Pregnancy during a pandemic

With COVID-19 being one of the leading health issues globally, the need to safeguard oneself from being exposed to the disease is crucial and more so if you are an expectant mother. In discussion with Consultant Obstetrician and Gynaecologist of the DGH Nawalapitiya, Dr. Kanishke Samaranayake, today’s Health Capsule will be focusing on how best pregnant mothers could cope with the pandemic.

“The novel Coronavirus infection resembles more of a mild to moderate upper respiratory infection similar to a common cold. However there are certain features that make our suspicion to be skewed towards COVID,”said Dr.Samaranayake. Explaining the symptoms, he said that these include anosmia, loss of taste sensation and significant severity of sore throat. Also there is high temperature with a new onset of continuous cough. “Rhinorrhea which is commonly seen during a cold is less prominent here. These along with a suspicious contact or travel history help us to differentiate COVID-19 infection from an otherwise harmless URTI” he added.

A COVID positive mother and her fetus 
When asked what the are chances that it may not lead to infant mortality or any other serious complication on the growing fetus or a new born baby under such conditions, he acknowledged that vertical transmission is possible from mother to baby. “However newborns testing positive for COVID either by nasopharyngeal swab or cord blood PCR, were clinically possible; so whether it leads to infant mortality or any complications on the growing fetus is still to be ascertained” the doctor said. 

“The presence of IgM antibodies in the neonate suggest that intrauterine transmission triggered the immune response. However incidence of cases among newborn is low, therefore the risk of transmission is also likely to be very low, given that testing of placenta, amniotic fluid or maternal vaginal secretions did not suggest enough evidence to show that viral transmission occurs by the above media. Another area with this regard is the increased incidence of prematurity in babies born to mothers testing positive for COVID. Whether this was due to complications of COVID or due  to unimproved maternal health is however unclear” he said.

Pregnancy complications 
He said that complications in pregnant ladies infected with COVID are the same as others; that is hypoxia, respiratory distress or insufficiency and acute respiratory distress syndrome (ARDS). “As new evidence is showing that the propensity to form blood clots causing pulmonary embolism (clot in the blood vessels of the lungs) is also there, this however is a higher risk in pregnancy due to their already present hypercoaguability status. Some risk factors are there that increase the risk in pregnancy to have a complicated course of illness – diabetic (gestational or pre-existing, age >35, overweight or obese, with pre-existing medical comorbidities, Asian ethnicity and being in the third trimester. 

Some may  have a complicated course, especially if they have other comorbidities or in the third trimester. Such females will have hypoxic events and respiratory distress requiring ICU care, ventilator support and sadly may even end up with death. Diagnosis is mainly based on PCR demonstration of novel Coronavirus either using nasopharyngeal samples or cord blood” he said. When asked if miscarriage is possible in a COVID infected mother, he said that there is no evidence as of now to suggest as such, nor is there any data suggesting increased second trimester loss.

“I suggest it would be advisable to formulate a method to deliver the basic necessity antenatal clinic followed by limiting the number of visits and categorizing the needs based on comorbidities, risk factors and the period of gestation,” Dr Samaranayake stressed. 

Precautions to minimise the  risk 
Follow guidance of social distancing, use of masks, hand washing, following safe and hygienic practices at home, travel and workplace and reducing exposure to crowded environments are key to minimising risk.

Regular exercise, healthy and balanced diet and folic acid supplementation is beneficial in improving immunity. 

Staying mobile is important to reduce risk of blood clot formation.

Vitamin D supplementation has been found to have an added benefit. This is due to the high prevalence of vitamin D deficiency and the role of it in preventing ARDS from developing.