SARS-CoV-2 strain of the coronavirus was first identified in 2019 in Wuhan City, China. As all viruses, mutations have emerged with the virus and five new variants are identified to date including Delta and Omicron variants. Delta variant is associated with severe infection where Omicron variant is highly transmissible. 

Majority of women in the reproductive age group in Sri Lanka are now fully vaccinated against the virus so, severe infection during pregnancy is becoming less common. 

“Pregnant women have the same risk of contacting the SARS-CoV-2 virus as the general population. Majority of pregnant women acquiring the infection (66%) are asymptomatic. In practice I have seen many patients who routinely admit to give birth or other indications become positive for SARS-CoV-2 while they remain asymptomatic. In symptomatic mothers, the common symptoms include loss of taste, cough, sore throat, fever and body aches” explains Dr. Neomal Abeysekera, Senior Registrar in Obstetrics and Gynecology National Hospital, Kandy.

Effects of the infection during pregnancy On the mother 
SARS-CoV-2 virus is commonly transmitted via respiratory droplets and rarely by contaminated surfaces. It has milder effects during the first 28 weeks of the pregnancy, but they have an increased risk of developing severe illness during the latter twelve weeks. Remaining unvaccinated, being infected by the Delta variant, obesity, diabetes and high blood pressure further increases the risk. 

“The enlarging womb in pregnancy limits expansion of the lungs and restricts positioning the mother on prone. Severe SARS-CoV-2 needs maternal ventilatory support via a face-mask or non-invasive/ invasive positive airway pressure ventilation.  They may require an early delivery to facilitate maternal resuscitation or due to fetal concerns”

Pregnancy itself increases the risk of blood clotting resulting in venous thromboembolism (VTE) and it is further increased by SARS-CoV-2 infection. Therefore, all women hospitalized will be prescribed prophylactic treatment to prevent venous thrombosis with heparin. 

Effects on the developing fetus 

Commonly maternal viral infections during pregnancy vertically transmits to the developing fetus via the placenta. SARS-CoV-2 infection has not shown to cause any congenital anomalies but it has adverse effects on placentation increasing the risk of small-for-gestational age babies and still births. In practice we have noted several low risk patients developing gestational hypertension and placental abruptions during or following SARS-CoV-2 infection in pregnancy. 

Effects during labour 
Symptomatic women with SARS-CoV-2 infection are found to have fetal distress during labor and it is recommended to monitor intra-partum fetal well-being by continuous electronic fetal monitoring.  Regular clinic visits will facilitate a healthy delivery.

Effects of the infection during post-partum period 
According to doctor, transmission to the baby is not affected by the mode of birth, skin-to-skin contact or breast feeding and therefore, SARS-CoV-2 infection is not a contraindication for breast feeding. 
During pregnancy, maternal antibodies against the virus are also transmitted to the fetus via the placenta minimizing the effects of the infection in newborns. However, the newborn requires observation for respiratory effects of the infection. 

As mentioned above, an increased risk of blood clotting persists through the post-partum period and prophylactic treatment is recommended. 

Tackling the problems need non-delayed medical advice
Use of contraception is recommended to avoid unintended pregnancies. 
Good personal hygiene including hand washing and wearing the mask will minimize the risk of contacting the infection. 

“Vaccination is the most effective method of prevention for severe SARS-CoV-2 infection and reducing its adverse outcomes. Almost all patients who died in pregnancy due to severe SARS-CoV-2 infection were found to be unvaccinated. Adverse effects of SARS-CoV-2 in pregnancy can further be reduced by maintaining a normal BMI of less than 25kg/m2 and by controlling diabetes” Dr Abesekera highlights.

Safety of the vaccine
“Pregnant women are considered as a priority group for vaccination and vaccination STRONGLY RECOMMENDED for all pregnant women” Dr Abesekera says.

Vaccination can be carried out at any time during pregnancy or post-partum period (safe during breast-feeding) and there is no evidence showing it has any adverse effects on fertility or the developing fetus. 

“Studies have shown that 98% of pregnant women who develop severe SARS-CoV-2 infection are unvaccinated. Patients who have completed the vaccination regime including the booster dose are 88% less likely to require hospital admission following SARS-CoV-2 infection” Dr Abesekera concluded.

Take home message 
Majority of women infected with SARS-CoV-2 virus in pregnancy are asymptomatic. 
Almost all patients developing severe illness were found to be unvaccinated. 

Symptomatic women requires hospital admission and severe symptoms will need intensive care. 

Contraception, personal hygiene, wearing a mask and vaccination reduces the risk of SARS-CoV-2 in pregnancy. 
Vaccination is safe during pregnancy and breast-feeding.