How does the coronavirus affect pregnant women?

By Hannah Dahlen AM, Western Sydney University and David Ellwood, Griffith University

Having a baby is stressful enough without a pandemic caused by COVID-19 and all the misinformation surrounding the coronavirus. Therefore, if you are pregnant or are giving birth soon, you should go to credible sources such as the World Health Organization. (Note: In Spain, the most reliable institutions are the Spanish Society of Gynecology and Obstetrics and the Ministry of Health).

Below, we show you the main guidelines to proceed correctly if you are pregnant:

It is an unknown virus

As it is a disease caused by a new virus, every day we learn something about COVID-19. Most pregnant women are young and in good health, making them less likely to be seriously affected (certainly good news). In any case, the condition of the baby must also be taken into account, which can slightly complicate the situation.

A baby born a few days ago in the United Kingdom tested positive for COVID-19. The mother was infected, so it is not known for sure whether the baby was infected in the womb (which seems unlikely) or after birth (the most plausible option).

To the best of our knowledge, the baby is in perfect condition and the mother is receiving treatment. The other babies with COVID-19 that we have been aware of have shown very mild symptoms and optimal recovery.

From China's experience to WHO recommendations

To date, much of the information we have about COVID-19 comes from China. It was in the Asian country where one of the first studies was carried out, in which only nine pregnant women suffering from the disease participated.

All these women had caesarean sections. The procedures went as planned and both the mothers and their babies recovered satisfactorily. The study revealed that none of the newborns appeared to have COVID-19 and that the virus was not present in their body, breast milk, or any fluid. It is unclear, however, why the babies were delivered by cesarean section. China has very high caesarean section figures, which, although it is not the most recommendable, could have influenced the response of the health workers.

The new guidelines established by the World Health Organization indicate that:

There is no evidence that pregnant women have symptoms other than those known or face an increased risk of serious illness. Until now, there have been no mother-to-child transmissions when the infection manifests in the third trimester of pregnancy (…). The WHO recommends practicing caesarean sections only in justified cases.

Why are pregnant women not at increased risk of COVID-19?

Pregnant women are often more susceptible to viruses that cause respiratory problems, such as the flu. This is because your immune system is weakened, your lungs are compressed, and they require higher oxygen levels.

However, this does not appear to be the case for COVID-19. An analysis of 147 women suffering from the disease showed that only 8% experienced serious consequences, while 1% were in critical condition, lower figures than the world average.

Reducing the immune response during pregnancy, necessary to prevent a woman's body from reacting to the baby as if it were a threat, could provide additional protection against COVID-19. The disease appears to affect patients with a low immune system to a greater extent from other health disorders.

Men are harmed to a greater degree than women by COVID-19, in addition to the fact that they are less likely to become seriously ill and die. To date, mortality figures are 1.7% for women and 2.8% for men.

However, the advance of the pandemic could produce the alteration of these data. Women make up the majority of the healthcare fabric, while care networks generally remain in contact with more sick people.

How can pregnant women protect themselves (and protect others)?

Pregnant women should take the same measures as the rest of the population. These include:

– Cover your mouth when coughing (and do it in the elbow bleeding).

– Avoid coming into contact with sick people.

– Stay away from people with symptoms.

– Regularly wash your hands with soap and water or with an alcohol hand sanitizer.

– Avoid crowded meetings.

It is recommended to avoid traveling abroad, since it would be necessary to seclude later (Note: Some of these measures are already being carried out in countries such as Italy or Spain).

Women who believe they have contracted the virus can make a telephone consultation (List of autonomous numbers for information on COVID-19) or with a specialist in order to avoid the face-to-face visit. Pregnant women and those who have recently given birth have priority in this type of service.

If you are homebound at the request of the authorities or suffer from the disease, contact your midwife or obstetrician and follow their recommendations. Also:

– The center that controls the pregnancy must be notified that it is in an isolated situation.

– You must notify the corresponding center before going to scheduled appointments.

– You will be advised not to go to the emergency department if it is not strictly necessary. In this case, the pregnancy situation will be notified before going

What is the position regarding hospital visits prior to birth and to give birth?

If you have a scheduled date for delivery in a hospital or a maternity hospital, rest easy: the precaution to minimize the risk of infection is maximum. Most of the time, labor will take place normally. Again, returning home as soon as possible would be ideal as long as both you and the baby are in perfect condition.

Finally, keep in mind that they will restrict visits and even the number of people close to you who may be by your side in order to reduce the risk.

Can the baby get COVID-19 in its mother's womb?

The placenta acts as a highly effective filter to protect babies from harm. There was one exception, however: the Zika virus was able to break through that barrier.

There is no scientific evidence to indicate that the coronavirus may cause additional complications. Still, if the woman is sick (if she has a fever or pneumonia, for example), doctors are likely to cause a premature delivery if they deem it necessary.

In any case, a diagnosis of COVID-19 should not precipitate the decision to advance labor, unless the termination of the pregnancy is beneficial for the mother based on her general state of health.

Likewise, there is no evidence to suggest that COVID-19 increases the probability of having a miscarriage. It is still early to determine the possible existence of other effects that could affect the baby in the long term.

What should I do after giving birth?

The benefits of breastfeeding are so significant that the WHO recommends doing so during the first hour of life of the newborn. If the baby is in good condition, skin-to-skin contact is recommended immediately after birth.

If the mother is not in a position to do it herself, she should get outside help to express her milk. Breastfeeding is especially effective against infectious diseases, since there is a transmission of antibodies and other important immune elements for the baby. If the woman or newborn has an infection, the composition of breast milk can even be modified to increase the amount of essential components to help fight the infection of the little one. Therefore, if you were planning to stop breastfeeding your child, it may be a good idea to continue until the pandemic comes to an end.

The WHO recommends that women with COVID-19 wash their hands before and after being in contact with the baby, as well as encourage them to wear a mask if they have symptoms (such as a cough) and to regularly clean and disinfect their surfaces they have touched.

What else can you do?

As the season approaches when seasonal influenza manifests itself most, try to get vaccinated, as it is a measure that provides safety during pregnancy. The vaccine does not pose any risk to the baby's health. Although it will not offer protection against COVID-19, it will do so against the flu, which can be especially harmful during pregnancy. The last thing anyone would want would be to have the flu and COVID-19 at the same time.

Above all, do not lose your cool and contact your midwife or your doctor if you are concerned about the situation we are going through.

Article translated thanks to collaboration with Fundación Lilly.

Hannah Dahlen AM, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University and David Ellwood, Professor of Obstetrics & Gynaecology, Griffith University

This article was originally published in The Conversation. Read the original.

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