Contributed by:
Dr. Narine Singh
Chief Medical Officer
Ministry of Health

SINCE the first report (December 2019) of the COVID-19, the number of confirmed cases and associated mortality and morbidity has increased rapidly. Pregnant women are considered a high-risk group because of concerns about the effects of COVID -19 on them during and after pregnancy and on their neonate.

Due to changes in their bodies and immune systems, we know that pregnant women can be badly affected by some respiratory infections. The overall risk of COVID-19 to pregnant women is low. However, pregnancy increases the risk for severe illness with COVID-19.

Pregnant women who have COVID-19 appear more likely to develop respiratory complications requiring intensive care than women who aren’t pregnant. Pregnant women or recently pregnant women who are  older, overweight, and have pre-existing medical conditions such as hypertension and diabetes, seem to have an increased  risk of developing severe COVID-19.

Latest Research
New research findings published in the September 2020 edition of the BMJ help to shed light on the risks of COVID-19 for pregnant women and their babies.

The paper suggests that pregnant women seen with suspected or confirmed COVID-19 are less likely to experience a fever or muscle pain, but if they develop severe disease, they are more likely to need intensive care than non-pregnant women with COVID-19.

There is currently no data to suggest increased risk of miscarriage or early pregnancy loss in relation to COVID-19. It isn’t yet known how frequently COVID-19 causes problems during pregnancy or affects the health of the baby after birth.

Some research suggests that pregnant women with COVID-19 are more likely to have a premature birth and their babies are more likely to be admitted to a neonatal unit.

Mother to Child Transmission
It is still not known for sure if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery. Early studies indicated no evidence for vertical transmission of COVID-19 from mother to child in late pregnancy, but more recent reports indicate that vertical transmission may occur in some cases.

To date, the active virus has not been found in samples of fluid around the baby in the womb or breast milk. Community efforts to control the spread of the COVID-19 virus might affect your access to routine prenatal care.

It is strongly advised that antenatal and postnatal care should be regarded as essential, and that pregnant women will continue to need at least as much support, advice, care and guidance in relation to pregnancy, childbirth and early parenthood as before.

It is recommended that in-person appointments be deferred by seven days after the start of symptoms of COVID-19 or 14 days if another person in the household has symptoms.

Where in-person appointments are required, pregnant patients with symptoms or confirmed COVID-19 who require obstetric care are advised to notify the hospital or clinic before they arrive in order for infection control to be put in place.

Remote Appointments
To minimize the risk of infection, some appointments may be conducted remotely via teleconferencing or video conferencing, where possible. This is being done especially for those in the early stages of low-risk pregnancy by the Maternal and Child Health (MCH) Department of the Ministry of Health in several regions.

Talk to your health care provider about whether the use of virtual prenatal care is an option for you, if it’s available in your area, and how it works. Ask your health care provider if there are any tools that might be helpful to have at home, such as a blood pressure monitor. To make the most of any virtual visits, prepare a list of questions ahead of time and take detailed notes during the visit.

If you have certain high-risk conditions during pregnancy, virtual visits might not be an option. Ask your health care provider about how your care might be affected. Contact your health care provider right away if you have COVID-19 symptoms or if you’ve been exposed to someone with COVID-19.

It’s recommended that you are tested for the virus that causes COVID-19, if testing supplies are available. Call your health care provider ahead of time to tell him or her about your symptoms and possible exposure before going to your appointment.

If you have COVID-19 and are pregnant, your treatment will be aimed at relieving symptoms and may include getting plenty of fluids and rest, as well as using medication to reduce fever, relieve pain or lessen coughing. If you’re very ill, you may need to be treated in the hospital.

In Part II next week, we will look at labour and delivery, breastfeeding, postpartum guidance and safe medical treatment to conclude this topic. Do not miss the conclusion!
This article is submitted as part of the Ministry of Health’s COVID-19 public information and education programme. For questions, email ministersecretaryhealth@gmail.com.