• Dr Peter Chew

COVID-19 and pregnancy

She sighed a big sigh of relief when her COVID-19 tests were negative. M, 29, pregnant with a pair of twins was at 30 weeks of gestation. She had been having fever and cough for 2 days before she was admitted to the ward for observation.


For expectant mothers, the deadly virus has caused much stress and anxiety. It also raised many unanswered questions.


Effects on the mother:

Current data indicates that pregnant mums do not have a greater chance of getting sick from COVID-19 than the general public. There is also no evidence to suggest that infected expecting mums have more serious complications than non-pregnant women. In an analysis of 147 women, only 8 percent had severe disease and 1 percent were in critical condition, according to a report published on February 28 by the World Health Organization.


At present, there is no data to show an increased risk of miscarriage. Though there have been some babies born prematurely, it is unclear whether it is due to the virus.


Effects on the baby:

Available evidence has suggested that the virus is unlikely to cross the placenta and infect the fetus. Babies born to women with the infection seemed to be free from the virus and appeared healthy at birth according to a study published in Lancet in February 2020. After birth, the newborn is susceptible to person-to-person spread. Researchers have reported 33 babies with COVID-19 infection shortly after birth; only three had mild symptoms and signs of the illness.


Breast feeding:

Current evidence suggests that breast milk does not contain the virus. The Royal College of Obstetricians and Gynaecologists (RCOG) advises that breast feeding is permissible if the baby is well. The concern is whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding.


American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine have the following suggestions:

· Mothers with confirmed COVID-19 should take all possible precautions including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding.

· If breast milk is expressed with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.


As very little is known about COVID-19, there are currently no recommendations specific to pregnant women regarding the evaluation or management of COVID-19 according to obstetrics fraternities (ACOG and RCOG).


Prevention:

As the immune system in the body does change during pregnancy and expectant mums infected with viruses from the same family as COVID-19 (e.g. SARS) can become more seriously ill, it is important for expectant mums to try to protect themselves by:

· Avoiding people who are sick or who have been exposed to the virus

· Cleaning their hands often using soap and water or alcohol-based hand sanitizer

· Cleaning and disinfecting frequently touched surfaces daily

· Wearing a facemask and avoid touching the face and eyes

· Social distancing

· Any other measures recommended by the local government

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