Sometimes our lives have to be completely shaken up, changed and rearranged to make us sit up and take note. As the number of SARScov2 cases are increasing, pregnant women are increasingly getting stressed about its effects during pregnancy. As per UNICEF, India will have the largest burden of Covid-19 pandemic baby births in the world. India is set to witness the birth of 20 million babies in 2020 under the shadow of Covid-19, China is second with 13 million. UNICEF estimates that 116 million babies will be born worldwide in the 40 weeks period from March to Dec 2020.
The most recent publication on pregnancy is from Europe 2 days ago - Focus on Reproduction, which states that the effect of COVID-19 on pregnancy is still a priority for research.
As per ICMR (Indian Council of Medical Research), pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body's immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19.
Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery.
Pregnant women with heart disease are at highest risk (congenital or acquired).
There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was due to Covid-19 or other reasons.
The coronavirus pandemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible
A small study of 9 pregnant women in Wuhan, China, with confirmed COVID-19 found no evidence of the virus in their breast milk, cord blood or amniotic fluid.
1. Stay at home as much as possible and keep the number of visitors at home including maids to a minimum.
2. Keep social distancing of at least 1 meter from any other person in the house.
3. Wash hands frequently with soap and water for at least 20 seconds or use a disinfectant.
4. Cover mouth and nose with bent elbow or tissue during coughing or sneezing and dispose the tissue in the bin. Avoid touching eyes, mouth and nose as much as possible.
Answer: Not advisable especially as she may be exposed to many people in a small area without proper ventilation
Answer: At present work from home is advisable especially in the last 3 months of pregnancy. Do not use public transport.
For first time mothers, it is especially more stressful, however, all pregnant women will experience stress during this pandemic as it is a new situation.
First trimester is usually the most stressful of all as it brings with it undesirable symptoms like nausea, vomiting, fatigue, weakness and giddiness, fear of pregnancy loss makes it very difficult for some women to cope. With appropriate medications, counselling and dietary changes, women usually overcome these symptoms by the end of 12 weeks. As women reach their second trimester, they are more relaxed and calm.
It is important for all pregnant women to get their facts right about COVID-19, its mode of transmission and risks associated to better protect themselves and avoid believing rumours and fake news circulating in social media, which is likely to create unnecessary panic. COVID-19 is caused by a contagious newly identified virus SARS COV-2. The virus is similar to those causing common cold but is more infective and can cause serious health problems, especially in those with immunocompromised status like diabetes or lung problems.
Pregnant women do not appear more likely to contract the infection than the general population. Pregnancy itself alters the body's immune system and response to viral infections in general, which can occasionally cause more severe symptoms and this will be the same for COVID-19. Most women will experience only mild or moderate cold/flu like symptoms. The symptoms may include fever, dry cough, muscle pain, tiredness, loss of smell and in advancing cases breathlessness. Majority of reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery
There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. With regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined. So far very few babies have tested positive once the mother had COVID later in pregnancy. But most babies were not infected.
There are no signs that COVID-19 increases the risks of birth defects, although there are only few women in literature who got the virus at this stage and are yet to deliver their babies.
Most cases of COVID-19 globally have evidence of human to human transmission. There are two routes by which COVID-19 can be spread: directly from close contact with an infected person (within 2 metres) where respiratory secretions can enter the eyes, mouth, nose or airways. This risk increases the longer someone has close contact with an infected person who has symptoms; and secondly indirectly by touching a surface, object or the hand of an infected person that has been contaminated with respiratory secretions and then touching own mouth, nose or eyes.
In keeping with the mode of transmission, it is necessary to prevent the spread of virus by:
Following strict social distancing (keeping a distance of at least 2 mt with another person).
Wearing face masks at all times and frequent hand washing.
Visit to hospitals only when called with no/one attendant to ensure safety.
Keeping in touch with your obstetrician on phone regarding the scheduled visits.
Continue with their routine Antenatal visits as per advise of obstetrician although they maybe fewer in number or more spaced according to clinical profile. Simple queries should be addressed on phone itself. Patient should also make arrangements and stock up essential medicines for few months in case there of closure of clinic or society.
Advised to self-monitor baby movements at home according to the advised protocol.
Should take adequate rest. Should eat healthy and follow well-balanced diet.
Diet and nutrition invariably influence the immune system competence and determine the risk and severity of infections. Recent studies have shown an important role of immune boosters like vitamin C, Vitamin D and Zinc in the diet and their deficiency associated with increased susceptibility to infectious diseases, particularly upper respiratory tract infections. Adequate levels of micronutrients have shown to decrease the duration and severity of these viral infections. With increased social isolation and restricted outdoor activities and decreased exposure to sunlight there is bound to be deficiency of vitamin D levels. It is important to replenish Vitamin D stores with adequate sunlight exposure and vitamin D supplements.
Meditation for relaxation and stress busting is important as stress can negatively impact pregnancy.
Excessive stress during pregnancy is associated with preterm labour, preterm delivery, gestational hypertension, gestational diabetes and can also negatively affect growth of baby and can result in low birth weight babies. Every possible step should be taken to avoid stress. Watching favourite television shows and book helps to avoid negative thoughts from mind.
Keeping busy with at home activities like cooking, gardening, decorating, or learning new things help. Be better prepared for motherhood by reading books on what to expect when you are expecting. Stay connected with friends and family regularly. Avoid alcohol, smoking and caffeine. Should avoid watching excessive news as it creates fear and stress. Regular sleep at same time daily 1 to 2 hours in afternoon and 8 hours at night is important. Regular mild to moderate exercises at home like yoga or simple walking at home premises helps to ward off stress. Breathing exercises are recommended to improve lung capacity and decrease stress. As pregnancy advances gravid uterus pushes on lungs and cause breathlessness.
Most pregnant women are currently stressed out about the thought of going into labour during these times. Most important worry in their minds is will they get a safe environment to deliver. Will they have to undergo Covid-19 testing before getting admitted? For women with planned admissions for induction of labour or C-section, complete birthing plan should be discussed with the consulting doctor at the time of their routine visits. It is also important that patient informs the clinician on phone prior to their visit to the clinic for both routine and emergency purpose. It is advisable to continue with protective mask during labour and delivery as well.
After delivery due to sudden hormonal changes, sleep deprivation, new responsibilities, and lack of time with added lack of support from family members in COVID times can increase stress for new mothers. Avoid being master of all trades, skip household work, take adequate sleep, eat timely healthy meals, try meditation, taking help from partner, and taking out some quality time for self care to overcome challenging times.
"Atlthough no one can go back and make a brand new start, any one can start from now and make a brand new ending"- Carl Bard
As per ICMR emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate has yet to be determined. At present, there are no recorded cases of vaginal secretions or breast milk being tested positive for COVID-19
Recent evidence suggests that virus may be transmitted vertically from mother to baby (Dong L JAMA 2020). Approx 9% of babies - all by Caesarean section - to COVID + mothers tested + for coronavirus.
About the author: Dr Shivani Sachdev Gour, Director of SCI Healthcare, Gynaecologist & IVF Expert
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