COVID-19 in pregnancy

This opinion article was written by Dr. Peter Koll, CryoSave Medical Director and a renowned specialist Obstetrician and Gynaecologist who has been in private practice for over 27 years.

I believe that it is important to point out from the onset that there is a lot that we still do not understand about COVID-19. What we do believe and the advice that we give may change before and after the publication of this article, which is 01 September 2021.

“Initially, we thought that pregnant women are equally likely to get severe disease than the non-pregnant population. However, studies have indicated that there are some increased risks in pregnancy. It is important to understand that although certain risks are increased in pregnancy, the overall risk of severe disease is still low and the vast majority of pregnant women who contract COVID will have mild disease. Two-thirds of women who get COVID in pregnancy will have no symptoms at all, the majority of those who develop symptoms will experience mild flu-like symptoms, and only a very small number will develop severe disease. In addition, women who fall pregnant tend to be younger and healthier than the general population.

Some factors increase the risk of developing severe disease in pregnancy. These include pre-existing diabetes, high blood pressure, obesity, and being over the age of 35. People of Black, Asian and Hispanic origin have also shown an increased risk to severe disease.

Pregnant women who develop severe disease will have a greater chance of needing admission to ICU and a greater need for mechanical ventilation. There is an increased risk of developing blood clots as well as an increased risk of premature birth and fetal loss, nevertheless, the absolute number of these complications remains small. Needless to say, the vast majority of women who get infected with COVID will have mild disease.

Mother-to-baby transmission is uncommon and most infected babies have mild symptoms or no symptoms at all. The method of delivery does not seem to affect the infection rate in the baby. It is thus most likely that if the mother has COVID in her pregnancy, the baby will not be infected.

Vaccination is advised in all women contemplating pregnancy, as there is no current evidence linking the vaccine to infertility. If you are pregnant, vaccination is strongly recommended. There is no evidence that the vaccine could harm your baby but as a precaution in South Africa, it is suggested that you vaccinate after 12 weeks. If you get the vaccine in early pregnancy, before you know you are pregnant, there is no evidence to suggest that the baby will be harmed. The choice lies with you as parents, whether you vaccinate before you know you are pregnant, after the first trimester, or even soon after birth, there is no indication that it could harm your baby.

There is however a small increased risk of severe disease in pregnancy, especially if the known high-risk co-morbidities like diabetes, obesity, and high blood pressure are present as well. Be extra careful about wearing a mask, social distancing, washing hands, and disinfecting, as well as avoiding crowds and gatherings.

The South African Society of Obstetricians and Gynaecologists (SASOG) has a website with very useful and regularly updated information on COVID in pregnancy. Search for SASOG, and the section on COVID in pregnancy will be easy to find.

The Royal College of Obstetricians and Gynaecologists (RCOG) also has a patient information section on their website covering a large number of topics. The section on COVID also contains links to other useful sites. Search RCOG and look for “COVID in pregnancy”.”

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