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:

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.