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What are the risks of COVID-19 infection in pregnant women?

What are the risks of COVID-19 infection in pregnant women?

Last Reviewed : 12/14/2020
What are the risks of COVID-19 infection in pregnant women?

Novel Coronavirus is a close cousin of two other viruses that caused previous outbreaks - SARS and MERS viruses. Pregnant women were at increased risk and had increased fatality rates during both these outbreaks. There is a rising concern about severity of COVID-19 illness in pregnant women. Body immunity, heart and lung organ systems, endocrine system and most of the other organ functioning of pregnant women are already compromised due to pregnancy state. Any infection or any additional stress to pregnant women may result in serious consequences.

Maternal outcomes: Based on the study published in Ultrasound Obstet Gynecol, 32 women affected by COVID-19 in pregnancy were reported. Twenty-seven delivered by Cesarean and two by vaginal delivery. Three pregnancies were ongoing at the time of publication. There were no maternal deaths by the end of the study. Severity of the illness seems to be similar to general population.

Early pregnancy: There are not many studies identifying the risk of COVID-19 illness during early pregnancy. Based on the clinical outcomes, the risk seems to be very low.

Second and third trimesters: Among 32 women reported, one pregnant woman was admitted at 34 weeks when she presented with fever and sore throat. Her condition rapidly deteriorated and she required ICU level of care. She had a stillbirth, delivered by Cesarean section.

Prematurity: The study reported that 15 out of 32 patients (47%) affected by COVID-19 delivered preterm. Exact causes were not identified in all the cases. Almost all the pregnant women except for two were delivered by Cesarean section.

Fetal growth and placental effects: Pregnant women affected by COVID-19 who delivered did so within 13 days of onset of illness. With COVID-19, during the first week, symptoms are usually mild. It usually gets severe only during the second week. This time period is too short to have any effect on the fetuses. No fetal growth abnormalities were identified in the reported cases.

Delivery and postnatal: As mentioned earlier, 27 women delivered by Cesarean section and 2 women had normal vaginal delivery. There is no transmission of Novel Coronavirus from infected mothers to newborns during delivery. Samples tested from amniotic fluid, umbilical cord blood, neonatal throat swabs and breastmilk were all negative. There were couple of reports where newborns were infected more than a day later. This happened as the newborns were in close contact with the mother and did not happen at the time of delivery. This underscores the importance of separating the newborn from the infected mother right after delivery.

Neonatal outcomes: Based on several small studies published so far, most of the newborns did fairly well. Preterm delivery affected 47% of women affected by COVID-19 but most babies improved as expected. In one study, six out of ten babies had to be admitted to neonatal intensive care for respiratory support. There was greater prematurity in this one small study. One baby born at 34 weeks died of multiple organ failure and shock. In another small study, there were nine live births and one stillbirth. All the live newborns were stable.

Overall, compared to SARS and MERS, Novel Coronavirus is less lethal to pregnant women. Neonatal outcomes are reasonable as ell. As COVID-19 progresses, there will be more data available that may provide us a better picture of the disease. In any case, pregnant women have to be very careful taking all the necessary precautions not to contract the disease. Prevention is always better than cure.

 

 

References:

  1. What are the risks of COVID-19 infection in pregnant women? Qiao J. Lancet. 2020 Mar 7;395(10226):760-762. doi: 10.1016/S0140-6736(20)30365-2
  2. Coronavirus in pregnancy and delivery: rapid review. Mullins E et al. Ultrasound Obstet Gynecol. 2020 Mar 17. doi: 10.1002/uog.22014
  3. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Huijun Chen et al. Lancet 2020; 395: 809–15. https://doi.org/10.1016/ S0140-6736(20)30360-3

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