Is a pregnant woman more at risk of being infected with coronavirus?

In pregnancy a woman’s body has immunologic and physiologic changes which might make her more susceptible to viral respiratory infections. This logically would include coronavirus (COVID-19). But there are reports in the media (to my knowledge not based on scientific evidence) that advise a pregnant woman does not have greater risk. Whether or not there is increased risk, I suggest you are extra careful. Refer to ‘How to minimise your risk of getting coronavirus‘ article.

Is it more likely to be a worse infection if a pregnant woman is infected with coronavirus?

Because of the immunologic and physiologic changes in pregnancy it is logical to conclude that a coronavirus infection is potentially more dangerous in pregnancy. There is no data to substantiate it. But because most pregnant women are generally well and don’t have significant co-morbidities it is logical to say if you were infected you and baby would both be ok. You are more likely if you were infected to have a limited ‘cold like’ illness rather than a severe respiratory infection. A study of 15 consecutive pregnant women with COVID-19 pneumonia in a hospital in Wohan from January 20, 2020, to February 10, 2020 reports ‘Pregnancy and childbirth did not aggravate the course of symptoms or CT features of COVID-19 pneumonia. All the cases of COVID-19 pneumonia in the pregnant women in our study were the mild type. All the women in this study—some of whom did not receive antiviral drugs—achieved good recovery from COVID-19 pneumonia.’

Is there an increased risk for adverse pregnancy outcomes if infected with coronavirus?

There is no data available. But with other related coronaviruses [SARS-CoV and MERS-CoV] infections a higher incidence of miscarriage and stillbirth have been reported. As well, high fevers during the first trimester of pregnancy can increase the risk of some birth defects.

Mortality rate with coronavirus

Douglass Hanly Moir Pathology (DHM) report: ‘Taking into account undiagnosed cases, experts estimate actual mortality to be around 0.3-1% (compared with flu ~0.1%, SARS 10% and MERS 34%)’. (1)

The death rate is found to be much higher in the very elderly (especially >80 years old). The death rates are lowest for the under 30s.  Deaths are more common among people with pre-existing medical conditions (. diabetes, high blood pressure or heart or breathing problems, immunosuppressant drugs, cancer treatment). Men have had a slightly higher death rate than women.

While there is no data specific to pregnant women, it is likely if you get infected you will make a full recovery.  While there is probably more risk of being infected because of the immunologic and physiologic changes in pregnancy because of the typical younger age of pregnant women, being of female gender and usually not having any other health concerns you are likely to have a milder infection and make a full recovery.

Is coronavirus more infection that the flu?

It is considered about twice as infections than the flu but DHM report; ‘Transmission appears to be more containable than flu, with current travel restrictions in place and contact tracing’. (1)

Is swab checking reliable if I don’t have any symptoms?

A negative swab result, if you are asymptomatic, sometimes is inaccurate and so does not negate the possibility of coronavirus infection.

What do I do if I suspect I have coronavirus?

Symptoms can range from possibly nothing to mild illness cold-like to pneumonia and severe acute respiratory distress. Typical coronavirus symptoms are fever, flu-like symptoms (such as coughing, sore throat, running nose), fatigue and shortness of breath. The screening focus at airports and at hospitals, offices, restaurants and schools where checking is done, is whether you have a fever.

If you are concerned you may have coronavirus you will need to see your GP or a hospital A&E department to arrange appropriate assessment and checking if you qualify. I suggest you phone the GP’s office or the hospital before attending as your GP or the hospital will not want you to be in the waiting room with other patients.

Should I have a coronavirus check?

Commonwealth Chief Medical Officer advises (20th March 2020) doctors: ‘The current testing protocol is as follows. A test should only be administered if the patient:

  • has returned from overseas in the past 14 days and developed respiratory illness with or without fever,
  • been in close contact with a confirmed COVID-19 case in the past 14 days and developed respiratory illness with or without fever,
  • has a severe community-acquired pneumonia and there is no clear cause, or
  • is a healthcare worker who has direct patient contact and has a fever (≥37.5) AND acute respiratory infection (e.g. shortness of breath, cough, sore throat).’

Should I be vaccinated against whooping cough and influenza?

Definitely yes. Your immune system will be weakened by another infection (influenza) and so it is logical to conclude you are at more risk of becoming infected with coronavirus if you come in contact with someone infected and also of you having a more severe coronavirus infection in pregnancy.

Symptoms of influenza are similar to coronavirus. To have had a flu shot will help in the diagnosis if you have relevant symptoms.

How long does the COVID-19 infection last?

The infection period for the virus will vary from person to person. Mild symptoms in an otherwise healthy individual may resolve over just a few days.  Similar to influenza, for an individual with other ongoing health issues, such as a respiratory condition, recovery may take weeks and in severe cases could be potentially fatal. A study of Wohan residents infected (2) reported the median duration of viral shedding was 20 days in survivors (ranging from 8-37 days).

Can pregnant women with coronavirus pass the virus to their foetus or newborn baby?

The virus is spread mainly through close contact with person infected via respiratory drops. Whether the virus can cross from the mother to her unborn baby via the placenta is unknown. Where or not the virus can be transmitted in breast milk is unknown.

A study (3) from Wuhan, China of 33 babies of mothers with COVID-19 reported three babies showing symptoms of coronavirus infection. All babies have done well. But the study findings do suggest transmission from mother to baby before delivery can occur. There has been another report from the UK consistent with this. This baby, even though infected, has done well.(4).The virus has not been detected in samples of amniotic fluid or breastmilk.

