- For whom is the coronavirus particularly dangerous?
- The immune system in pregnancy
- Symptoms of COVID-19 in pregnant women
- COVID-19 and pregnancy complications
- Treatment of pregnant women and careful selection of drugs
- Can COVID-19 harm my baby?
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During the COVID-19 pandemic, research into the SARS-CoV-2 virus causing this disease has become a priority in the world of medicine. Despite the efforts of scientists, there is still a lot of conflicting information about the possible complications of this disease in various social groups. Particular care is taken for pregnant women, who in a way risk a double infection and its subsequent complications. Is the coronavirus a greater threat to mothers-to-be? Is this disease dangerous for the developing fetus or newborn?
Coronavirus can cause negative he alth effects in both women and men, regardless of the age of the person affected. It turns out that SARS-CoV-2 infection can also have a negative impact on the course of pregnancy. Complications related to infected pregnant women include, among others: increased risk of miscarriage, increased risk of preterm labor. Conversely, a high fever from an infection can adversely affect the formation of neurons in a child. This virus can also harm the unborn baby in early pregnancy. It also increases the risk of maternal postcovid complications. However, are the above-mentioned complications common and should you be concerned about them?
For whom is the coronavirus particularly dangerous?
Most people who develop COVID-19 show rather mild symptoms similar to a cold or pneumonia. About 14% of the population is severely affected by dyspnoea and even respiratory dysfunction requiring connection to a ventilator.
The deterioration of the course of this disease is greatly influenced not only by the patient's age, but most of all by the existence of chronic diseases, such as diabetes, hypertension, cardiovascular diseases, and disorders of the immune system.
Interestingly, it turns out that while the virus attacks regardless of gender, men die from COVID-19 more often than women. Why?
It may be related to the existence of many previously undiagnosed comorbidities. Research studies also show that in many cases, women have a better and stronger immune response to infections, and their bodies can produce greater amounts of immune antibodies. But is it always like that?
The immune system in pregnancy
Pregnancy involves a number of changes that affect almost every system in the female body. The immune system must be reorganized in such a way as not only to fulfill the current protective function against pathogens, but also to "get used" to the tissues of the emerging fetus, which is a foreign organism.
That is why developing cells of the placenta produce a whole group of factors with an immunosuppressive (i.e. immune-lowering) effect, e.g.
- interleukins,
- growth factors,
- placental proteins.
During pregnancy there is also a weakening of cellular immunity (which is caused by leukocytes, which can absorb and digest viruses and bacteria).
On the other hand, the activation of the non-specific response is increased, in which the main role is played by cells such as granulocytes or macrophages, which can absorb and digest foreign microorganisms or mediate inflammatory responses.
It is believed that changes in the activity of nonspecific immunity balance the temporary decline in cellular immunity. As a result, the immune system of pregnant women is ultimately subject to the so-called immunomodulation - that is, changes in the way it works - rather than attenuation, and should still be effective in protecting against infections.
Symptoms of COVID-19 in pregnant women
The most common clinical symptoms of coronavirus infection, observed in the entire population of patients, are primarily:
- high fever (around 92%),
- cough (67%),
- chronic fatigue (51%),
- shortness of breath (30%).
It turns out that in women expecting a baby, the characteristic symptoms are very similar, but they may appear slightly less frequently:
- fever will occur in approximately 68% of patients,
- cough at 34%,
- and breathlessness in only 12% of women.
However, other symptoms may appear, not initially associated with Sars-CoV-2 infection, for example diarrhea (about 6%) and general malaise (12% of respondents).
A study conducted by WHO in 2022 on a group of 147 pregnant women with COVID-19 showed that 8% of patients had advanced symptoms of infection (severe respiratory failure), and only 1% had very severe disease.
However, the situation may become more complicated when the woman has other comorbidities. Although most future mothers plan to conceive before the age of 40, when there are no serious burdens on the body yet, a big problem may be untreated hyperglycaemia and hypertension.
These factors, along with fluctuations in cellular immunity, may contribute to increasing the susceptibility of pregnant women to bacterial and viral pneumonia.
COVID-19 and pregnancy complications
While most pregnant women seem to experience coronavirus infection fairly gently and recover quickly, be aware thatany infection with severe fever may have a potential risk to the fetus . Especially in the first trimester, these are:
- developmental defects,
- neural tube defects,
- miscarriages.
The mean risk of miscarriage in women with developed COVID-19 pneumonia, compared to its related severe SARS and MERS syndromes, has been estimated to be relatively low at around 1%.
More complications may arise in the later stages of pregnancy, in the second or third trimester.
There have been reports of a higher incidence of spontaneous preterm deliveries or low birth weight in women with COVID-19.
However, there is still too little credible research that would actually indicate the negative impact of coronavirus infection, and not other factors.
Treatment of pregnant women and careful selection of drugs
Taking medications and supplements during pregnancy should always be consulted with a physician to determine whether a given substance is harmful to the developing fetus. Even with more severe infections, a risk assessment must always be carried out to determine if the benefits of treatment outweigh the potential side effects.
So far, no universal drug for COVID-19 has been developed. During severe disease, patients are given oxygen or have more advanced mechanical respiratory support under a ventilator.
Additionally, corticosteroids (e.g. dexamethasone) are recommended, with a strong anti-inflammatory effect and suppressing the over-response of the immune system. These drugs significantly reduce the risk of severe respiratory failure and death, and - in the case of pregnant women - also miscarriage. Dexamethasone may be administered to pregnant women in special cases, but preferably in the period up to 32 weeks.
In milder forms of COVID-19 infection in pregnant women, typical symptomatic treatment is used, similar to the treatment with flu. However, if a high fever does occur, careful selection of medications is necessary.
It was proven a few years ago that taking popular painkillers and antipyretics (the so-called NSAIDs - non-steroidal anti-inflammatory drugs) in early pregnancy(under 8 weeks) is a risk factor for miscarriage.
Paracetamol seems to be a much safer drug, helpful in treating fever symptoms during "home treatment".
Can COVID-19 harm my baby?
So far, the SARS-CoV-2 virus has not been detected either in the umbilical cord blood, in the placenta, or in the amniotic fluid of sick mothers. This indicates that there is probably no so-called vertical transmission and the woman cannot infect her unborn child with coronavirus. A positive maternal coronavirus test is also not an indication for cesarean delivery.
In a recent study of 836 newborns of mothers with COVID-19, only 35 children (4.5%) had a positive PCR test for the coronavirus. It is likely that newborns could become infected accidentally, through contact with medical clothing, mother's skin, or other surfaces in the delivery room. The overwhelming majority of the examined children, however, did not show any symptoms of the disease or respiratory problems.
Scientists also tested milk samples from infected mothers - proving that the coronavirus does not pass into natural food. So, based on the first data collected around the world after one year of the pandemic, it seems that a maternal COVID-19 infection will not be harmful to the baby.
Doctors encourage new mothers suffering from COVID-19 to breastfeed their babies naturally, but subject to special hygiene of the hands and skin of the breasts and wearing a mask.
To sum up, the research results so far indicate that, in general, pregnant women are not a high-risk group that is more likely to develop coronavirus disease.
The symptoms of a possible infection are similar to those of other people of a similar age, and even slightly milder. On the other hand, diarrhea or general malaise were observed more frequently.
With severe SARS-CoV-2 infection in pregnant women, rare cases of miscarriage or premature birth may occur. Proper treatment of the patient is then difficult, because many drugs (including the popular NSAIDs) may be harmful to the fetus.
The comforting fact, however, is that the virus does not transmit in the womb, does not pass into breast milk, and newborns do not show symptoms of the disease.
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