No reason to delay pregnancy in Covid times

As the Covid-19 pandemic continues haunt us and there is no way of knowing for sure when it is going to leave us forever, there are fears among young married women about the impact of the virus on pregnancy. There is no particular reason to delay conception. As long as women follow all the precautions and get vaccinated, they can plan pregnancy. However it is a personal decision and needs to be individualized based on age, medical history and other factors. It is better to consult a gynaecologist before taking a decision.

The overall risk of COVID-19 infection among pregnant women is the same as non-pregnant population. However, pregnancy alters the way the body handles and responds to infections making them more susceptible to respiratory complications requiring intensive care than non pregnant women. Clinically, we have seen this risk to be higher in pregnancy beyond 28 weeks.

Pregnant women should take certain precautions to stay safe from the infection. They should visit hospital only if absolutely necessary. Double masking and use of face shield is a must. Regular exercises and keeping themselves well hydrated are other important things to remember by pregnant women. And finally, they should report immediately to their gynecologist if they develop any symptoms such as cough, cold, fever, loss of smell or taste, diarrhea, breathlessness.

The pandemic has brought about a huge change in the routine of pregnant women. For instance, hospital visits for routine checkups have been reduced; video consultations are being encouraged particularly during early stages of pregnancy; and direct consultation only when absolutely required and advised by gynecologist. Attending virtual antenatal classes is also highly recommended.

If pregnant women develop Covid symptoms like high fever, continuous cough, cold, sore throat, loss of sense of smell or taste, breathlessness, diarrhea, they should immediately consult a gynecologist through video consultation. Based on symptoms, further testing and medical advice will be given. In case of mild symptoms and in the absence of risk factors, they will be advised home isolation with monitoring of oxygen saturation thrice daily. It is important not to self diagnose or take any of the symptoms lightly

Pregnant women are at increased risk of becoming severely unwell particularly in the second half of the pregnancy. Severe infection is known to cause miscarriage in early pregnancy. We have seen increase in the risk of preterm birth, growth restriction, sudden intrauterine demise and increased bleeding following delivery in severe cases. Covid-19 infection is unlikely to affect the development of the baby. Vertical transmission from infection mother to baby through placenta is possible although no untoward effects have been noted in the babies that have tested positive following delivery.

The Government of India and Ministry of Health and Family Welfare have approved and licensed Covid vaccination in lactating mothers. Both the vaccines are approved. We recommend that all postpartum and breastfeeding mothers get vaccinated at the earliest available slot.

The Federation of Obstetricians and Gynaecologists of India recommends vaccination in pregnant women as the benefits seem to far outweigh any theoretical and remote risk of vaccination. Pregnant women can therefore take an informed decision while awaiting approval from the authorities concerned.

Testing positive for Covid-19 infection does not change the mode of delivery. Cesarean section is only indicated for obstetric indications as in non-Covid patients. Although in cases of severe Covid infection requiring intensive care, emergency Cesarean delivery may be needed in order to save the newborn from hypoxia.

There have been changes in the admission/ delivery protocols during this pandemic. Covid testing is mandatory for the patient and her partner prior to admission or delivery. Visitors are strictly not allowed. Only one attendant is allowed and they are also required to undergo Covid test. Wearing a mask is a must throughout the hospital stay. In case of normal vaginal delivery, patient's birthing partner is allowed to accompany the patient in the labour delivery room provided he has tested negative for Covid.

Breastfeeding of newborn babies by woman who tests Covid positive is not prohibited. There is no risk of transmission of Covid infection through breast milk and the benefits far outweigh the risk of transmission. In case of mild infection, the mother can directly breastfeed the baby after wearing a double mask. When this is not possible, the mother can pump the milk which can be fed to the baby.

(The author is a Lead Consultant, Obstetrics & Gynecology, Aster RV Hospital)