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Updated on 1st August, 2020

Being pregnant and expecting the arrival of your little bundle of joy over nine months of gestation is an experience that no mother forgets. From taking care of your pregnancy diet to getting enough exercise, you must be taking ample care to ensure your health and that of your baby.

If you’re pregnant in 2020, however, you might be more stressed than anything else because of the ongoing public health emergency due to the global spread of COVID-19

The novel strain of coronavirus, known as COVID-19, has spread across 188 regions and countries including India, and billions of lives are now at risk with the fatalities rising every day. Many of the confirmed cases of COVID-19 across the world are of pregnant women. A study published in Science Immunology in July 2020 indicates that pregnant women are four times more likely to get COVID-19 than the general population, mostly due to their higher risk of nosocomial infections at medical centres and hospitals.

Although there are no concrete numbers for those affected, there's been a rising number of COVID-19 cases among pregnant women in India. While in most cases, appropriate medical care is saving the lives of both mother and child, the healthcare system is strained due to the pandemic, and there are cases where pregnant women are falling through the gap too.

In one case in Navi Mumbai, doctors performed a successful cesarean delivery to safely birth the baby before beginning the prescribed COVID-19 treatment for the mother. The mother and child are both safe, as per reports. In another case from Kerala, an infected pregnant woman not only recovered from COVID-19 on 7 April 2020, but also delivered a healthy baby boy while still in the isolation ward.

However, another presumptive pregnant patient of COVID-19 passed away in Mumbai, and her child was unable to survive, unfortunately. There is, as yet, no confirmation whether this woman was COVID-positive or not. In mid-June, an eight-month old pregnant woman in Noida who showed COVID-19 symptoms was turned down from admission in eight hospitals before finally passing away in the ambulance. 

With the still-rising number of COVID-19 cases, pregnant women - both COVID-19 positive and not - are being affected to a large degree. This is a matter of great concern globally since the mother’s health also dictates the health of the baby. Proper antenatal care and sticking to screening appointments at hospitals and clinics has become more difficult during the pandemic, and there's a huge risk of rising maternal morbidity and mortality.

What’s more, women have a compromised immune system during pregnancy - they tend to be more susceptible to bacterial infections, viral infections and fungal infections during these nine months. COVID-19 is a highly contagious viral infection - and since women are more susceptible to viral infections during pregnancy than at other times in their lives, pregnant women may be at risk of COVID-19 too.

The greatest downside is that since COVID-19 is a new strain of virus. Until a month or so ago, leading epidemiologists of the world were unable to give decisive information about the risks involved with pregnant women getting infected with COVID-19, and if vertical transmission (the transmission of the virus from mother to child) is possible in the case of the SARS-CoV-2 virus. Recent case studies have, however, been able to throw some light on this matter, which should be illuminating for all pregnant women and their families.

Here’s what every pregnant woman needs to know about the COVID-19 infection:

  1. COVID-19 and pregnancy risks
  2. COVID-19 and pregnancy questions
  3. Labour and delivery for COVID-19 positive pregnant women
  4. COVID-19 and pregnancy updates: effect of COVID-19 on babies of infected mothers
Doctors for COVID-19 and pregnancy

Data and research regarding pregnancy and COVID-19 are continuing all over the world, and shedding light on the issue gradually. Over time, it's expected that our understanding of how COVID-19 exactly affects pregnancy will increases. This is what we know so far.

The WHO and Chinese government's Joint Mission on Coronavirus Disease 2019 (COVID-19) Report, which was released in March-April 2020, stated clearly that as opposed to the H1N1 virus (also known as swine flu), “pregnant women do not appear to be at higher risk of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.”

While this initial report was heartening, recent studies indicate the COVID-19 risks associated with pregnancy are indeed high. The WHO and obstetricians around the world have always clarified that there are a number of changes that occur in women’s bodies and immune systems during pregnancy, which might make pregnant women immunocompromised. Pregnant women can, in fact, be badly affected by viral respiratory infections. 

As mentioned before, a recent study in Science Immunology indicates that pregnant women are four times more likely to get COVID-19 than others - which makes sense given what experts already know about the immune system during pregnancy. The study observed the presence of antibodies in 1,200 pregnant women in Philadelphia, and found that over 6% of these women were exposed to the SARS-CoV-2 virus as compared to only 1.4% of prevalence in the general population. The study found that the risk was higher among Hispanic and black women rather than white and Asian pregnant women.

A study by the US Centers for Disease Control and Prevention (CDC) in June 2020 further revealed that pregnant women are also more likely to contract severe COVID-19 disease. They are not only at a higher risk of being hospitalised for the infection, but also at an increased risk of needing intensive care and ventilation or oxygen support.

