Q&A: Insights on Covid-19 in Pregnant Women

Q&A: Insights on Covid-19 in Pregnant Women

Pregnancy Stage

1. Does pregnancy increase the risk of contracting COVID-19?

Answer: Pregnancy does not increase the risk of contracting COVID-19.

2. Do the symptoms of COVID-19 differ in pregnant women compared to non-pregnant women?

Answer: The symptoms of COVID-19 in pregnant women do not differ from those in non-pregnant women. Common symptoms include fever, cough, headache, muscle pain, loss of smell, and nasal congestion. It has been found that around 90% recover without requiring hospitalization. However, pregnant women, especially those with risk factors such as age >= 35 years, obesity, diabetes, or high blood pressure, may experience more severe illness.

3. Are there increased complications for both the mother and the fetus if a pregnant woman contracts COVID-19?

Answer: Pregnant women with COVID-19 may experience the following increased complications:

• Preterm birth, especially in cases of severe pneumonia or illness.
• Cesarean delivery.
• Pre-eclampsia.
• Increased risk of stillbirth or fetal death.

4. Is there a risk of COVID-19 transmission to newborns from infected mothers?

Answer: There is no clear evidence that COVID-19 can be transmitted through the placenta and infect the fetus. However, there have been some reports of approximately 2% of newborns testing positive for COVID-19 after being born to infected mothers in the third trimester.

5. In the current situation with a high prevalence of COVID-19, are there any changes in the approach to prenatal care to reduce the risk of infection for pregnant women?

Answer: Healthcare providers will adjust the care provided based on the individual risk of each pregnant woman. Steps that can help reduce the risk of infection include:

• Telehealth consultations.
• Reducing the frequency of prenatal visits.
• Decreasing the duration of in-person visits to healthcare facilities.
• Limiting the number of people in waiting areas and maintaining physical distancing.
• Consolidating laboratory testing into fewer appointments.
• Conducting targeted ultrasound examinations.
• Adjusting the timing and frequency of prenatal health assessments for the fetus.

Labor and Delivery Stage

1. Should pregnant women infected with COVID-19 but asymptomatic delay induction of labor or opt for cesarean delivery if there are medical indications such as pre-eclampsia or fetal growth restriction?

Answer: It is not recommended to delay induction of labor or opt for cesarean delivery solely based on COVID-19 infection in pregnant women without symptoms. However, medical indications such as pre-eclampsia or fetal growth restriction may pose greater risks to both the mother and the fetus, warranting appropriate medical advice.

2.What is an appropriate method for relieving pain during labor for pregnant women with COVID-19 infection?

The answer is administering epidural anesthesia, which has several advantages:

• It helps reduce the stress on the cardiovascular and respiratory systems caused by pain and anxiety.
• It eliminates the need for general anesthesia in emergency cesarean sections.
• Nitrous oxide should not be used, as it is an inhalation-type analgesic used during labor, and there is insufficient information regarding cleaning, filtering, and the potential for aerosolization.

3. Should individuals staying with pregnant women during labor be screened for COVID-19?

The answer is that individuals in the labor room should undergo COVID-19 screening (though specific requirements may vary in different locations).

The following individuals should not be allowed in the labor room:

• Spouses who have tested positive for COVID-19 but are asymptomatic.
• Individuals with a history of contact with COVID-19 patients within the past 14 days.

4. Is it necessary for pregnant women with COVID-19 infection to undergo cesarean section?

The answer is no. Cesarean section is not necessary as it increases the maternal risk without improving the neonatal outcomes. However, it may be necessary in cases where the mother experiences severe exhaustion, severe symptoms, or obstetric complications that require cesarean delivery.

Postpartum Period

1. How are infants born to mothers with COVID-19 cared for in hospitals?

Answer: Infants born to mothers infected with COVID-19 receive care following infection control precautions. They are separated from other infants, and nasopharyngeal swabs are taken to test for COVID-19 infection. The care provided is based on the test results.

2. How should infants be cared for if their mother is infected with COVID-19?

Answer: Infants can stay in the same room as their mother, but they should be kept at least 6 feet away. The mother must wear a face mask and clean her hands before touching the infant.

3. How long should a mother infected with COVID-19 maintain distance (isolation) and follow infection prevention guidelines from their newborn?

Answer: In mothers with symptoms, the isolation and infection prevention guidelines should be followed for at least:

• 10 days from the onset of symptoms
• 20 days in case of severe symptoms or compromised immune system
• 24 hours without using fever-reducing medications
• Improvement of other symptoms

In asymptomatic mothers, at least 10 days after testing positive for the infection.

4. Can infants breastfeed from a mother infected with COVID-19?

Answer: Although there is no evidence of COVID-19 transmission through breast milk, considering the benefits of breastfeeding, it is recommended that infants receive breast milk.

5. What should a mother infected with or suspected of having COVID-19 do when breastfeeding her newborn?

Answer: Clean hands, breasts, and wear a face mask (face mask) while breastfeeding to prevent droplet transmission. Alternatively, the mother can clean hands, breasts, wear a face mask, and express milk for others to feed the infant.

COVID-19 Vaccine for Pregnant Women and Breastfeeding Women

1. What recommendations are there regarding the administration of the COVID-19 vaccine for women who are planning to become pregnant?

Answer: Since there is no evidence showing that the spread of the disease increases complications during pregnancy, it is not recommended to postpone pregnancy. However, it is advisable to receive the vaccine before getting pregnant, if possible. The vaccine does not affect fertility, and there is no need to delay pregnancy after vaccination.

2. Is the vaccine safe for pregnant women?

Answer: The vaccine does not contain components of the virus that can replicate, so it does not cause the disease. Adjuvants such as aluminum salts used in vaccines are safe, and they have been administered widely in pregnant women, such as the Tdap (Tetanus, Diphtheria, and Pertussis) vaccine. However, it is recommended to receive the vaccine after 12 weeks of gestation. In the case of pregnant women who have already received the first dose, they should receive the second dose at the same time as women who are not pregnant.

3. Does the administration of the vaccine in pregnant women lead to different side effects and complications compared to non-pregnant women?

Answer: The vaccine may have similar side effects as those experienced by non-pregnant women due to the stimulation of the immune system. However, the specific side effects may vary depending on the type of vaccine administered.

4. What is the effect of the vaccine on the fetus during pregnancy?

Answer: Available data shows that the rates of miscarriage, fetal abnormalities, growth restriction, preterm birth, and stillbirth are not increased in pregnant women who received the vaccine.

5. What is the effectiveness of the vaccine in pregnant women?

Answer: The vaccine helps reduce the severity of the disease in pregnant women who are infected with COVID-19. Additionally, some vaccines have been found to induce cross-reactive immune responses in pregnant women, and antibodies have been detected in breast milk, potentially providing immune protection to newborns from vaccinated mothers.

6. Can pregnant women receive the COVID-19 vaccine along with other recommended vaccines during pregnancy?

Answer: Pregnant women can receive other vaccines such as TdaP (Tetanus, Diphtheria, and Pertussis) and influenza vaccines concurrently with the COVID-19 vaccine.

7. Can breastfeeding women receive the COVID-19 vaccine?

Answer: Antibodies generated from the vaccination of mothers can be passed through breast milk and may provide protection against infection in infants.

Article by Dr. Piraphan Phanphakdeekul, Obstetrician-Gynecologist at Vibhavadi Hospital, President of the PCT Obstetrics and Gynecology Subcommittee.

For inquiries, please contact the Obstetrics and Gynecology Department at 02-561-1111 / 02-058-1111 ext. 2219-20.

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