COVID-19 and Pregnancy

More than two-thirds of pregnant women infected with COVID-19 have no symptoms, whereas the most common symptoms of COVID-19 in pregnant women are cough and fever.

There is growing evidence that pregnant women may be at an increased risk of severe illness from COVID-19 as compared to women who are not pregnant. The risk is particularly high in the third trimester. However, the overall risk of death due to COVID-19 in pregnant women remains very low.

The risk factors associated with being infected as well as hospitalised with COVID-19 include belonging to ethnic groups or minorities, having a BMI above 25 kg/m2, having a co-morbidity such as diabetes or hypertension before getting pregnant, being 35 years or older when pregnant, living in increased socioeconomic deprivation and working in healthcare or other public-facing occupations.

The delta variant of the SARS-CoV-2 virus seems to be associated with more severe disease. 1 of 10 symptomatic women infected with the alpha variant of the SARS-CoV-2 virus admitted to a hospital were admitted in the intensive care unit. In the case of the delta variant, 1 of 7 women hospitalised had to be admitted into the intensive care unit.

On the other hand, the omicron variant may be associated with less severe disease as compared to the delta variant. However, it is more infectious in terms of spreading from one person to another, and it is still likely to be associated with adverse maternal and neonatal outcomes, especially in unvaccinated pregnant women.

There has been no reported increase in congenital anomalies in newborn babies, due to the mother being infected with COVID-19 when she was pregnant or when the child was born. Such vertical transmission is uncommon.

However, COVID-19 infection in pregnant women is associated with an approximately doubled risk of stillbirth and may be associated with an increased incidence of babies who are small for their gestational age.

The preterm birth rate in women with symptomatic COVID-19 appears to be two to three times higher than the background rate. However, these are primarily iatrogenic preterm births i.e. preterm birth initiated by the healthcare provider.

The rate of perinatal mental health disorders, including anxiety and depression, have been reported to increase during the pandemic.

Vaccination

Vaccination against COVID-19 is strongly recommended for pregnant women and should be offered at the same time as the rest of the population, based on age and clinical risk.

More than 2,75,000 women in the UK and USA have taken a COVID-19 vaccine during pregnancy and exhibited no concerning safety signals. There is excellent real-world evidence of the efficacy of the vaccines. 98% of the women who haven’t received the vaccine were admitted to a hospital and got a severe infection.

Those who have had two doses and a booster (or three doses) of the COVID-19 vaccine are 88% less likely to be admitted to a hospital with the omicron variant as compared to those who aren’t vaccinated yet.

COVID-19 vaccines can be given at any time during pregnancy, or postpartum. This also includes an uncomplicated instrumental birth or a Caesarean section.

Breastfeeding women can also receive a COVID-19 vaccine, without having to stop breastfeeding. There is no evidence to suggest that COVID-19 vaccines affect fertility. Hence, women planning to get pregnant or undergo fertility treatments can also receive a COVID-19 vaccine. They don’t need to delay conception.

Dr Anitha Rao – MBBS, MD (OBGYN), MRCOG & Laparoscopic Surgeon, Consultant – Obstetrics & Gynecology
Dr Anitha Rao
BirthRight By Rainbow Hospitals, Hebbal, Bengaluru
Gynecology and Obstetrics

Source: The Indian Express