The Corona Pandemic- Safety/Risk of COVID 19 During Pregnancy and Lactation

Motherisk Int J 2020;1:8

 

Tal De-Haan, Natalie Dinavitser, Rana Cohen, Mati Berkovitch and Maya Berlin

Clinical Pharmacology Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Sackler Faculty of Medicine, Tel-Aviv University,  Tel Aviv, Israel

 

Question:

What is known about the fetal, neonatal and maternal risks of infection with the Corona virus?

Answer:

According to preliminary reports from China it does not appear that pregnant women exhibit more severe symptomatology as compared to non pregnant women. Presently it is not known whether the virus exerts teratogenic effects. In a few cases amniotic fluids, umbilical blood or neonatal throat cultures were examined and the virus was not detected. In contrast, a newborn in London UK has tested positive for the coronavirus SARS-CoV-2,  minutes after being born to a mother who was  infected with the virus, and was admitted to a hospital for symptoms of pneumonia. The Guardian reported.

 

The Coronaviruses constitute a large group of viruses that can infect animals and humans. The infection spread through droplets, associated with coughing or sneezing. The virus can stay alive for several hours on surfaces. It appears that  COVID 19 causes higher infection rates than influenza, chacterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

In pregnancy, one tends to be more vigilant, as several different viruses have been shown to afflict more complications (e.g. varicella, influenza, SARS). On average, in every pregnancy there is a miscarriage risk of 10-15% and congenital malformations at 3-5%.

 

What is known about COVID 19 in pregnancy?

From previous reports on MERS and SARS infections outbreaks ( belonging to the same family of Coronaviruses), pregnant women who contracted the virus did not exhibit more severe symptoms than non pregnant women. Presently this group of viruses have not been associated with a measurable teratogenic effect. In a few Chinese cases amniotic fluids, umbilical blood or neonatal throat cultures were examined and the virus was not detected. In contrast, a newborn in London UK has tested positive for the coronavirus SARS-CoV-2,  minutes after being born to a mother who was  infected with the virus, and was admitted to a hospital for symptoms of pneumonia(1)

Regarding the risk of miscarriage, the data are sparse and conflicting.

Some babies born to women with symptoms of coronavirus in China were premature. It is not known whether the virus caused this or there was a decision to deliver the baby earlier. (2-3)

 

Breastfeeding:

A few milk samples from women with COVID 19 diseasewere negative for SARS-CoV-2, hence it is possible that the virus does not find its way through the mammalian epithelium (2).

Because the virus spread through droplets, expecting mothers should use protective gear, including face mask and repeatedly sterilize their hands (4-5).

 

Information Sources:

The CDC
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html

Mother to Baby
https://mothertobaby.org/news-press/statement-on-coronaviruses/

UK Guidelines
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronaviruspregnancy/covid-19-virus-infection-and-pregnancy/

Israeli Ministry of Health
https://govextra.gov.il/ministry-of-health/corona/corona-virus/

 

References:

1) LiveScience . Com: newborn-has-coronavirus-london https://www.livescience.com/newborn-has-coronavirus-london.html

2) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J, Zhao D, Xu D, Gong Q, Liao J, Yang H, Hou W, Zhang Y. Lancet. 2020 Mar 7;395(10226):809-815. doi: 10.1016/S0140-6736(20)30360-3.

3) Yangli Liu , Haihong Chen , Kejing Tang , Yubiao Guo , Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy, Journal of Infection (2020), doi: https://doi.org/10.1016/j.jinf.2020.02.028

4) Royal college of obstetricians and gynaecologists. OVID-19 Virus Infection and Pregnancy.  https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

5) The American College of Obstetrics and Gynecology. Practice Advisory: Novel Coronavirus 2019 (COVID-19). https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false