Pregnancy is usually a joyful time in a woman's life, but with everyone in a heightened state of anxiety over the COVID-19 pandemic, what ought to be a period of excitement and anticipation for many mums-to-be might feel anything but. Along with worrying about your own health and the health of your loved ones, you will also be concerned about your unborn baby and unsure if you are doing enough to keep him or her safe.
While pregnant women are equally at risk as anyone else of contracting the new coronavirus, they may be more susceptible to complications arising from the infection, due to the many changes going on in their body. According to Dr Ann Tan, an obstetrician-gynaecologist at Women Fertility & Fetal Centre in Singapore, pregnant women sometimes have altered immunity " as a result of hyperemesis (severe vomiting), anaemia or gestational diabetes, for instance, " so they should take extra care to minimise their risk of infection.
Coronavirus And Pregnancy
"If you are expecting, you should take the same precautions as everyone else to protect yourself and avoid exposure," Tan explains. "This includes washing your hands with soap and water regularly throughout the day, and especially if you've been out; avoiding touching your eyes, nose and mouth with unwashed hands; avoiding close contact with people who are sick; and following social distancing rules."
Unless you are in self-isolation, Dr Helen Tang Hiu Tung, an obstetrician-gynaecologist at Matilda International Hospital in Hong Kong, says that you should continue to attend your antenatal appointments. If you develop COVID-19 symptoms or feel unwell, then you might want to avoid your appointments and update your doctor about your condition. To keep your immune system strong during and after pregnancy, Tang also recommends eating healthily, getting enough sleep and keeping stress to a minimum.
There is currently no evidence suggesting an increased risk of miscarriage or early pregnancy loss during COVID-19. There is also no increased risk of birth defects. However, it is important to know that it is possible to transmit the infection to your unborn baby through the placenta, according to a small study published on March 26 in the Journal of the American Medical Association. Even though this emerging evidence suggests that vertical transmission is possible, it should be pointed out that what causes the fetus to be infected and adversely affected are still not definitively clear.
If you have the coronavirus, you may also experience more severe symptoms, particularly towards the end of your pregnancy, although the risks are small. This is due to changes to your immune system. Severe symptoms might include pneumonia and marked hypoxia (inadequate oxygenation of the blood). This is significant because if you are in labour and unable to take in as much oxygen as you normally would, your baby might find it more difficult to cope with labour " that is, fetal distress may occur.
This, however, is not a reason to choose a caesarean section over vaginal delivery, according to the Internal Society of Ultrasound in Obstetrics & Gynaecology (ISUOG) in London. The obstetrician and infectious disease specialist would handle such pregnancies on a case-by-case basis and would consider the speed at which an emergency caesarean can be performed in light of the need for personal protective equipment.
If you do contract the virus, especially in early pregnancy (between four and six weeks after conception), what you should be concerned about is developing a high fever, which is one of the symptoms of the infection. "A high fever is generally not good for the growing fetus as it may affect the way the fetus' cells divide and may increase the risk of problems with the baby's spine and brain," says Tan. The ISUOG adds that these problems are not specific to COVID-19 but come with any reason for having a fever and that the risk of your unborn baby developing these problems is low.
You might also be worried about how to keep your home and your baby's nursery clean. Researchers from the National Institutes of Health's National Institute of Allergy and Infectious Diseases recently found that SARS-CoV-2, the virus responsible for the current outbreak, remained active on plastic and stainless steel surfaces for two to three days; remained infectious for up to 24 hours on cardboard and four hours on copper. These findings were published on March 17, 2020, in the New England Journal of Medicine.
Tan says that cleaning surfaces and objects " like your baby's cot and toys, for example " with recommended cleaning agents containing a bleaching agent and soap, should be sufficient. Be sure to give the objects an extra rinse or wipe down to remove soap or bleach residue. If you have had visitors, remember to sanitise surfaces regularly between cleaning sessions using alcohol wipes.
If you go out, Tang advises you to shower and change your clothes immediately after arriving home, to minimise the possibility of bringing the virus indoors.
After you have given birth, you may also want to restrict visitors at home for a few weeks at least. Tan says to be selective about who you invite. "A couple of close family members is an acceptable number, but you should be aware of where these visitors have been in recent days or weeks. It's impossible to tell who might have COVID-19 since the symptoms take several days to show."
Make sure your visitors wash their hands thoroughly before spending time with you and your baby. "They should also wear a mask and avoid talking, breathing, sneezing or coughing over your baby or kissing, cuddling or holding him or her," Tan adds.
What if you have the virus and are worried about breastfeeding? The Royal College of Obstetricians & Gynaecologists in London, the UK capital, reports that there is no evidence showing that the virus can be carried in breast milk. In fact, the "well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breast milk".
However, there is a risk of transmission while breastfeeding if you have suspected or confirmed coronavirus. To reduce exposure to your baby, Tang recommends washing your hands before touching your baby or handling the milk bottles. You should also wear a mask and avoid coughing or sneezing while nursing. Better yet, leave the feeding to someone else.
"Breastfeeding is a wonderful bonding experience, but being in such close contact with your baby may increase his or her risk of being infected, so you might want to express your milk and ask someone to feed your baby," Tan says. "Remember to wash your hands thoroughly before touching the breast pump and milk bottles."
This article originally appeared in the South China Morning Post (SCMP), the most authoritative voice reporting on China and Asia for more than a century. For more SCMP stories, please explore the SCMP app or visit the SCMP's Facebook and Twitter pages. Copyright © 2020 South China Morning Post Publishers Ltd. All rights reserved.