Another study in Endocrinology showed that pregnant women with COVID-19 have a higher risk of also developing blood clots due to the infection than non-pregnant COVID-19 positive women. Other studies have indicated that this increased risk of blood clots in pregnant women with COVID-19 can damage the placenta and obstruct the blood flow to the foetus. This in turn can cause further complications for the baby as well as the mother.

It’s therefore very important that pregnant women take every precaution to protect themselves from the virus that causes COVID-19. 

It is also important to remember that COVID-19 is not fatal - or even severe - in most cases. So while there is no reason to panic, people who are immunocompromised such as older people, people with lifestyle diseases and pregnant women should take extra to avoid infection. 

Read more: COVID-19 prevention for older people and those living with chronic diseases

You must have a lot of question if you are pregnant during the COVID-19 pandemic. Scientists and doctors are, of course, discovering new facts about the virus with each passing day and we will keep updating this section.

Here is a curated list of frequently asked questions about COVID-19 and pregnancy:

How can pregnant women avoid COVID-19?

The WHO suggests the same precautions to avoid getting the COVID-19 infection to pregnant women that it does to every other person in the world. The following are all the precautions pregnant women should take to avoid COVID-19:

  • Wash hands frequently with soap and water, or an alcohol-based hand sanitizer.
  • Practice respiratory hygiene by covering your mouth and nose with your elbow while coughing or sneezing. You can also use a tissue instead of your elbow, but make sure you dispose of the tissue immediately after use.
  • Avoid touching your eyes, nose and mouth.
  • Avoid crowded spaces, maintain a distance of at least three feet from other people, and stay at home if possible.
  • If you have fever, cough, or shortness of breath, seek medical care without any delay. Consult a doctor online or on the phone, and if you’re asked to go to a clinic or hospital, call ahead to let them know you’re coming.

The WHO also mentions that pregnant women who have medical appointments, especially for prenatal ultrasounds, important pregnancy tests, or postnatal checkups, should attend their appointments. However, it’s important to take all the precautions while doing so.

What pregnant women should do if they think they’re infected

Some discomfort and illness is natural during pregnancy, and there’s nothing to worry about in general. However, during the spread of a pandemic like COVID-19, being cautious is the best thing to do. 

If you’re pregnant and are showing symptoms of COVID-19, call your doctor or consult with them online. If they ask you to come into a hospital, do so by taking private conveyance instead of using public transport. Always call ahead to inform the healthcare providers about your arrival. 

According to the WHO, testing protocols and eligibility might vary depending on the country you live in, but pregnant women everywhere should be prioritized for testing if they show the symptoms of COVID-19. This is because pregnant women might need extra care if they’re infected with COVID-19.

What should pregnant women do if they test positive for COVID-19?

Like all confirmed COVID-19 patients, pregnant women will be screened by state health departments and public health professionals. There are two possible outcomes for pregnant women who have been infected with COVID-19, and they are explained below:

  • Mild COVID-19 infection: If you test positive for COVID-19 and have no or mild symptoms, you will be advised to go home and self-isolate until you get better. You and your family will have to ensure you get proper home care for COVID-19 and adhere to all the necessary protocols too. The healthcare providers should be in touch with you to monitor your progress, and if you get worse, you’ll be hospitalised.
  • Severe COVID-19 infection: If you have severe symptoms or are at risk of turning severe due to other underlying conditions - like gestational diabetes or gestational hypertension - you will be hospitalised and kept under professional care and surveillance. While this may mean that other family members or loved ones will not be around while you’re being treated in the hospital, you will have more chances of staying safe and not infecting others.

The Indian Ministry of Health and Family Welfare (MoHFW) has also pointed out that pregnant women who are infected with COVID-19 should be isolated and treated just like all other patients depending on their clinical assessment. Care should be taken that the infection is not transmitted to other pregnant women or healthcare providers as well as the newborn baby.

You might also be interested in: Mental health tips for those who are self-quarantined

Can new mothers with COVID-19 breastfeed?

Breastfeeding and skin-to-skin touch are very important during the first hour after delivery. This is the time when the bond between mother and newborn is sealed. However, during the spread of an infectious disease like COVID-19, pregnant women who are infected might wonder if they’ll be able to or even be allowed to perform any of these necessary actions.

The WHO says that as long as you wash your hands before and after touching your newborn and keep all surfaces clean, skin-to-skin contact should not be an issue. The WHO also recommends that like all new mothers, COVID-19 patients should also exclusively breastfeed their babies for the first six months of their life. This new coronavirus should not affect them or their babies as long as they follow the rules mentioned below:

  • Wash hands before and after touching the baby.
  • Practice respiratory hygiene during breastfeeding, and wear a mask whenever you’re close to the baby.
  • Routinely clean and disinfect surfaces touched by the infected mother and the baby.

