Why Pregnancy is considered high risk in COVID times?

The spread of COVID-19 and the consequent lockdown has been having the most significant effect on people already dealing with persisting medical conditions – such as pregnant women. Life for them has taken an especially unprecedented swerve, since visits to the doctor, routine checkups, or sanitizing surfaces for the baby are not ordinary anymore. Schedules have been disrupted, throwing the work-life-mom nexus off-balance.

Higher risk of severe disease, ICU admission

A recent study by the Centers of Disease Control and Prevention, USA, indicates that pregnant women are more likely to get severe COVID-19 and are at a high risk of being hospitalized or admitted in the intensive care unit (ICU) with need for mechanical ventilation when compared to non-pregnant women.

Higher risk of blood clots

Another study, published in the journal Endocrinology, indicated that pregnant women are at a higher risk of developing blood clots due to COVID-19 than non-pregnant women. Now, experts suggest that pregnant women are already 5 times more likely than non-pregnant women to develop a blood clot. This happens due to various changes that occur in the bodies of women during pregnancy; the blood clots more easily to prevent excessive bleeding during labour and not being active during pregnancy may reduce blood flow to legs, further increasing the risk of clotting. SARS-CoV-2, the COVID-19 causing virus, has also shown to cause blood clotting in patients. So, experts suggest that for pregnant women, this risk may increase further.

Placenta damage and vertical transmission

A study including 16 COVID-19 positive pregnant women found that blood clots were formed in the placenta leading to restriction of blood flow to the baby. Even though all the babies in the study were born in good health, it was suggested that pregnant women should be watched more carefully during the pandemic.

In two other cases, children born to COVID-19 positive women were found to have antibodies against the virus and clinical signs of the infection. However, in the latter, it was not exactly apparent if the infant got the disease while in the womb or during delivery.

Preterm birth

Even though no cases of preterm birth or miscarriage has been seen in COVID-19 positive pregnant women, on the basis of the data from SARS and MERS, experts suggest that the novel coronavirus may induce both of these conditions.

Despite all the current evidence, it is worth mentioning that the research is still ongoing and nothing can be said for sure yet. It is highly likely that new things would be found about the virus and its effects on pregnancy in the coming months.

Do pregnant women face greater risk from COVID-19?

So far, the data on COVID-19 does not suggest pregnant women are at higher risk of getting the virus, according to the American College of Obstetricians and Gynecologists. However, as we have seen from the flu they are at greater risk of harm if they get respiratory infections. Pregnancy causes a variety of changes in the body and results in a slight immunocompromised state which can lead to infections causing more injury and damage.

Does having the coronavirus create a greater risk of miscarriage or preterm labor?

Studies have not yet been done to show if having COVID-19 during pregnancy increases the chance of miscarriage, but there is some evidence from other illnesses. During the SARS coronavirus epidemic in 2002-2003, women with the virus were found to have a slightly higher risk of miscarriage, but only those who were severely ill.

Having respiratory viral infections during pregnancy, such as the flu, has been associated with problems like low birth weight and preterm birth. Additionally, having a high fever early in pregnancy may increase the risk of certain birth defects, although the overall occurrence of those defects is still low.

Can a mother with COVID-19 pass the virus to her baby in the womb?

This data is evolving fast. Two papers published March 26 describe finding coronavirus antibodies in three newborns of mothers with COVID-19. That could suggest they had been exposed to the virus in the womb, though the virus itself was not detected in their umbilical cord blood and researchers have raised questions about the type of test used. Researchers in an earlier study found no evidence of COVID-19 in the amniotic fluid or cord blood of six other infants born to infected women. While the research papers include only a small number of cases, a lack of vertical transmission – from the mother to child in utero – would be consistent with what is seen with other common respiratory viral illnesses in pregnancy, such as influenza.

There have been a few reports of newborns as young as a few days old with infection. But in those cases, it is believed that the mother or a family member transmitted the infection to the infant through close contact after delivery. The virus can be transmitted through a cough or sneeze, which could spread virus-laden droplets on a newborn.

How are prenatal checkups changing?

Prenatal care may look different for a while to control the spread of COVID-19 among patients, caregivers and medical staff.

Typically, a pregnant woman has about 14 prenatal visits. That may be reduced by approximately half, with telemedicine playing a larger role. Telemedicine is already endorsed by the American College of Obstetricians and Gynecologists for patients in rural settings. Now, the pandemic is making virtual care solutions an indispensable tool. Pregnant women are able to do some at-home monitoring, such as for high blood pressure, diabetes and contractions, and telemedicine can even be used by pregnancy consultants, such as endocrinologists and genetic counselors.

Dr.Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi , namely, max and apollo hospitals.

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