Reproductive Health

Jun 2, 2021

Pregnancy and COVID-19

COVID-19 presents both good news and bad news for pregnancies.

Julie Rosenberg

Key Takeaways:

  • COVID-19 does not seem to be the worst case scenario for pregnant women as far as respiratory diseases go.
  • However, pregnant women are at a higher risk than non-pregnant women of the same age for developing severe symptoms and getting hospitalised
  • COVID-19 can lead to more pre-term births in the third trimester
  • No clear protocol for vaccine, however current data suggests its safe to take - consult your GP.

COVID-19, being an emerging disease, is not supported with enough clinical data exploring its effect on pregnancies. Doctors and scientists are worried about pregnant individuals being a vulnerable or high-risk group. This is because of two main reasons - (1) pregnancy pushes up the diaphragm in a mother’s body and reduces her lung capacity. Consequently, a respiratory infection can easily affect the lungs and increase risk of disease severity. (2) Data from previous outbreaks of other respiratory diseases (swine flu pandemic), saw pregnant individuals getting hospitalised and suffering fatalities.

The data we have available so far from COVID-19 presents both good news and bad news.  The good news is that COVID-19 does not seem to be the worst case scenario for pregnant women, as far as respiratory diseases go. The risk of severe illness remains low overall and foetuses / new born babies are mostly spared the worst effects of the infection. However, a recent study conducted by the CDC indicates that pregnant women are at higher risk than non-pregnant women of the same age for developing severe symptoms, getting hospitalised and requiring invasive ventilation [1].  This is especially true in the case of pregnant individuals who are older, overweight or suffer from co-morbidities such as hypertension, heart disease and diabetes. Increased risk for ICU admission among pregnant women was also  particularly notable among certain minority racial and ethnic groups (non-Hispanic Asian women and non-Hispanic Native Hawaiian/Pacific Islander women). The rates of fatalities among pregnant people also aren’t especially high although the risk is slightly higher.

Furthermore, the data is limited and mostly concentrated during the third trimester of the pregnancy, rendering COVID-19’s impact on pregnancy a grey area that requires careful observation and consultation with health professionals.

COVID-19 and babies

Doctors and researchers still don’t know if a pregnant women with COVID-19 can pass the virus to a foetus or newborn. Mostly, people are not seeing what is called vertical transmission, which is what happens when a mother who has SARS-CoV-2 passes it on to her baby. To date, the active virus has not been found in samples of fluid around the baby in the womb or breastmilk.  Those instances are very rare. Some newborn babies have tested positive for COVID-19 shortly after giving birth, but it isn’t clear if the virus was passed before, during or after birth. They’re also not seeing high rates of stillbirths when babies don’t make it through because of the virus. [2]

The data however does suggest that the infection of COVID-19 in pregnant women in the 3rd trimester can lead to more pre-mature births or early births than normally observed. According to Thangaratinam’s analysis, pregnant women with COVID-19 had three times the odds of delivering preterm compared with those without the disease. [3]This should be  a point of concern, especially for those looking to get pregnant in the near term.

There has been no recommendation made regarding the mode of delivery: natural vs. cesarian births. Pregnant women have been advised to go ahead with the delivery mode that is best suited for their body at the given time.

Protocols to be observed

  • Regular physical distancing norms, wearing a mask and washing hands is recommended for women who are pregnant
  • Avoid interacting with individuals who are sick or have been exposed to the virus
  • Navigating pregnancy during COVID-19 can be especially stressful for those pregnant and it is important to take proper care of mental health, both at the pre-natal stage and at post-partum. Yoga and meditation are widely recommended during pregnancy.
  • Pregnant women who contract COVID-19 should alert their doctors immediately, especially if they start showing symptoms.
  • Breast-feeding is advised to continue since the pros are believed to outweigh any cons. The mother is advised to wear a mask and wash hands for at least 20 seconds prior to touching her baby.

Pregnancy and COVID-19 vaccine

The protocols for pregnant women getting vaccinated is not totally clear. Following norms, none of the major vaccine makers enrolled pregnant women in their first trials, thereby making it difficult to ascertain the efficacy and impact of the vaccine in this group. As a result, regulatory bodies were also hesitant in making blanket recommendations about pregnant women getting the jab.

Currently, there are trials underway and planned that include pregnant women, so as to get a more definitive answer. There have also been surveys conducted as well as studies that included accidental pregnancies that have so far shown no obvious red flags for pregnant women getting vaccinated. The WHO has recommended that pregnant workers on the frontline and those with pre-existing conditions should receive the vaccine as the benefits, once again, outweigh the cons.

Many health care providers and doctors are strongly advising those pregnant to consider taking the vaccine in consultation with their doctors. As the results of trials and studies are collected, there is expectation to have proper protocols in place soon. But the data, so far seems to suggest that COVID-19 vaccination is safe during pregnancy.

Bottom line:

There are many questions that remain unanswered around COVID-19 and pregnancy. If you are someone who is planning a pregnancy in the near term, we advise you to stay up-to-date with the research and evaluate whether the risks are worth the benefits. Social distancing norms, proper care at home and online consults with medical practitioners are especially important.

Citations:

  1. Centers for Disease Control and Prevention. (2020, November 5). Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22–October 3, 2020. Centers for Disease Control and Prevention.
  2. Thompson, B., & Subbaraman, N. (2021, March 12). Coronapod: COVID and pregnancy - what do we know? Nature News.
  3. Subbaraman, N. (2021, March 9). Pregnancy and COVID: what the data say. Nature News.

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