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COVID-19 Infection in Pregnancy

The global pandemic of SARS-CoV-2, the cause of COVID-19, has been linked with worse outcomes in a number of patient populations, including the elderly and people with chronic comorbidities.
If you are pregnant, or are breastfeeding, you may be concerned about the impact COVID-19 can have on you and your baby. Pregnancy causes changes in your body that can make it easier to become very sick from respiratory viruses like COVID-19. 


What are the risks of COVID-19 during pregnancy?

The overall risk of severe illness and death from COVID-19 for pregnant women is low. However, if you are pregnant or have recently been pregnant, you are more likely to get severely ill from COVID-19 than people who are not pregnant. Severe illness means that you may need care in an intensive care unit (ICU) or to be placed on a ventilator for breathing support. 
Pregnant women with COVID-19 are also more likely to deliver a baby before the 37th week of pregnancy (premature birth) and may be at higher risk for problems like pregnancy loss. Pregnant women with underlying medical conditions, like diabetes or obesity, may also be at higher risk of severe illness due to COVID-19. COVID-19 may also have an increased risk of preeclampsia (a serious blood pressure disorder) and coagulopathy in pregnant women (a blood clotting disorder).
Certain factors can further increase the risk of getting severely ill from COVID-19 during or shortly after pregnancy. These include:

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What is the impact of COVID-19 on fetus or newborn?

COVID-19 infection during pregnancy has been reported to cause the following symptoms:
  • There is a higher risk of preterm birth.
  • Data suggests that there is a possible increased risk of stillbirth.
After birth, reports have indicated the following:
  • There is an increased risk that babies delivered to women who have COVID-19 during pregnancy will need to be cared for in a neonatal critical care unit (NICU).
  • If a newborn is exposed to the virus, he/she can contract it.


What can you do to protect yourself against COVID-19?

  • One of the most effective strategies to protect yourself from COVID-19 is to be vaccinated. Vaccination has shown to lower the risk of serious illness and may also help prevent the risk of transmission.
  • You should also avoid contact with people who have been in a lockdown or hotspot location, as well as people who have recently travelled overseas, and practice proper hand and cough hygiene. It is also essential that everyone in your house also follow the same. 
  • If you have children, make them aware about the importance of good hand hygiene and how and when to wash hands.
  • Clean and disinfect phones, doorknobs, and counters that people touch frequently.
If you go out or interact with other people, you should:
  • Wash your hands often with soap and water for at least 20 seconds or use alcohol-based hand sanitizer. This is especially important before and after eating, and after going to the toilet.
  • Cover your mouth and nose when you cough and sneeze with tissue and throw them in the bin; wash your hands immediately.
  • Avoid touching your eyes, nose, or mouth.
  • Avoid crowds and mass gatherings where it is difficult to keep distance from others.
  • Maintain at least 6 feet distance where possible.

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COVID-19 and its impact on routine antenatal and postnatal appointments

If you are pregnant or have recently given birth during COVID-19, it may be a stressful and anxious period. Antenatal and postnatal care should be considered crucial, and you should be encouraged to attend while maintaining as much social distance as possible.

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To limit the number of times you need to travel and attend hospital or clinic, your maternity care may involve additional home visits, or some treatment and support may be provided over the phone or by video. Any modifications in your appointments will be communicated to you in advance. You should always wear a face mask while attending antenatal appointments or scans to reduce the transmission of COVID-19 in hospitals.


What should you do if you develop symptoms of COVID-19?

COVID-19 symptoms are similar to those of other viruses, such as colds and the flu. So, unless you get tested, there are chances you won’t know if you have COVID-19. If you experience any of these symptoms, call your healthcare provider immediately:

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Get a PCR test as soon as possible to check if you have COVID-19. If someone you live with has symptoms, they should also get tested.
You should isolate yourself while waiting for your test result. You should also inform your health care provider about your symptoms. It is also important to consider other possible causes of fever/ temperature in pregnancy, including urine infections and water breaking. If you experience any burning or discomfort when passing urine, any unusual visual discharge, or have any concerns about your baby’s movements, contact your health care provider for help.


