|Year : 2022 | Volume
| Issue : 1 | Page : 83-86
Pregnancy: COVID-19 demeanour
Iffat Jahan1, Mainul Haque2
1 Department of Physiology, Eastern Medical College, Cumilla, Bangladesh
2 Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, Malaysia
|Date of Submission||26-Oct-2021|
|Date of Decision||27-Oct-2021|
|Date of Acceptance||01-Nov-2021|
|Date of Web Publication||31-Dec-2021|
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jahan I, Haque M. Pregnancy: COVID-19 demeanour. Adv Hum Biol 2022;12:83-6
| Introduction|| |
The current coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its first identification in Wuhan, China, in December 2019, COVID-19 has spread globally at an accelerated rate with rapid increases in cases and mortality., In January 2020, the World Health Organization (WHO) declared it an international crisis as it has become a major global health threat. The International Committee on Taxonomy of Viruses renamed the virus from 2019 novel coronavirus (2019-nCoV) to SARS-CoV-2. Coronaviruses are enveloped, non-segmented, single-stranded ribonucleic acid viruses causing diseases from common colds to severe fatal diseases. Epidemiological studies indicated that people of any age are at risk of infection, and the severity is associated with age and comorbidities. Compromised immune function, presence of multiple comorbidities that include respiratory, cardiac, endocrine disorders, cancer, geriatric issues, obesity, and pregnancy are spotted as top risk factors for COVID-19.,
Pregnancy is one of the most pleasant and critical periods in most women's lives. Nevertheless, since the COVID-19 pandemic is emerging, pregnancy and childbirth are put under challenging conditions. Several issues have contributed to increasing concerns amongst people, particularly amongst pregnant women, including the stressful news of the number of infected individuals and the death toll, the diverse symptoms and complications caused by the disease and our limited knowledge about the disease.
| Clinical Presentation|| |
Pregnancy is associated with physical, emotional and social changes. Physiological changes during pregnancy include reduced functional residual volumes, diaphragm elevation, oedema of respiratory tract mucosa and changes in cellular immunity. Due to the modulation of the immune system, pregnant women are more susceptible to viral infections and may experience severe symptoms that can worsen outcomes. The WHO has reported no apparent difference in the risk of developing clinical symptoms between non-pregnant and pregnant women of reproductive age during the pandemic., Patients most commonly present with mild symptoms of the infection, including fever, cough, fatigue and shortness of breath, and some may be asymptomatic.,,,,,,,,,,,, Some studies have reported no maternal complications, such as postpartum COVID-19 infection and preterm labour.,, Previous studies reported that during the epidemics of H1N1 influenza, the Middle East respiratory syndrome and SARS caused pregnant women adverse clinical outcomes such as death, spontaneous abortion, premature birth and foetal death., Viral pneumonia is one of the leading causes of pregnancy deaths worldwide.
A real-time reverse transcriptase–polymerase chain reaction assay is the gold standard for diagnosis. More leucocytosis and elevated C-reactive protein levels are detected in biochemical findings of pregnant women. Most of the patients showed typical changes on chest computed tomography, with multiple patchy ground-glass shadows.
Mothers' treatment was individualised depending on their condition, and the treatment included antibiotic, antiviral, oxygen therapy and anti-inflammatory therapy. Some patients may require mechanical ventilation, haemodialysis and extracorporeal membrane oxygenation.
There is very little information about the effect of COVID-19 in pregnancy till now. Pregnant women are at significant risk by COVID-19 as pregnancy-related physiologic changes in the anatomy and the function of the lungs and impaired immunity occur during the period. During epidemics and pandemics, fear over affliction and death and disturbances in daily activities due to the necessity of quarantining may increase anxiety. Uncertainties over transmission routes and doubts about national readiness for pandemic management affect people's adherence to preventive measures and cause psychological strains., The sources of concern and anxiety for pregnant women during pandemics also include concern over quarantine-related loneliness during and after delivery, limited access to healthcare services due to fear over affliction, increased requests for delivery through elective caesarean section, concerns related to the frequent use of disinfectants and concerns over child care, breastfeeding and vaccination. Fear, worry and anxiety during pregnancy have negative physical and psychological impacts on pregnant women. Previous studies suggest that pregnancy stress may also lead to mother–infant relationship disorder, antenatal and postpartum depression, increased physical problems and an increased risk of pre-eclampsia.,, The COVID-19 pandemic has reduced pregnant women's access to routine prenatal care services due to fear of the rapid spread of the disease, lack of an effective treatment or vaccine, the necessity of quarantining and its subsequent loneliness during affliction, stigmatisation and despair and concerns over contamination with the virus in healthcare settings.,
In comparison with previous studies before the pandemic, women's worries about socioeconomic matters have increased. COVID-19 pandemic has negatively affected the economy almost in all countries leading to an increased poverty rate., Women are experiencing higher levels of worry about household livelihood and expenses than in the pre-pandemic period. Governments and charities should expand their programmes for providing financial support to pregnant women in low-income families to decrease their socioeconomic concerns.
