A year after the Coronavirus pandemic wrecked our collective lives, our society has been grappling with fear and insecurity. As a result, we have seen misinformation spread like wildfire, and many resorting to bizarre and incorrect methods of dealing with the virus. With this column, which will be published every Sunday, we aim to address any health or vaccine-related question our readers might have about the coronavirus pandemic.
In this week’s column, Dr. Manju Puri, Director Professor and HOD of the Dept of Obstetrics & Gynaecology at Lady Hardinge Medical College,
New Delhi talks about the possibility of premature babies, for pregnant women with COVID. She also discusses the ways in which thrombosis can be addressed in COVID-19 positive pregnant women.
Does pregnancy increase the need for critical care in the setting of COVID-19 infection?
Covid-19, if severe, can lead to several complications during pregnancy, especially when the infection occurs during the last trimester. This is due to certain pregnancy-related physiological changes and changes like enlarged uterus pressing on the diaphragm in the pregnant woman compromising her ability to cope with a fall in oxygen saturation. Such complications increase the need for intensive care.
Does COVID-19 present an increased risk of severe morbidity and mortality for pregnant and recently pregnant women compared with nonpregnant women?
Yes, the complications it can cause during the pregnancy can be fatal for both the mother and the child.
What is the effect of COVID-19 on fetal and neonatal outcomes?
If a mother has high fever or hypoxia, that is fall in blood oxygen level, there are high chances of preterm birth. And when born prematurely, a baby can face several health issues—if the lungs are not fully developed, there could be respiratory problems; at times these babies are not able to tolerate the oral feed; there are chances of haemorrhage in the brain, etc.
Second, there is some indirect impact of Covid-19 on expectant mothers. For example, if there is a delay in her seeking treatment by her due to fear of acquiring COVID from hospitals or non-availability of transport, or delay in receiving care at the facility as it is not a COVID facility it could affect both the mother and the baby adversely.
Should monoclonal antibodies be used as a treatment option for pregnant patients?
Any type of treatment that is indicated, evidence-based and important to save the mother, should not be withheld. The benefits should outweigh the risks. Monoclonal antibodies can be given on compassionate grounds.
How should thromboprophylaxis be managed for pregnant and postpartum patients with suspected or confirmed COVID-19 infection?
Pregnancy is a condition which predisposes a woman to thrombosis and Covid-19 also predisposes to thrombosis. In asymptomatic pregnant women and those with mild Covid thromboprophylaxis, treatment is not indicated. It is not given as a routine treatment to all COVID-positive pregnant women and those getting admitted only for delivery. But yes, if there is moderate to severe Covid during pregnancy, thromboprophylaxis treatment is a part of Covid management.
In normal circumstances also, we evaluate all our patients during the antenatal as well as postpartum time for risk of thrombosis. If a woman is at high risk for thromboembolism like those who are hypertensive, diabetic, obese, or if it is an IVF pregnancy, or if there is a serious infection requiring hospital admission, we do consider prescribing thromboprophylaxis treatment. We need to be more careful about assessing the need for thromboprophylaxis in pregnant and postpartum women with COVID infection.
As with other vaccine trials, pregnant women were not included in the trials for the vaccines that have been approved for COVID-19. Is the vaccine safe to take for pregnant women?
Initially, children and pregnant women are not included in any vaccine trial. But there could be some women who took the vaccine without knowing that they were pregnant in the trials. In the case of Moderna, Pfizer, and Johnson and Johnson vaccines, they followed up with such women and found there the vaccine did not harm the mother or the baby. Moreover, in present circumstances the risk vs benefit of the vaccination, the benefits outweighed the risks associated with it. And so, the government took the decision to vaccinate pregnant women against Covid-19.
If pregnant, what other precautions should a woman take to prevent covid?
We recommend that an expectant mother should wear a mask and maintain physical distance even when at home, amongst her family members. It is because even if she stays at home she might still contract infection from her family members who go out for work. So, a woman should follow all Covid-appropriate precautions during pregnancy, and after childbirth to protect herself and the child from catching the infection and related complications. Social events such as baby shower (Godhbharai) and other functions postdelivery should be avoided.
Does covid cause birth defects?
This is something that requires detailed study. Although we do not have any evidence of COVID infection leading to birth defects. But most of the data we have is from women who caught Covid-19 infection during the second or third trimester of the pregnancy. Birth defects generally happen if the mother develops an infection in the initial part of the pregnancy. So we need more data to answer these questions.