Are newborn babies born to women who are infected with coronavirus at increased risk of adverse outcomes?

While there is only very limited data, it can be concluded it would be a similar risk as would be the case with other relevant viral infections. Influenza has been associated with adverse neonatal outcomes such as low birth weight and preterm birth. High fever early in pregnancy may increase the risk of certain birth defects and is associated with miscarriage.

What happens about my pregnancy and childbirth management if I have coronavirus infection?

There are special coronavirus Government isolation protocols that will be put in place. Hospitals are establishing their own protocols on this topic. If you are more severely infected by coronavirus (viz. you have respiratory function compromise) when you go into labour you may need to be confined at Westmead or Northshore Public Hospital. If you become infected during the pregnancy and have recovered by the time you give birth then I am confident you can deliver at Norwest Private Hospital or the Sydney Adventist Hospital without any extra precautions.

General viral illness management includes taking paracetamol if you have a fever as the main danger to baby is you having a high prolonged fever. You can take up to 2 (500mg) tablets each 4 – 6 hrs. Also keep up your fluids and have cool shower. ‘Over the counter’ symptomatic medications are safe in moderation. Antibiotics won’t treat a viral infection.

Can coronavirus be transmitted during the incubation period (that is, before people develop symptoms)?

The incubation period is typically 5 to 6 days, although may range from 2 to 14 days. The majority of cases appear to be spread from people who have developed symptoms.

Are there long-term adverse implications for mother or baby?

While this is not known for coronavirus, it is likely to be similar as it is for other serious viral infections, such as influenza. While there is the immediate risk of death and pneumonia in severe cases, most people with coronavirus will make a full recovery. The specific anti-coronavirus antibodies a woman makes while infected should give her considerable protection from being reinfected.  The specific anti-coronavirus antibodies also can be transferred to her baby in her breast milk and so give her newborn baby some protection.

Being born prematurely, having low birth weight or having a congenital abnormality because of infection can affect the long-term wellbeing of the baby. There is no specific data about coronavirus on this topic.

Should I breastfeed if I have coronavirus?

Coronavirus is transmission by close contact with a person who is infected and is thought to occur mainly via respiratory droplets produced when a person with infection coughs or sneezes.

There is no evidence of the virus being been found in the breast milk of women with coronavirus.

No information is available on the transmission of the virus that causes COVID-19 through breast milk (i.e. whether infectious virus is present in the breast milk of an infected woman).

In limited reports of breastfeeding mothers infected with SARS-CoV, virus has not been detected in breast milk; however, antibodies against SARS-CoV were detected in at least one case. That implies protection of the newborn because of the transmission of relevant antibodies in breast milk.

So long as the infected mother wears a face mask, she should be encouraged to breast feed her baby.

What can I do to avoid getting infected?

There are regular updates from the Government on this topic and so I suggest you check appropriate platforms for information. There is lot of nonsense being posted on social media and on mainstream media (with a goal to only sensationalise the crisis and not give truthful reporting). I strongly suggest you ignore this sort of information. Government and reputable medical sources are best.

Practical steps you can take include…

  • Practice good hand hygiene – wash your hands regularly with soap and water for at least 20 seconds, particularly after going to the toilet and before eating food.
  • Cover your nose and mouth with a tissue when coughing or sneezing or cough or sneeze into the crook of your elbow and encourage others to do the same. Make sure you put the tissue into a bin and then wash your hands afterwards.
  • Avoid touching your eyes, nose and mouth with unclean hands.
  • Don’t share food or drinks.
  • Where possible, keep one metre away from people who have a respiratory illness.
  • Avoid contact with any new arrival (last 14 days) to Australia.
  • Avoid going to where there are people gathering. The Federal Gvernment has in place restrictions on the number of people who can gather. See Coronavirus (COVID-19) health alert
  • Try to work from home.
  • If you need to go to work and you need to use public transport to go to work try to avoid ‘peak hour’ travel, so you can travel when the bus or train is less congested. Try to avoid sitting next to someone else.
  • Be careful who cuddles your newborn baby. Keep your newborn away from larger shopping centres, etc.
  • Use a pram mesh cover when out and about with your new baby but be careful to make sure it does not cause your baby to be overheated.
  • Overseas travel should be deferred. Otherwise choose the destination very carefully. Avoid countries where this is a higher risk of being infected and those countries where there may be under detection and so under reporting (e.g. Indonesia and India). There is the risk you may not get back into Australia from overseas if Australia temporarily imposes a travel restriction on the country you are visiting.

What happens now a pandemic has been declared?

Your pregnancy care and confinement cannot be postponed. Hospitals may decide to cancel elective surgery cases but that will have no impact on you, your antenatal visits with me and on you having your baby at the hospital.

I want to have baby soon. Should I defer conceiving until the coronavirus problem are over?

I was asked this question today by a patient via Facebook messaging. My reply was: “It is unlikely you will have a coronavirus infection. It would be more concerning if you became infected in the first trimester of pregnancy. Playing it safe I suggest deferring pregnancy until coronavirus is no longer an issue.”

Office coronavirus precautions

If you are a current antenatal patient have cold or flu like symptoms can you please phone the office and advise us so we can rearrange your appointment for a time when you are well. Please don’t have anyone who is unwell attend with you.

(1) https://www.dhm.com.au/coronavirus-covid-19/coronavirus-factsheet/

(2) http://www.thelancet-press.com/embargo/coronavirusriskfactors.pdf

(3) https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763787

(4) https://www.iflscience.com/health-and-medicine/a-newborn-baby-in-the-uk-tested-positive-for-coronavirus/

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