Pregnancy is often a time for much anxiety for many, but during this coronavirus pandemic there is much anxiety for both the pregnant woman and her health care providers. Data on this pandemic are rapidly changing, but all available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.
Coronavirus (COVID-19) and pregnancy
Although there are currently no data showing that COVID-19 affects pregnant people differently than others, we do know that pregnant people are at greater risk of getting sick from other respiratory viruses than people who are not pregnant. Sometimes, this causes adverse outcomes for the mother or child. Therefore, if you are pregnant, be mindful about reducing your risk of getting this new virus.
Decreasing the risk of pregnant women developing COVID-19
In Anguilla, we must continue to take measures to decrease the transmission of COVID-19. Women who are pregnant should discuss with their obstetrician, or midwife, about how they can decrease the risk of transmission of this novel virus. The following are strongly recommended:
Practice social distancing.
• Avoid people who are sick or who have been exposed to the virus.
• Stay at home, or stay at least 6 feet away from people who do not live in your home.
Wash your hands often.
• Wash your hands often with soap and water for at least 20 seconds, especially:
o After touching other people, including children;
o After touching surfaces outside your home, or items from outside that you have brought into your home;
o After going to the bathroom;
o After blowing your nose, coughing, or sneezing;
o After handling dirty laundry;
o Before eating or preparing food; and
o Before breastfeeding or expressing milk.
• Always wash your hands when they are visibly dirty.
• If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
Cover your coughs and sneezes.
• Cover your coughs and sneezes with a tissue. Throw the tissue in the trash, and then wash your hands. Or, cough into your elbow and clean your hands.
Clean, disinfect, and launder safely.
• Clean and then disinfect frequently touched surfaces and objects (e.g., phones, personal electronic devices, remote controls, tables, countertops, light switches, doorknobs, and cabinet handles).
o Be sure to follow instructions for safely and effectively using disinfectants, including directions for rinsing off the chemicals after a period of time. In addition, be sure to keep products out of the reach of children.
• Launder items, including washable plush toys, by following the label or instructions. Launder items using the warmest appropriate water setting for the items – and dry items completely, if possible. Dirty laundry from an ill person can be washed with other people’s items, but wash your hands after handling the dirty laundry.
Why are pregnant women considered a vulnerable group for COVID-19?
Pregnant women are placed in a vulnerable group by various health authorities in regard to COVID-19 infection.
What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution. We know that some viral infections are worse in pregnant women – however, all available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.
What effect does coronavirus have on pregnant women?
Various studies have shown that the large majority of pregnant women experience only mild or moderate cold/flu-like symptoms if they develop COVID-19. Cough, fever, shortness of breath, headache and loss or change to your sense of smell or taste, are other relevant symptoms.
A small percentage of pregnant women when affected develop severe symptoms, or their recovery is delayed. If symptoms are severe hospitalization will be required – and they then require specialized care.
In a recent study, it was found that the majority of women who did become severely ill were in their third trimester of pregnancy – emphasising the importance of social distancing from 28 weeks of pregnancy.
This study also found that pregnant women from black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who were overweight or obese, and those who had pre-existing medical problems – such as high blood pressure and diabetes – were also at higher risk of developing severe illness.
What effect will coronavirus have on my baby if I am diagnosed with the infection?
As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage.
Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) is probable. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well.
Given current evidence, it is considered unlikely that if you have the virus it would cause problems with your baby’s development, and none has been observed currently.
Across the world, emerging reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover.
Prenatal and postpartum care during the COVID-19 pandemic
Pregnant women should continue their prenatal care during this epidemic. If they have concerns they are encouraged to contact their obstetrician or midwife. Women are encouraged not to skip their prenatal appointments. Pregnant women should not delay getting emergency care because of COVID-19.
Even during this COVID 19 pandemic, it is very important that if you have any concerns about yourself or your pregnancy at any time, you should contact your obstetrician, doctor or midwife. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage, so you should seek urgent medical advice. Avoid turning up at any healthcare facility before calling, so that arrangements can be made for your visit, especially if you have symptoms suggestive of COVID-19 infections.
Antenatal and postnatal care are based on years of evidence to keep the pregnant woman and her baby safe in pregnancy and birth, and beyond. Antenatal and postnatal care should therefore be regarded as essential – and you should be encouraged to attend, despite being advised to engage in social distancing measures.
Will COVID-19 affect mode of delivery?
If a pregnant woman is symptomatic an elective procedure might be delayed, but the type of delivery will be based on each patient’s individual clinical circumstances. A senior obstetrician might be needed in seriously compromised pregnant women, especially if surgical delivery is required.
Breast feeding and COVID-19
There are many advantages of breastfeeding, and it is strongly recommended with few contraindications:
• Breast milk provides protection against many illnesses and is the best source of nutrition for most infants.
• The pregnant woman, along with her family and healthcare providers, should decide whether and how to start or continue breastfeeding.
• We do not know for sure if mothers with COVID-19 can spread the virus to babies in their breast milk, but the limited data available suggest this is not likely.
• If you have COVID-19 and choose to breastfeed:
o Wear a cloth face covering while breastfeeding and wash your hands before each feeding.
• If you have COVID-19 and choose to express breast milk:
o Use a dedicated breast pump.
o Wear a cloth face covering during expression and wash your hands before touching any pump or bottle parts and before expressing breast milk.
o Follow recommendations for proper pump cleaning after each use – cleaning all parts that come into contact with breast milk.
o If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home.
Mental health
There is no doubt that the coronavirus pandemic will inevitably result in an increased amount of anxiety in the general population, and this is likely to be even more so for pregnant women as pregnancy represents an additional period of uncertainty. Anxieties for the pregnant woman might be related to the following:
• The virus itself
• The impact of social isolation resulting in reduced support from wider family and friends
• The potential of reduced household finances
Isolation, financial difficulties, insecurity and inability to access support systems are all widely recognised risk factors for mental ill-health. The coronavirus epidemic also increases the risk of domestic abuse or violence. Your midwife or obstetrician should be asking all pregnant women about their mental health during this period of much uncertainty. By acknowledging these difficulties, healthcare professionals can help to contain some of the anxieties. If you require support, you should be referred to the appropriate professionals. If you are experiencing domestic violence, please disclose this to a health professional who can provide information and support to keep you safe.
Conclusion
Women who are pregnant are naturally anxious about various issues related to the coronavirus pandemic. Clinicians are still learning new facts about this new virus but, so far, all the studies are indicating that COVID-19 is not having a severe impact on the pregnant woman and her developing fetus. The most important thing a pregnant woman can do to decrease her risk of getting the virus is to wash her hands regularly and effectively. Use soap and water and wash for at least 20 seconds. As a precaution, you should follow the Ministry of Health advice about social distancing, stay away from public places and avoid anyone who has symptoms suggestive of coronavirus. Healthcare providers in Anguilla are working to ensure that pregnant women, their babies and their families, are supported and cared for during these uncertain times. There might be some changes but these will be explained to you by your health care provider. All pregnant women who have questions about their pregnancy, and the coronavirus pandemic, should contact their midwife or obstetrician.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-seven years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