The only issue with breastfeeding while infected with COVID-19 is that if you have severe symptoms, you might be too tired to feed the baby. If this is the case, the WHO recommends that you provide breast milk to your baby by any of the three following means:

  • Use a breast pump to express the milk and feed your child with it without coming into contact directly.
  • Feeding the baby formula until you recover, then trying re-lactation.
  • Using breast milk from a donor until you recover and can try re-lactation.

Since there have been some cases of premature delivery by infected pregnant women in China, you might wonder if you’re at the same or more risk in case you’ve contracted the COVID-19 infection too. 

The current research and expert opinion, however, stipulates that you should not take unnecessary stress about labour and delivery if you’re COVID-19 positive. The Royal College of Obstetricians and Gynaecologists, London, recommends that home births should be avoided if you’re a pregnant woman with COVID-19 infection. Delivery and postnatal care for the mother and newborn care should be performed in obstetric wards at hospitals only in these cases so that the mother and child’s health can be closely monitored to ensure the safety of both.

Many pregnant women are also concerned if they will be able to deliver their babies vaginally or will they have to have a cesarean delivery if they have COVID-19 infection. The WHO has, however, made it very clear that there’s no need for cesarean delivery unless medically justified by your healthcare providers. 

Since COVID-19 is a new virus, its exact impact on pregnant women and their babies is not known. There is no evidence yet that it can cause miscarriages, or lead to premature labour and childbirth. Though previous research coming out of China and the WHO had found that vertical transmission of COVID-19 from mother to child was not possible, cases and studies in the US are overturning this belief now—they have found the virus in the amniotic fluid and placenta. Further, they've found that the virus may use a different route to enter the womb (CD147 receptors) than the one it uses for the lungs (ACE2 receptors).

Both the UK’s Royal College of Obstetricians and Gynaecologists (RCOG) and the Indian Council of Medical Research (ICMR) also believe that vertical transmission is probable due to emerging evidence, although the exact nature and extent of the impact is yet to be determined.

RCOG reveals that two studies have suggested that antibodies for the Sars-CoV-2 virus were found in the serum of newborn babies, which suggests that the virus was passed on to the baby and the baby’s immune system then created antibodies against the infection while still in the womb. This evidence is, however, based on a very small number of cases. With research into this new disease still underway, information like this is still evolving, and we will continue to add updates as and when they are released.

Recent studies also indicate that the risk of blood clots among pregnant women with COVID-19 is much higher, and such blood clots can also cause damage to the placenta and lead to vertical transmission of the infection to the baby. In fact, with India's first case of vertical transmission of COVID-19 from mother to child in July end in Pune indicates that while experts believe that vertical transmission is uncommon, it's still emerging in quite a few cases.

Dr. Sonam Yadav

Dr. Sonam Yadav

Obstetrics & Gynaecology
7 Years of Experience

Dr. Priyanka Gupta

Dr. Priyanka Gupta

Obstetrics & Gynaecology
10 Years of Experience

Dr. Vrinda Khemani

Dr. Vrinda Khemani

Obstetrics & Gynaecology
6 Years of Experience

Dr Megha Apsingekar

Dr Megha Apsingekar

Obstetrics & Gynaecology
4 Years of Experience


Medicines / Products that contain COVID-19 and pregnancy

References

  1. Royal College of Obstetricians and Gynaecologists [Internet]. London, United Kingdom; Coronavirus infection and pregnancy
  2. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Q&A on COVID-19, pregnancy, childbirth and breastfeeding
  3. Schmid, Manuel B. et al. COVID-19 in pregnant women. The Lancet, Infectious Diseases. Published:March 17, 2020.
  4. American College of Obstetricians and Gynecologists. [internet], Bethesda (MD), USA; Novel Coronavirus 2019 (COVID-19)
  5. Schwartz, David A. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med. 2020 Mar 17. PMID: 32180426
  6. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; Coronavirus Disease 2019 (COVID-19): Pregnancy & Breastfeeding
  7. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
  8. Royal College of Obstetricians and Gynaecologists [Internet]. London, United Kingdom; Coronavirus (COVID-19) Infection in Pregnancy
  9. Indian Council of Medical Research [Internet]. Department of Health Research. New Delhi. India.
  10. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Pregnancy, Childbirth, breastfeeding and COVID-19
  11. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020
  12. Flannery, Dustin D. et al . SARS-CoV-2 seroprevalence among parturient women in Philadelphia. Science Immunology 29 Jul 2020: Vol. 5, Issue 49, eabd5709.