An ob-gyn tackles the most urgent questions from expectant mothers’ on the novel coronavirus and their unborn babies.

Whether you’re expecting your first or third child, it’s normal to worry when you’re pregnant as you want to make sure that both you and the precious foetus you’re carrying are healthy.

Since the coronavirus is such a new disease and we are still learning how it spreads, expectant mothers understandably, have numerous questions relating to how COVID-19 might affect their pregnancy and unborn babies.

For instance, digital editor Jassmin Peter, 38, who is four months pregnant with her second child, wants to know if she is susceptible to catch the virus. She adds, “Do I need to wear a mask even if I’m well?”

Obstetrician-gynaecologist Dr Tan Toh Lick who practises at Thomson Women’s Clinic (Jurong), answers all your COVID-19 questions relating to pregnancy.

How susceptible is an expectant mother to catching COVID-19?

SARS-CoV-2 is a novel coronavirus that causes coronavirus disease 2019 (COVID-19).

There is no evidence that pregnant women are more susceptible to COVID-19 or coronavirus disease 2019. Experience from other severe coronavirus infections also show no increased susceptibility for expectant mothers. Currently, more men have been affected than women, although this could be due to various reasons including exposure risks.

Pregnant women do not need to wear a mask if they are well and have no symptoms of respiratory infection such as cough, runny nose or fever.

Any special measures pregnant women need to take to avoid getting COVID-19?

Pregnant women should take similar precautions as non-pregnant women to avoid getting COVID-19. These include:

* Avoiding touching your eyes, nose and mouth with unclean hands.

* Regular thorough hand hygiene with soap and water or an alcohol-based hand rub hand sanitiser). This is particularly important after coughing or sneezing, when dealing with food, after toilet use or handling of waste.

* Avoiding close contact with people who are unwell or have COVID-19.

* Avoiding large crowds and maintain more than 1 metre from a person who is coughing or sneezing.

* Avoiding affected places or countries with ongoing transmission of COVID-19.

Pregnant women who are unwell should avoid meeting vulnerable people including other pregnant women in an obstetric clinic. They should telephone the clinic to see if they should attend or postpone their appointment. When coughing or sneezing, cover the mouth and nose with a disposable tissue or bent elbow. In public places, unwell pregnant women should wear a mask. Pregnant women with fever, cough and difficulty breathing should seek medical attention at designated centres such as a public health preparedness clinic (PHPC).

Should pregnant women wear a mask even if they are well, just in case?

In general, pregnant women do not need to wear a mask if they are well and have no symptoms of respiratory infection such as cough, runny nose or fever. A surgical mask is used to protect other people when one coughs or sneezes.

 

If a pregnant woman gets COVID-19, will it affect her pregnancy at all, whether it’s her first, second or third trimester?

COVID-19 was first reported about two months ago at the time of writing. Current medical literature suggests similar clinical outcomes in pregnant and non-pregnant women with COVID-19 infection. However, only a small number of cases are available for analysis over a short duration, therefore, the true picture may be different.

Studies suggest COVID-19 infection may have similar pathogenesis (the manner in which a disease develops) to SARS infection. SARS infection during pregnancy was associated with a high incidence of adverse maternal and neonatal complications such as miscarriage, preterm delivery, foetal growth restriction, disseminated intravascular coagulopathy*, and admission to an intensive care unit.

* Condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. This depletes the platelets and clotting factors needed to control bleeding and causes excessive bleeding.

The breastmilk can be pumped [by the mother], and the expressed breastmilk fed to the infant by someone who is well.

Will the virus be passed from the affected mother to her baby?

COVID-19 was first reported about two months ago at the time of writing. Current medical literature does not suggest vertical transmission of the virus from the mother to the baby. The SARS-CoV-2 virus has also not been detected in the amniotic fluid. Two neonatal cases of COVID-19 infection have been confirmed so far. One of the cases involved an infant aged 17 days who had close contact with the affected mother and maternity matron. The source of COVID-19 infection in the other newborn diagnosed at 36 hours is less certain as there was no direct testing of amniotic fluid, cord blood or placenta to refute an infection in the womb. As only a small number of cases are available for analysis over a short duration, testing and precautions are usually taken to isolate the newborn after birth.

If the mother has COVID-19, can she still breastfeed her baby safely?

While breastmilk is a good source of nutrition and can offer protection against many illnesses for most infants, there are exceptions when it is not recommended. It remains uncertain if COVID-19 can be transmitted via breastmilk or while breastfeeding. The National Health Commission of China proposed that neonates of mothers who are suspected or have confirmed COVID-19 infection should be isolated in a designated unit for at least 14 days after birth. During this time, the baby should not breastfeed, and should avoid close contact with the affected mother. The Centers for Disease Control and Prevention (CDC) in United States of America suggest that if breastfeeding is initiated after a discussion between the mother and her healthcare providers, then the mother should observe hand and breast hygiene and wear a face mask when latching. Alternatively, the breastmilk can be pumped, and the expressed breastmilk fed to the infant by someone who is well.

Do pregnant healthcare workers risk adverse outcomes to their pregnancy/baby if they care for patients with COVID-19?

Pregnant women are more susceptible to infections particularly if they have chronic diseases or maternal complications. Therefore, pregnant healthcare personnel should inform their employer, so that a risk assessment may be performed. As with non-pregnant staff, they should adhere to recommended infection prevention and control guidelines in their hospital and take all the precautions to avoid putting themselves at risk of COVID-19 infection at work.

Photos: iStock

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