Decoding the impact of COVID-19 on pregnancy

August 3, 2022

5 minutes read

The ongoing COVID-19 pandemic caused by the SARS-CoV-2 virus has changed the way of life. It has affected all walks of our lives and works of life. Being a challenge, especially for the immunocompromised, Covid has made solitary existence a norm. COVID is a challenge, but being pregnant makes you even more vulnerable. Here I have reviewed what is known in the context of pregnancy and covid infections.

The infected individuals initially exhibit mild respiratory symptoms. A fraction of them further progresses to severe disease resulting in acute respiratory distress syndrome (ARDS), affecting various organ systems and leading to fatal multi-organ failures. This deterioration is provoked by aggravated cytokine storm (such as interleukin (IL)-6, IL-8, IL-10, tumour necrosis factor (TNF), and GM-CSF) and inflammatory responses in different organs.

Studies have crystalized an increased risk and maternal complications, including preterm birth and caesarean section in COVID-19-positive pregnant women [29]. A recent population-based study in the UK reported that the SARS-CoV-2 infection rate in pregnant women between March 1 and April 14, 2020, was 49 per 10,000 maternities [31]. This study also found that 4.5 per cent of infants delivered from infected mothers were positive for SARS-CoV-2 RNA [31], suggesting the possibility of SARS-CoV-2 transmission during the delivery process. Further, An analysis of COVID-19 surveillance data from January to June 2020, the US Centers for Disease Control and Prevention (CDC) confirmed the likelihood of pregnant women suffering a more significant clinical burden as 31.5% of pregnant women with COVID-19 required hospitalization, higher than non-pregnant counterparts non-pregnant (5.8%) [35]. They found that more than 2500 35].

A study in COVID-19-positive pregnant women revealed a relationship between the severity of COVID-19 and pre-eclampsia-like occurrence [32]. The researcher found that 62.5% of women with severe COVID-19 developed pre-eclampsia-like syndrome [32]. Again studies have also reassessed the role of co-morbidities in the mortality of pregnant women with COVID-19 and found that patients who died were older and more likely to have co-morbidities [33]. Multipronged factors, including physiological anatomic, hormonal, and immunological changes, might be associated with increased severity of COVID-19 in pregnancy. Close monitoring of body parameters and timely treatment coupled with preventive measures may help limit the transmission of COVID-19 in pregnant women

Breastfeeding

Close and early contact and exclusive breastfeeding for babies are highly beneficial. However, women with COVID-19 have challenges in breastfeeding as Covid demands physical distancing and social isolation. Various studies do not suggest a strong correlation between breast milk and covid transmission. And breastmilk samples (Including Amniotic fluid, cord blood, and throat swabs of neonates) from COVID-19 women have been reported to be harmful [81 [6]. [139]. A systematic review analyzing the evidence from 37 studies concluded no evidence of SARS-CoV-2 transmission through breast milk [140].

Although SARS-CoV-2 transmission through breast milk is unlikely [[140], [141], [142]], close contact during breastfeeding may contribute to the information of infection [75]. [143]. In the case of infected mothers, using milk extractors under strict hygiene is recommended, and feeding the newborn by a healthy person [93]. Adequate COVID precautions, including practising respiratory hygiene, wearing a mask, washing hands, routine cleaning, and disinfecting surfaces, are recommended. The National Health Commission of China also recommended using breast pumps instead of direct breastfeeding to mitigate the chances of the spread of infection [129].

Treatment

Effective therapies and treatment regimens are rapidly developing against COVID-19 [146]. Recent clinical trials for developing anti-viral therapies against SARS-CoV-2 c excluded pregnant women s [147,148]. In a systemic review, D’Souza et al. [149] supported using corticosteroids, magnesium sulfate, aspirin, and anticoagulation, based on clinical suitability for pregnant women with Covid. Although no specific treatment exists against COVID-19 during pregnancy, various drugs have been used to treat the disease in pregnancy, such as arbidol, remdesivir, lopinavir/ritonavir combination, dexamethasone, and a combination of IFN-α-2b and arbidol as well as convalescent plasma, conservative fluid management, mechanical ventilation and other supportive therapies [150,151].

Vaccines

Vaccines are one of the most promising preventive measures to protect the mother and neonate against COVID-19 [172]. An ideal COVID-19 vaccine during pregnancy should induce an immune response without excessive maternal immune system activation [176]. Excessive immune system activation may cause an exaggerated inflammatory response, leading to adverse events during pregnancy. Maternal immunization is not only for protecting the mothers, but it is also critical for protecting the newborn until their immune system can develop its defence against viruses. An ideal COVID-19 vaccine upon vaccination of pregnant women, IgG antibodies are actively passed through the placenta to provide passive immunity to newborns. Live or live attenuated vaccines may not be safe as there is a risk of developing the disease during pregnancy; however, the inactivated or subunit and nucleic acid vaccines will be safer as there is no risk of developing disease from the vaccine.

Various vaccines like BNT162b2 mRNA (BioNTech and Pfizer),mRNA-1273 (Moderna and National Institutes of Health (NIH)), Sputnik V (Gamaleya Company), Covaxin (Bharat Biotech Company, India), Covishield (Oxford-AstraZeneca vaccine developed in the UK) have been created successfully [[182], [183], [184]]. However, these studies have not included (few or no) pregnant women as their study participants. To ensure efficacy and safety in all groups, there is a need to design dedicated vaccine trials with a more significant number of men and women participants, including pregnant women and lactating women [185].

Pregnant women are a vulnerable population, as seen by the detrimental effects of SARS-CoV-2 infection observed in expectant mothers and their fetuses. Since there is limited information specific to pregnant women affected by covid associated with preventive measures, good hygiene management practices must be emphasized to minimize cross-infection between COVID-19-infected pregnant women, health care workers, and neonates. All possible preventative measures and the adoption of good personal and respiratory hygiene must be ensured during delivery and breastfeeding to reduce the risk of Covid transmission. All the strategies, including early diagnosis, timely management, and prevention measures, should be employed along with robust research to generate evidence for effective strategies.

Table 1. Guidelines provided by WHO and CDC for pregnant women during the COVID-19 pandemic

Name of the organization

Guidelines for the pregnant women

References

World Health Organization (WHO)

Regular checkups and monitoring
Isolation of affected women
Provision of skilled medical staff with all associated remedial provisions
Counselling to deal with the physiological and mental stress during pregnancy
Thorough counselling of pregnant women related to the breastfeeding and isolation of the fetus after birth
Expert decision for the vaginal or cesarean delivery
Use of minimum essential protective gears and maintenance of proper hygiene to prevent the transmission of infection
Routine ante-natal or postpartum care of fetus and mother

[127]

Centres for Disease Control and Prevention (CDC)

Confirmed/suspected COVID-19 pregnant women should be isolated immediately and notified of the obstetric unit
Immediate emergency care should be provided to pregnant women with COVID-19
Regular provision of counselling related to the prenatal or postpartum care
Maintenance of proper hygiene, including washing of hands with soap or sanitizing with 60% alcohol, using a mask etc. before breastfeeding the newborn baby
The women suspicious or infected with SARS-CoV-2 virus infection must be isolated from the newborn, and breast pump milking should be recommended
Tdap and influenza vaccines can be used during pregnancy

[121,128]

Author

Dr. Jyoti Rawat is a biology researcher by profession. Her research focuses on making life-saving drugs more affordable. She is interested in seeing more women in science. She cooks, paints, and tends to plants in her free time.