Are pregnant women at a higher risk for covid-19?

COURSE IN PREGNANCYTo date limited available data suggest that pregnancy and childbirth do not increase the risk for acquiring SARS-CoV-2 infection, do not worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same age, and most infected mothers recover without undergoing delivery. 

The patient group most commonly affected by severe disease includes older adults (>60 years), particularly with comorbidities, and most pregnant women are younger than middle age; however, they may have comorbid conditions that increase their risk (eg, diabetes, severe obesity, severe asthma). It is known that some patients with severe COVID-19 have laboratory evidence of an exuberant inflammatory response (similar to cytokine release syndrome), which has been associated with critical and fatal illnesses. Whether the normal immunosuppression of pregnancy affects the occurrence and course of this response is unknown.

In pregnant women who develop COVID-19 pneumonia, early data show approximately the same rate of intensive care unit (ICU) admissions as in the nonpregnant population, but an increased risk of preterm and caesarean delivery. A preliminary report from the United States indicated 4 of 143 pregnant COVID-19 patients were admitted to an ICU, but these data were incomplete . In an initial United States experience from New York City including 43 pregnant patients with confirmed COVID-19, the disease course was mild in 37 (86 percent), severe in 4 (9.3 percent), and critical in 2 (4.7 percent). In a larger cohort of 147 pregnant patients in the WHO-China Joint Mission Report, 8 percent were severely ill, and 1 percent were critically ill. These percentages are similar to those of nonpregnant, reproductive-age adults. Severe sequelae of maternal infection include prolonged ventilatory support and need for extracorporeal membrane oxygenation.

Pregnancy complications 

 Hyperthermia, which is common in COVID-19, is a theoretical concern as elevation of maternal core temperature from a febrile illness during organogenesis in the first trimester may be associated with an increased risk of congenital anomalies, especially neural tube defects, or miscarriage. Use of acetaminophen in pregnancy, including in the first trimester, has been shown overall to be safe and may attenuate the pregnancy risks associated with fever exposure.

Infected women, especially those who develop pneumonia, appear to have an increased frequency of preterm labor, prelabor rupture of membranes, preterm birth, preeclampsia, and cesarean delivery for abnormal fetal heart rate tracings, which is likely related to severe maternal illness 

Vertical transmission 

SARS-CoV-2 has not been detected in cord blood, amniotic fluid, or placenta. Maternal viremia rates appear to be low, study suggesting placental seeding and vertical transmission are unlikely. 

Pregnant women should take the same precautions to avoid COVID-19 infection as other people. You can help protect yourself by:

1.Washing your hands frequently with an alcohol-based hand rub or soap and water.

2.Keeping space between yourselves and others and avoiding crowded spaces.

3.Avoiding touching your eyes, nose and mouth.

4.Practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately. 

We still do not know if a pregnant woman with COVID-19 can pass the virus to her foetus or baby during pregnancy or delivery. To date, the virus has not been found in samples of amniotic fluid or breastmilk.

Breast milk provides protection against many illnesses and is the best source of nutrition for most infants. 

You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding.

In limited studies, COVID-19 has not been detected in breast milk; however we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk.