COVID-19 AND PREGNANCY
The COVID 19 disease is sweeping through countries and affecting families with devastating effects. Pregnancy presents a very special situation of interest in terms of how pregnancy may be affected by the disease and the management of pregnancy during the pandemic.
Knowledge about the manifestations and outcomes of this disease evolve daily, and so does advice and recommendations from professional medical bodies.
Is it more infectious or more serious in a pregnant woman?
COVID 19 is not known to affect pregnant women more than the general population and is not more serious in pregnant women than other healthy adults. It is expected that pregnant women would experience mild or moderate cold or flu-like symptoms if infected by the virus. More severe symptoms are expected in the elderly with underlying medical conditions.
How will it affect my baby?
Knowledge of this new virus is changing frequently, however, there is no evidence of increased miscarriage rate in pregnant women with COVID-19 infection. Transmission from a mother to her child may be possible, but in all suspected cases where the newborn child contacted the virus, the child remained healthy. It is also not known to affect the child’s growth after birth.
How can I avoid contacting the virus?
It is very important to adhere to laid down guidance for pregnant women and the family. These include:
- Staying at home during the government instituted period or movement restriction.
- Regular standard hand washing with soap and running water.
- Wearing a mask if you have a cough or sneeze.
- Cough onto the elbow of your non dominant hand.
- Use a tissue paper when coughing or sneezing, discard and wash your hands.
- Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough.
- Avoid non-essential use of public transport when possible.
- Avoid large and small gatherings in public spaces and closed spaces where people gather together.
- Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
- Use telephone or online services to contact your doctor or other essential services
Is pregnancy a special situation?
Pregnancy presents a special situation because pregnancy has been known to cause a slight reduction in the immunity of the pregnant woman. Though COVID 19 is not known to affect more pregnant women than the general population, the severe disease may be handled poorly by the pregnant woman. There is also need for great ‘caution’ to avoid affecting the unborn baby.
Should I attend antenatal and postnatal care appointments?
Some antenatal and postnatal care appointments are extremely vital and should be kept. Other non-critical ANC appointments or where some questions arise during the period of movement restrictions, contact can be made with your doctor through phone calls, or the Limi Hospital’s telemedicine channels- www.myhealth.limihospital.org. There is a potential risk of harm to you and your baby if you don’t attend your critical appointments, even in the context of coronavirus. You may attend Limi Hospital’s antenatal classes starting shortly on Facebook and Instagram.
If I develop COVID 19 symptoms while pregnant, what should I do?
If a new cough or fever or both develop during pregnancy, please call the Hospital via phone, WhatsApp or the Lim Hospital’s telemedicine channels for advice. Where COVID 19 is strongly suspected, the appropriate authorities will be contacted for further evaluation and testing. However, other conditions in pregnancy like urinary tract infection, malaria, infection of baby’s membranes especially after waters broke, etc, can cause fever during pregnancy and must not be missed. If you test positive for coronavirus, you should contact your antenatal team to make them aware of your diagnosis so that adequate provisions can be made.
Can I pass coronavirus to my baby?
Very few babies have been diagnosed with coronavirus after birth, so there is a chance that infection may have occurred in the womb, but it is not certain whether transmission was before or soon after birth. Your maternity team will maintain strict infection control measures at the time of birth and closely monitor your baby.
Will I be able to stay with my baby if I have suspected or confirmed COVID 19?
Some authorities require that a mother with COVID 19 be separated from the newborn baby for 14 days. This has negative effects on feeding and bonding. Knowing that most of the newborn babies are not sick from COVID 19, it may be better to allow the mother stay with her new born and breastfeed/bond appropriately. Breastmilk may provide some protection for the infant especially where the mother has already been exposed.
A discussion about the risks and benefits should take place between the parents and the doctors caring for the baby (neonatologists) to individualize care for the baby.
Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?
Yes. There is no evidence showing that the virus can be carried in breastmilk. The well-recognized benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.
The main risk of breastfeeding is close contact between the mother and baby. Coughing or sneezing could contain droplets which maybe infected with the virus, leading to infection of the baby after birth.
When you or anyone else feeds your baby, the following precautions are recommended:
- Wash your hands before touching your baby, breast pump or bottles
- Try to avoid coughing or sneezing on your baby while feeding at the breast
- Consider wearing a face mask while breastfeeding, if available
- Follow recommendations for pump cleaning after each use
- Consider asking someone who is well to feed your expressed breast milk to your baby.
If you are expressing breast milk in hospital, a dedicated breast pump should be used.
After the birth, is there any increased risk to me or my baby?
There is no evidence that women who have recently had a baby and are otherwise well are at increased risk of contracting coronavirus or of becoming seriously unwell. A recently pregnant mother’s immune system is normal unless she has other forms of infection or underlying illness. You should however remain well-nourished with a balanced diet. Observe mild exercise as you feel fit and ensure social distancing guidance is followed.
Children, including newborns, do not appear to be at high risk of becoming seriously unwell with the virus. However, close observation of hygiene is important especially with family members resident in the house. Anyone who enters the home should take standard hygiene precautions, including washing their hands, and be careful about handling the baby if they have symptoms of any illness including the coronavirus.
It is important that the baby is feeding well and gaining weight and if you have any concerns please contact your doctor. Once restrictions are lifted, we would caution against large family gatherings to celebrate baby’s arrival until more is known about the spread of the virus in the community.
Do not put off seeking medical advice if you have concerns about your baby’s health during the pandemic. Seek medical advice if your baby has a fever, weakness, excessive cry, poor feeding, or any other symptoms you may have concerns about.
At this point in Nigeria, detailed labour and delivery care for a suspected COVID 19 case would be undertaken in government designated centres for the management of the disease. It is however, very important that every pregnant woman avoids contracting the disease by strictly adhering to the recommendations of the NCDC and WHO on social and physical distancing among other measures.
Stay safe and stay healthy.
Dr. S.E Orji
Consultant Obstetrician and Gynaecologist,
Head Obstetrics and Gynaecology and Assisted Reproductive Unit,
The Limi Hospital and Maternity Ltd.
Central Area, Abuja-FCT.