Coronavirus (COVID-19): It is possible for a pregnant woman who is positive for COVID-19 to pass on the virus to her child, the ICMR has said, laying down norms both for the care of the mother and the child in such instances. The guidelines also call for the use of personal protective equipment for hospital staff, especially at the time of delivery.
The Guidance for Management of Pregnant Women in COVID-19 Pandemic, released by ICMR on Monday, says, “With regard to vertical transmission (transmission from mother to baby antenatally [before birth] or intrapartum [during labour]), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affected and the significance to the neonate (new born) has yet to be determined.”
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While the science on whether a pregnant woman with COVID-19 can pass on the virus to her child, is still emerging, with only small studies done on a limited number of cases so far, there is evidence in COVID literature both of such transmission having taken place and of instances when an infected mother has given birth to a perfectly healthy child.
Dr Vinod Paul, Member (Health), NITI Aayog, who is also chairman of the empowered group of medical emergency management plan for COVID-19, said, “Pregnancy is a very special period in life where an infection which potentially could be severe could have significant adverse effects. Therefore, we must make all efforts to look after the mother and child optimally.
This is a new virus, whose ways we are still understanding but there are indications that vertical transmission is possible. But we are still learning. However, it is important that during pregnancy and during labour, health workers and the baby who come in contact with the mother’s body fluids take special precautions. Isolation of the baby too is important.”
On March 26, Chinese researchers reported in the Journal of the American Medical Association of a case involving a woman with COVID-19 who delivered a baby girl on February 22 at Renmin Hospital, Wuhan. The baby was found positive both for the virus and antibodies against it soon after birth. It was the presence of the latter that led researchers to believe that the infection happened at the foetal stage. However, before this case, a study done on nine pregnant women found no evidence of mother-child transmission.
“The elevated IgM antibody level suggests that the neonate was infected in utero. IgM antibodies are not transferred to the foetus via the placenta. The infant potentially could have been exposed for 23 days from the time of the mother’s diagnosis of COVID-19 to delivery. The laboratory results displaying inflammation and liver injury indirectly support the possibility of vertical transmission,” the researchers reported.
In London last month, a baby born to a COVID-positive mother had tested positive immediately after birth. Doctors at the North Middlesex hospital in Enfield had said it was not possible to make an assessment on whether the infection happened in the womb.
However, the NHS now says, “As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage. With regard to vertical transmission (transmission from mother to baby), the evidence now suggest that transmission is probable, although there has only been a single case reported. The significance to the neonate is not yet known and we will continue to assess and monitor the situation for women and babies.”
The US Centers for Disease Control and Prevention says, “Mother-to-child transmission of coronavirus during pregnancy is unlikely, but after birth, a newborn is susceptible to person-to-person spread. A very small number of babies have tested positive for the virus shortly after birth. However, it is unknown if these babies got the virus before or after birth. The virus has not been detected in amniotic fluid, breastmilk, or other maternal samples.”
There are scientific guidance documents that prescribe separation of the mother and child in such cases immediately after birth.
The ICMR document too says, “It is unknown whether new-borns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. Facilities should consider temporarily separating (e.g. separate rooms) the mother who has confirmed COVID-19 or is a PUI (person under investigation) from her baby until the mother’s transmission-based precautions are discontinued.”
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