Conception and Pregnancy During COVID Times

Dr Zareena Algiers Khalid,
Senior consultant, Gynaecologist
Centre of Excellence in women's health,
Astermedcity,
Kochi

Pregnancy is a very special period in a women’s and her family’s lives and going through it during a pandemic can be really stressful.

Pregnant women have a similar risk like the rest of the healthy population to get covid 19. Roughly three fourths of pregnant women with covid 19 have no symptoms at all and most pregnant women who do have symptoms only have mild cold or flu like symptoms.

However, a small number of pregnant women can become seriously ill with covid 19 including loss of lives. Pregnant women are at an increased risk of becoming severely ill when compared to non pregnant women especially after the 28th week of pregnancy. This category of pregnant women with covid has been included in the moderate risk group of covid infections. Severe illness is seen in women over the age of 35 years, obese women, associated diseases like Diabetes, Mellitus and Hypertension.

All pregnant women are naturally concerned about the effect of covid 19 on their unborn babies. Studies so far have shown that covid 19 infection in pregnancy is unlikely to cause miscarriages or fetal anomalies, though it has been linked to low birth weight, growth delays and preterm deliveries (before 37 weeks). Premature deliveries can occur due to the severe infection itself, most often it is due to early caesarean deliveries undertaken by the obstetrician to promote recovery of the sick mother.

Another common matter of concern is whether the covid infection will be transmitted from the mother to the baby during pregnancy or child birth. Studies so far have not shown an in utero transmission of the virus to the fetus. Routinely all such babies are tested for covid infection after birth. If at all a new born gets the covid infection they have been found to remain well without any consequences.

Regarding breast feeding in covid positive mothers, World Health Organization (WHO) has recommended to encourage it so long as adequate precautions are taken like using hand hygiene and face mask. Covid virus has not been detected in breast milk. In spite of this directive by the WHO, many institutions still isolate the baby from the mother and give expressed breast milk. Finally, it is a combined decision of the mother and the caregiver regarding whether to breast feed or not.

Hospitals and care providers have made adjustments in the antenatal care to avoid risk of getting exposed to covid by reducing the number of visits a pregnant woman makes to the hospital with extra support provided over telephone or telemedicine. It is important to counsel pregnant mothers with covid infection that during delivery she must be prepared to have less visitors and extended family support in the labour room in view of the covid protocol of the hospital. This may result in mental health issues in the form of anxiety and loneliness in the pregnant woman which needs to be expertly dealt with by counselling, A birth companion is definitely encouraged in the labour room during delivery though unfortunately it is not followed in most of the delivery points.

In the initial days of the covid pandemic, there was a trend towards discouraging pregnancy and assisted fertilization which is no more believed to be practical or necessary. Women can definitely plan a pregnancy as well as take treatment for infertility unless there is rampant covid infection in their vicinity. Whether the covid infection as such affects a couple’s fertility is still not clear though some studies have demonstrated an adverse effect on the sperm count in men.

Women undergoing fertility treatment and pregnant women should be encouraged to receive covid vaccination. Since covid vaccine is not a live vaccine, there is no reason to delay pregnancy attempts because of the vaccine administration or to defer treatment until the second dose has been administered. Neither does the covid vaccine increase the risk of infertility nor miscarriage.

Finally, it is a shared decision between woman and care providers when considering vaccinating in pregnancy. Whereas WHO recommended covid vaccine to all pregnant women, the Indian government only recently approved covid vaccination to be given any time in pregnancy and lactation. The benefits of vaccination outweigh the potential risk of covid infection especially considering the fact that the second wave of covid 19 hit the pregnant and lactating women more severely when compared to the first.

Needless to say, following social distancing, hand hygiene, using face mask, keeping well hydrated and mobile, staying active with regular exercise and a healthy balanced diet can help to support a healthy pregnancy and reduce infections.