnant women must be very careful during this time when COVID-19 is causing this entire catastrophe globally. That said, there is no need to panic. Most experts agree that pregnant women do not appear more likely to contract the infection than the general population.

She further said that most of the women who have been studied under some case reports had COVID-19 during the third trimester of pregnancy. As of now, there is no evidence of any fetal malformations or effects due to maternal infection with COVID-19 at least in India, according to Dr. Khandelwal.

She recommended that expecting mothers should maintain hygiene, avoid unnecessary contact with people or surfaces, meditate, stay calm, eat healthy, be hydrated and rest well.

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On precautions that pregnant women need to take, Dr. Neerja Bhatla, a professor of gynaecology and obstetrics at the AIIMS said during the webinar,

It is important that pregnant women abide by social-distancing measures and as much as possible communicate with doctors through teleconsultations. Their family members should also take special care to practise social distancing.

In order to guide pregnant women in managing their pregnancy and healthcare workers in taking care of pregnant women, Indian Council for Medical Research (ICMR) and National Institute for Research in Reproductive Health (NIRRH) have issued a set of guidelines. According to the guidelines, it is critical that family support for women is strengthened as far as possible and their mental health and well-being is looked after. It specifies that if a woman meets the criteria for COVID-19 testing, she should be tested and until test results are available, she should be treated as though she has confirmed COVID-19.

Via the guidance document, ICMR and NIRRH further say that pregnant women with heart disease are at the highest risk of becoming COVID-19 positive. Pregnant women are advised to increase their social distancing to reduce the risk of infection and practice hand hygiene, as per the guidelines. It also says that during the term of pregnancy and delivery process, a single person should be permitted to stay with the women. Visitors should be instructed to wear appropriate personal protection gears, including gown, gloves, face mask, and eye protection.

If required, the number of visits to the hospital during pregnancy may be reduced in consultation with the doctor. It further says that if there is a need to visit a health centre, then the women should be driven in a private vehicle or in an ambulance by calling 108 services.

For women who are self-quarantined because someone in their household may have symptoms of COVID-19, doctor’s appointments should be delayed for 14 days.

On the effect of COVID-19 on the pregnancy, ICMR says that there is currently no data suggesting an increased risk of miscarriage or early pregnancy loss and the novel virus is currently not leading to Medical Transmission of Pregnancy.

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Can A COVID-19 Positive Pregnant Woman Pass On The Infection To Her Baby In The Womb?

Health agencies around the world like the World Health Organisation (WHO), Centre for Disease Control (CDC), USA and ICMR say that as of now it is not known if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery and the virus has not been found in samples of amniotic fluid which is found in the innermost membrane that encloses the embryo.

According to Dr. Rakesh Sahay, Endocrinologist and Diabetologist, and Professor at Osmania Medical College in Hyderabad, limited information suggests that COVID-19 does not cross the placenta and get to the fetus. Thus the baby is safe inside the womb but after delivery, if the mother has been tested positive or is suspected of having COVID-19, she should be temporarily kept in a separate room until no longer suspicious and should touch baby while taking precautions like wearing a mask, cleaning hands properly. This is because aerosol/ respiratory droplets generated from a COVID-19 positive mother can transmit to the infection to the baby. He said,

There are a few cases of pregnant women catching the infection, and in all these cases we have seen that children who were born were not infected. So till now, we have seen that there is no transmission from mother to child inside the womb. But there is a need to precaution once the child is out of the womb to avoid any infections.

Dr. Khandelwal also, seconds Dr. Sahay and said that pregnancy does alter the body’s immune system but with regard to transmission from mom to baby, previous case reports from China suggested that there was no evidence for this and amniotic fluid, cord blood, neonatal throat swabs, placenta swabs, genital fluid and breastmilk samples from COVID-19 infected mothers have so far all tested negative for the virus. However, she further said that more research is warranted to determine the proportion of pregnancies affected and the impact on the neonate.

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