Some wonder if pregnant women are more prone to Covid-19 severity. The National Health Service (NHS) states that there is no evidence that pregnant women are more likely to get seriously ill from coronavirus. However, pregnant women have been included on the list of people at moderate risk (clinically vulnerable) as a precaution. NHS adds that this is because pregnant women can sometimes be more at risk from viruses like flu. It’s not clear if this happens with coronavirus. But because it’s a new virus, it’s safer to include pregnant women in the moderate-risk group. Dr Kenneth Ruzindana, a consultant at University Teaching Hospital Kigali (CHUK), says pregnancy and childbirth generally do not increase the risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but appear to worsen the clinical course of Covid-19 compared with no pregnant individuals of the same sex and age; however, most (90 per cent greater) infected persons recover without undergoing delivery. Although most (90 per cent greater) infected pregnant persons recover without undergoing hospitalisation, rapid clinical deterioration can occur, and symptomatic pregnant patients are at increased risk of death compared to symptomatic non-pregnant females of reproductive age, Ruzindana says. Should mothers with Covid-19 be separated from their babies? “No, because the new-born risk for acquiring the virus from the mother is very low. However, it is advisable that the mother wears a mask and practices hand hygiene during contact with their infants. At other times, physical distancing between the mother and the new-born, or placing the baby in an incubator if it’s possible,” Ruzindana says. Does breast milk transmit the virus? He says that there is a general consensus that breastfeeding should be encouraged because of its maternal and infant benefits. It is unknown whether the virus can be transmitted through breast milk as very few breast samples have been tested. The World Health Organization (WHO) conducted a small study and breast milk samples from about 43 mothers were negative, but there were samples from three mothers that tested positive for the virus. But specific testing for viable and infective virus was not profound. Ruzindana adds that samples that are of SARS-CoV-2 positive do not necessarily contain a viable and transmissible virus. Generally, it’s admissible to say that breastfeeding should be encouraged for its benefits. He adds that the infant can even receive passive antibody protection from the virus since breast milk is a source of antibodies and other anti-infective factors. One encouraging fact is that the virus that causes Covid-19 has not been found in breastmilk, according to the U.S. Center for Disease Control and Prevention (CDC). Doctors advise that if you have symptoms, then you need to pump the breast milk into a bottle and get someone else to feed the baby. If a mother chooses to feed her baby with formula or expressed milk, she is advised to strictly follow sterilisation guidelines. Observational data demonstrates that while the chances for these severe health effects are low, pregnant women with Covid-19 have an increased risk of severe illness, including illness that results in ICU admission, mechanical ventilation, and death compared to non-pregnant women of reproductive age. Additionally, pregnant women with Covid-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared to pregnant women without Covid-19. Does Covid-19 increase the risk for pregnancy complications? Yes, infected women, especially those who develop pneumonia, appear to have an increased frequency of preterm birth (birth before 37 weeks of gestation) and caesarean delivery, which is likely related to severe maternal illness. Most preterm births are iatrogenic (for instance, induced labour or scheduled caesarean delivery), Ruzindana says. Does the virus affect the baby? Ruzindana explains that there is no definite evidence that SARS-CoV-2 (the virus that causes Covid-19) crosses the placenta and infects the foetus; however, a few cases of placental tissue or membranes positive for SARS-CoV-2 and a few cases in utero infection have been reported. Some of the neonatal cases may have been false-positive test results or due to acquisition of infection soon after birth. Reports of Covid-19 infection in the neonate have generally described mild disease. One very small study, published in ‘The Lancet’ in 2020, looked at nine coronavirus-positive pregnant women in their third trimester in the Wuhan region of China—the original epicentre of the outbreak—and found no evidence that the virus was transferred from mother to foetus. Are vaccines safe for pregnant women? “Probably, the first vaccines to become clinically available are based on ribonucleic acid (mRNA) or protein subunits and don’t contain infectious virus. Based on WHO recommendation, it is recommended not withholding these vaccines on the basis of pregnancy alone for those who are eligible for all desired vaccination in agreement with other expert guidance. So pregnant and lactating women were excluded from the vaccine trials,” Ruzindana says. He adds that vaccination should be timed so that patients don’t receive Covid-19 vaccines within 19 days of receipt of the routine administered vaccine such as a dose of influenza. CDC and the independent Advisory Committee on Immunization Practices (ACIP) have provided information to assist pregnant women with their decision to receive the Covid-19 vaccine. Precautions for pregnant women U.S experts say that, for now, women should comply with the same recommendations that governments have made for other people. However, they recommend that pregnant women should self-isolate for 12 weeks, they should be working from home and minimising their contact with people. And women should not miss their appointments and should be in touch with their designated medical team regarding the best course of action.