What should you do when you are asked to self-isolate?

Pregnant women who have been advised to self-isolate should remain indoors and avoid interaction with others for ten days. To avoid spreading the infection, everyone in your household should stay at home for at least 10 days. Even if you are self-isolating, it is crucial to be active and hydrated to avoid blood clots during pregnancy. Keep in touch with family and friends via phone and video chats.

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Can you pass the infection to your baby?

COVID-19 infection may be passed on to your baby during pregnancy or birth.
However, this is quite uncommon. The infection has been diagnosed in a small number of babies shortly after birth; however, it is unclear whether the virus was transmitted before or soon after birth. Your maternity team will maintain strict infection control measures and monitor your baby closely at the time of birth.


What will happen if you have COVID-19 during labor and delivery?

If you have COVID-19, you should wear a mask while at the hospital. Wearing a mask, however, may be challenging when pushing during labor. As a result, your health care team should wear masks or other respiratory protection equipment. They may also take other precautions, such as donning goggles or face shields, to decrease the risk of spreading the virus.


Can your baby stay with you after delivery if you have COVID-19?

The risk and benefits of separating yourself from your baby should be discussed by the health care team. While the baby is under investigation, a separate isolation room should be made available.
The decision to discontinue temporary separation of the mother from baby should be made on a case-by-case basis by consulting with your doctor. The severity of the condition, the signs and symptoms of illness, and the findings of laboratory tests for the virus that causes COVID-19, SARS-CoV-2 in the mother and newborn should all be considered when making a decision. If you plan to share a room together, maintain physical barriers, and keep the baby’s crib at least 6 feet away from you.


How can you feed your baby? 

The best source of nutrition for most newborns is breast milk. It provides protection against many diseases. It is unlikely that mothers with COVID-19 can transmit the virus via breast milk. The decision of
breastfeeding should be taken by you, in coordination with your family and healthcare providers. The main risk of feeding is close contact between you and your baby. 
Wash your hands using a soap and water before touching your baby, breast pump, or bottle. Use hand sanitizer with at least 60% alcohol if soap and water is not available. Wear a mask when expressing breast milk and while feeding. Avoid coughing or sneezing while feeding your baby at breast or from a bottle. After each usage, clean the pump/bottle as instructed.
If you have been temporarily separated from your baby, consider asking someone who is well and is not at high risk of illness from COVID-19 to feed your expressed breast milk or formula milk to your baby.


Taking care of your mental wellbeing during COVID-19 pandemic 

The COVID-19 epidemic is inevitably causing an increased amount of anxiety in the general population, and this is likely to be even more so for pregnant women and their families, as pregnancy puts an additional level of uncertainty. These fears are most likely to revolve around the following topics:
– The virus itself
– Vaccination for COVID-19
– The impact of social isolation, which leads to a reduction in support from family and friends.
– Household finances may be impacted.
You can try the following stress-relieving tips and practices:
– Avoid looking at physical media or viewing the news frequently. Instead, you can limit the news to key times of the day, like morning or before dinner. 
– Discuss with your health care provider about online antenatal classes.
– Meditation and deep breathing exercises are good options.

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– Connect with friends and family over the phone or via video conferencing.
– Get enough sleep by going to bed at the same time every night and limiting your screen time before bed.
– Maintain a healthy diet and exercise on a regular basis. In times of mental illness, eating well and staying active can help the body stay healthy.
– Take up or rediscover an old hobby. 
– Anyone suffering from anxiety, depression, or stress may benefit from counseling.
– Ask for extra help whenever required. Share your feelings with your partner.
Remember, the focus should be on you and your baby’s health. Consult your health care provider to discuss about your concerns. If you are having trouble managing stress or anxiety, remember that you are not alone. Talk to your health care provider about coping strategies.

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