Many studies reported asymptomatic newborns born to mothers with COVID-19 infection. One study by Zhu et al. has reported neonatal COVID-19 symptoms to include shortness of breath, fever and gastrointestinal symptoms such as vomiting and abdominal distension. The study by Yu et al. also reported similar symptoms. Other studies have reported maternal and foetal complications, including preterm delivery, respiratory distress, foetal distress and Premature rupture of membranes (PROM).
Transmission of this virus from infected mother to foetus has been debated since the beginning of the COVID-19 pandemic.,,, Vertical maternal–foetal transmission with severe foetal consequences may occur with maternal infection with toxoplasma, other, rubella, cytomegalovirus and herpes agents and Zika virus.,, As the foetal organs develop during the first trimester of pregnancy, maternal infections at this stage may be more severe compared to later stages of pregnancy., Abortion in mothers with COVID-19 is inflammation and placental insufficiency due to the virus's direct effect on the placenta., Therefore, foetal death can be an outcome of COVID-19 in pregnancy.
Mode of delivery
There has been no evidence of vertical transmission of COVID-19;, COVID-19 is not an indication for caesarean section. The mode and timing of delivery should be individualised based on the severity of the disease, existing comorbidities and obstetric indications. Early cord clamping may minimise the risk of viral transmission by avoiding longer, close contact with the infected mother. Regional and general anaesthesia can be considered during the delivery, depending on the patient's clinical condition.
| Conclusion|| |
Although extensive research is being done worldwide with urgency to understand the impact of COVID-19 on pregnancy and postpartum, there is a long way to go to truly understand the accurate picture. The timing of pregnancy and entry time of the infection in the body have different outcomes at delivery needs to be investigated by conducting large clinical trials in different geographical and cultural settings. Cohort studies might investigate the long-term consequences of this virus on neonates and infants. Fortunately, we are on the way to several incredible vaccines that can begin to bring an end to this pandemic. The fast availability and accessibility of these vaccines to pregnant women are vital in reducing their current risk. It is crucial to assess the safety of these vaccines for expectant mothers and ensure equitable distribution across the world irrespective of geographic locations, socioeconomic status, culture and ethnicity.
In reproductive healthcare programmes worldwide, programme managers are concerned about the couples planning to have babies in this pandemic. They recommend that couples during this time ensure informed decision-making while taking risks associated with pregnancies during the COVID-19 pandemic. In this case, long-term contraceptive methods such as implants and intrauterine devices (copper T) might be beneficial, according to them. Public health authorities should plan for situations like this in advance and adopt appropriate measures to reduce pregnant women's concerns. The Centres for Disease Control and Prevention stated that pregnant women should rigorously follow the same steps suggested by healthcare providers. Expectant mothers are advised to follow the national guideline of staying alert and safe by maintaining social distancing, practicing caution when outside the home and ensuring appropriate use of face masks. They should take additional care by keeping them mobile and hydrated to reduce the complications due to blood clots, be active through regular exercise, have a healthy and balanced diet and take essential supplements such as folic acid and Vitamin D.
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There has been a rapid increase in cases and deaths since it was identified in Wuhan, China, in early December 2019. Limited data about the clinical characteristics of pregnant women with COVID-19 have been reported till now. Because of the maternal physiologic and immune function changes during pregnancy, pregnant women are possibly at a higher risk of being infected with SARS-CoV-2 and developing more complicated clinical events.
Information on SARS and the Middle East respiratory syndrome (MERS) may provide the effects of COVID-19 during pregnancy. Even though SARS and MERS have been associated with miscarriage, intrauterine death, foetal growth restriction and high case fatality rates, the clinical course of COVID-19 pneumonia in pregnant women has been similar to non-pregnant women. In addition, pregnant women do not appear to be at a higher risk of catching COVID-19 or suffering from more severe disease than other adults of similar age. Moreover, there is no evidence that the virus can be transmitted to the foetus during pregnancy or childbirth. Babies and young children are also known to only experience mild forms of COVID-19. We summarise the possible symptoms, treatments and pregnancy outcomes of women infected with COVID-19 during pregnancy.
Consent for Publication
The author reviewed and approved the final version and has agreed to be accountable for all aspects of the work, including any accuracy or integrity issues.
The author declares that they do not have any financial involvement or affiliations with any organisation, association or entity directly or indirectly with the subject matter or materials presented in this article. This includes honoraria, expert testimony, employment, ownership of stocks or options, patents or grants received or pending or royalties.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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