People of all age groups are susceptible to the coronavirus as cases among infants, pregnant women and people of most other age groups have shown. But it has not been clear if pregnant women infected with COVID-19 face severe consequences if they can transmit the infection to their child while it is in their womb and if the disease leads to any complications during or after pregnancy.
Now, a review article published in the Journal of Reproductive Immunology states that by altering the maternal immune responses, the disease may affect the well-being of mothers and infants. Read this story in Tamil
The WHO has said that there is no evidence yet to show that pregnant women are more vulnerable or are at a higher risk of severe illness from COVID-19 than the general population. WHO has advised pregnant women to wash their hands frequently, to avoid crowded spaces and to practice respiratory hygiene.
The US Centre for Disease Control (CDC) also maintains similar guidelines for pregnant women. Regarding a COVID-19 mother who wants to breastfeed her infant, the CDC says the following, “Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. Because people may be able to spread COVID-19 without symptoms and because COVID-19 illness is spreading in communities across the country, a breastfeeding mother should take all possible precautions to avoid spreading the virus to her infant.”
As per the China-WHO joint investigation report on COVID-19, eight per cent of all the pregnant women among the total cases were severe cases.
Further, according to the National Health Commission, among 147 pregnant women (out of which 64 were confirmed cases, 82 were suspected and one was asymptomatic) that were investigated in China from February 16-24, one per cent were severe COVID-19 cases. This means that while the morbidity and mortality of pregnant women with COVID-19 may not be exactly known, the current studies into the subject show that pregnant women may be “particularly vulnerable” to COVID-19 infection.
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We know that the immune system’s role in fighting off an infection is very important. This holds true even for those infected with the SARS-CoV-2 virus. The immune system needs to function optimally to fight off the COVID-19 disease. For instance, in case of some cancer patients, the immune system may be compromised, which means it will be weakened and not fully equipped to deal with the infection. In some other patients, even seemingly healthy ones, the virus itself is capable of sending the immune system into an overdrive (cytokine storms), such that the immune cells start attacking even the healthy tissue, leading to sepsis and even death.
Therefore, in pregnant women too, the immune system’s role will be supreme and their COVID-19 outcomes will partly depend on how pregnancy changes a woman’s immune system.
The review article states that while the maternal immune system is well prepared to defend the invasion of foreign pathogens, some immune cells respond more strongly to viral challenges, whereas some other immune responses may be down-regulated during pregnancy. Significantly, during pregnancy, the upper respiratory tract tends to be swollen due to high levels of estrogen, progesterone and restricted lung expansion, which makes such women susceptible to respiratory pathogens.
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Further, while there is no evidence of vertical transmission of the infection from mother to the womb, the article cites previous research that indicates that SARS infection during pregnancy can lead to high rates of spontaneous abortion and premature birth. Citing recent literature, the article points out that in severe COVID-19 cases, the infection is associated with cytokine storms (when the immune system goes into overdrive), and this may also happen with pregnant women since they are in pro-inflammatory stage in their third trimester. This means that a cytokine storm induced by the virus can push pregnant women to a more severe inflammatory stage, increasing the chances of them getting severely ill.
Maternal inflammation during pregnancy can also affect aspects of fetal brain development and can lead to a “wide range of neuronal dysfunctions” that are recognised later in life.
Pregnant women are prone to respiratory distress even without COVID-19, due to the aforementioned factors such as increased estrogen and progesterone and restrictive lung expansion. Therefore, if a pregnant woman gets infected with COVID-19 there are chances that they may be more susceptible to COVID-19 infection.
Further, because of the changes in the immune response of a woman induced by pregnancy and the probability that the SARS-CoV-2 virus may trigger the immune system to become hyperstimulated, there is a chance that because of cytokine storms pregnant women face severe morbidity and mortality. Also, while there is no evidence yet that vertical transmission of the virus can take place between the mother and fetus, maternal infection and inflammation that develops in response to the infection could affect the developing fetus.
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Authors of the article suggest that more attention should be paid to pregnant women with COVID-19 in their first and second trimester and even after the viral infection is controlled, the intrauterine development of the fetus should be closely monitored, “since the early gestation data is lacking, and placental inflammation may persist for a prolonged time.”
“Pregnant women with COVID-19 should be carefully monitored throughout pregnancy and the postpartum period since they had anti-viral drug therapy and radiation exposure from CT examinations,” the authors note.
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