Pregnancy and COVID-19: Avoiding risks and staying up-to-date on vaccinations is half the battle won

Protect your hands, protect your face, and protect your face from your hands – this continues to be the key prevention strategy against the coronavirus.

The novel coronavirus has taken the world by storm resulting in a lot of uncertainty, panic and confusion. While we have almost sailed through an entire year, doubts and anxiety continue to impact people especially pregnant mothers who are gearing up to bring a life into the world. The latest mutant strain and the progressive news of a possible bird flu (influenza A) outbreak in India have added to stress in the minds of expectant mothers. The key is to understand the impact of the virus and navigate through it by seeking the right advice from your healthcare professional and following the rules laid down for one’s safety.

 It is not yet established that pregnancy is a vulnerable group, as there is variable evidence that the virus passes on to the foetus from an infected mother. It is unlikely for the baby to have any defects in development as a result, unless the woman has an extremely high-grade fever which may be a cause for the defects.

What are the risks involved?

There is a lot of ambiguity associated with pregnancy and COVID-19, because research is still underway and there has been very little consensus, what with the virus' rapidly evolving nature. Immunity is known to reduce during pregnancy, so it is essential to take special care during this phase and even more so now, with the COVID-19 pandemic raging on. If a pregnant woman is infected, there is a higher possibility of hospitalization, followed by intensive care or ventilation if needed.

It is not yet established that pregnancy is a vulnerable group, as there is variable evidence that the virus passes on to the foetus from an infected mother. It is unlikely for the baby to have any defects in development as a result, unless the woman has an extremely high-grade fever which may be a cause for the defects. Pregnant mothers can look forward to delivering a healthy baby unaffected by the virus, with adequate care and precautions as supported by more and more data coming out. However, a breastfeeding mother, if infected, needs to be extremely careful to avoid passing the infection to her newborn.

Protective Measures

The precautions that expecting mothers need to take during their pregnancy aren't different from what most people are currently undertaking. It is imperative to wash your hands frequently with soap or use an alcohol-based hand sanitiser. Maintain social distancing and avoid crowded places. Always wear a mask and avoid touching your eyes, nose and mouth. It is important to practice respiratory hygiene.

Pregnant women can go to their doctor’s appointments by maintaining the protocols that can minimise exposure and reduce possible transmission of the virus. Use the opportunity of online consultations for your non-emergency queries.

Right Management Essentials

Maternal management and fetal safety are of utmost importance and right steps must be followed. It is essential to keep an eye out for any symptoms and then take quick and necessary actions accordingly. Contact your healthcare provider or diagnostic centre and make arrangements to get tested and call ahead if you are visiting personally. It is very crucial to intimate your healthcare provider of your symptoms before visiting to avoid potential cross-infection from/to others. Continue to take essential multivitamins and nutrition to keep your immunity in place. One must be in constant touch with their healthcare provider for proper assessment and management of infected pregnant women and the potential risk to the baby.

Don’t forget your shots amidst the pandemic

While COVID-19 has taken centre stage, it is more important now than ever that one must not forget protection from other existing infections that can have an impact on you and your baby’s health. Thus, while taking those extra steps due to coronavirus, expectant mothers must also pay attention to vaccine-preventable diseases. Immunization of the mother and caretakers is essential to create a cocooning effect for prevention of transmission to your little one. Thus, vaccines are also recommended for the other family members and care takers.

Live, attenuated virus and live bacterial vaccines generally are contraindicated with pregnancy. But inactivated viruses can be given safely. It is best is to consult your doctor for your specific needs based on your case history and current health.

Pre-conception Vaccinations

Rubella

Congenital rubella syndrome (CRS) is a condition that occurs in a foetus whose mother is infected with the rubella virus during pregnancy especially in the first trimester. It causes abortion, miscarriage, stillbirth, foetal anomalies and birth defects. Centres for Disease Control & Prevention (CDC) recommends the MMR vaccine (measles, mumps, and rubella) prior to conception. Since it is made with live attenuated viruses, it is preferably not administered to pregnant women.

Hepatitis B

Hepatitis B infection poses a serious risk to infants at birth. When babies become infected, they have a risk of developing a life-long, chronic infection, including liver damage, liver disease and liver cancer. Infected mothers can transmit the virus to the foetus hence its suggested that the couple get vaccinated before conception.

Chickenpox

Varicella infection or chickenpox in the first or early second trimester of pregnancy could lead to ‘congenital varicella syndrome’ that can cause abnormalities in the foetus as well as risk for serious birth defects. The varicella vaccine is advised before planning a pregnancy to avoid these complications.

HPV

The human papillomavirus (HPV) vaccine targets HPV types that cause most cervical cancers. The vaccination is recommended for girls as early as nine years of age and if missed earlier, can be given up to the age of 45. It is better to give sooner than later. The quadrivalent vaccine also protects against perennial warts.

Vaccines to take during pregnancy, if missed earlier

Tetanus toxoid

As per the World Health Organisation, a pregnant woman must be given the tetanus toxoid vaccination in two doses. The second dose recommended is the 3-in-1 Tdap vaccine having acellular pertussis component that can prevent tetanus, diphtheria and pertussis or whooping cough. If taken after 26 weeks, it not only protects the mother but also the newborn in the first few months of life.

Influenza

Tropical countries like India experience flu season throughout the year. Thus, everyone should be immunized with the seasonal influenza vaccination preferably two-three weeks before conception or flu season. If taken around the seventh month of pregnancy, it not only protects the mother but also the baby for the first six months of life.

While travelling to high-risk zones, it is advisable to take the Yellow fever, Japanese encephalitis and Typhoid vaccinations as per the travel recommendations. Post-delivery, in case you have not been vaccinated, you can take the pending vaccines like Rubella, Chicken Pox, Flu and HPV, Hepatitis and other vaccines.

The author is an Obstetrician & Gynaecologist at Le Nest Hospital Malad, Mumbai



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