Pregnancy and COVID-19 can seem like an uncomfortable combination, but with the right information, you can have a safe and happy pregnancy during this time.

Getting pregnant is a feeling like nothing else. For many it’s the successful outcome of years of trying, for some it may be a happy surprise. However, getting pregnant during the pandemic can bring in mixed feelings of happiness along with worry.

It’s natural to be concerned, since the pandemic is still out there and we’re still following government guidelines for the same. In the midst of this, bringing in a new life, that too a delicate and vulnerable one, can seem scary. Yet, several studies show us that there is really no need to worry. Since knowledge is power, we’ve put together a guide on everything you should know about pregnancy and COVID-19.

Pregnancy and COVID-19 – What you should know

Pregnant women are as likely to get COVID-19 as anyone else, although getting infected during pregnancy does increase certain risks. Nearly two-thirds of pregnant women have no symptoms on being infected with the coronavirus, and those who do have mild symptoms similar to the common cold. However, some women can get more seriously sick during COVID-19, especially during the third trimester. This could be because during pregnancy, the body’s management of viral infections can change. Due to this, pregnant women are considered ‘people of moderate risk’, when it comes to COVID-19.

Some pregnant women are more vulnerable to serious illness due to COVID-19. These include the following:

• Being over the age of 35
• Having a BMI of 25 or more
• Having pre-existing conditions like hypertension, diabetes, heart disease, asthma, COPD or sickle cell disease
• Being a recipient of an organ transplant
• Undergoing dialysis
• Taking immunosuppression therapies

Pregnant women who have one or more of the conditions listed above are more likely to have severe illness if they get infected with the COVID-19 virus. Severe illness can lead to hospitalization requiring intensive care or a ventilator. Studies show that pregnant COVID-19 patients are more likely to require admission to ICUs compared to non-pregnant female patients.

Complications due to COVID-19

One of the biggest complications that arise due to COVID-19 in pregnant women is the risk of premature birth. Babies born before 37 weeks are considered premature and they are vulnerable to a range of medical issues.

Another risk of COVID-19 is pre-eclampsia. This is a condition that causes high blood pressure and can damage vital organs like the liver and kidneys. Pre-eclampsia is dangerous and can have long lasting medical implications on health.

When pregnant women get COVID-19 during the third trimester, they are also more likely to need emergency caesareans, and there is an increased risk of still births.

Babies born to COVID-positive mothers are also more likely to require admission in the neonatal intensive care unit (NICU).

Pregnancy and COVID-19 Vaccine

While there was some confusion earlier, the National Technical Advisory Group on Immunization (NTAGI) has now announced that all pregnant women over the age of 18 are now eligible to receive the COVID-19 vaccine. The vaccine can prevent all the complications that may arise due to getting infected during pregnancy. It can reduce the severity of disease in case the pregnant woman gets infected, and it also avoids a risk of transmission to other members of the family.

Currently in India, we have three vaccines that are approved – Covaxin, which is an inactivated vaccine, as well as Covishield and Sputnik V, which are based on nonreplicating viral vector platform. COVID-19 vaccines do not contain any ingredients that are known to be harmful in pregnancy.

While a single dose offers a good deal of protection, it is advised to take both doses in an interval of 8-12 weeks for longer lasting protection against infection. Be sure the second dose is of the same vaccine that you took the first dose of; for instance if you started your vaccination with Covishield, the second dose should be the same.

The COVID-19 vaccine can be taken at any stage of pregnancy, although some women may wait till the first 12 weeks of pregnancy are complete. You can consult with your doctor as to what the best course for you will be. While everyone can benefit from the vaccine, it is more strongly recommended for pregnant women who have prior health conditions, live in areas of high transmission or work as frontline workers.

The COVID-19 vaccines have some mild side effects that usually last for a day or two and go away on their own. The most common side effects are pain in the spot of the injection, fatigue, headaches, body pain and a general ill feeling. In case of mild fever, it is recommended to take paracetamol, which is safe for pregnant women.

However, if the symptoms don’t subside in 4 days or there are more severe side effects like blurred vision, nausea, seizures, shortness of breath, chest pain, abdominal pain or extreme headache, a doctor should be contacted right away.

Pregnant women who test positive for COVID-19 can take the vaccine after delivery. While the vaccine is safe for most people, those who have had an allergic reaction to previous vaccines or medicines may need to seek further medical advice before taking the COVID-19 vaccine. Pregnant women who have been previously treated for COVID-19 with monoclonal antibodies or
convalescent plasma also need to consult with a doctor about taking the vaccine.

Safety Tips for Pregnancy and COVID-19

Pregnant women need to follow the same guidelines as others for keeping the infection at bay. This includes wearing a double mask, washing hands frequently and avoiding touching the face. However, pregnant women may want to take extra precautions like sanitizing all surfaces and frequently touched objects at home, like door knobs and remotes.

Keep windows open at home to ensure air circulation, especially if there is someone else in the room. Avoid entertaining visitors and stay away from crowded places. Stock up on essential supplies to avoid frequent visits outside and opt for online ordering wherever possible.

Since pregnant women are confined to their homes, their activity may be greatly reduced. It’s important for pregnant women to stay active with light exercise to avoid the risk of blood clots. A lack of exposure to sunlight can also lead to a deficiency in Vitamin D, which can increase the risk of respiratory complications in case of a COVID-19 infection. A Vitamin D supplement of at least 10 micrograms is recommended for all pregnant women, along with other antenatal supplements.

It is important for pregnant women to attend all pregnancy scans in the specified time periods. Wherever possible, doctors may club together scans and appointments so the number of hospital/clinic visits can be reduced. In some hospitals, pregnant women are required to take a COVID-19 test before their scans or appointments.

In most cases, a single bystander is permitted with the pregnant women, but not more. The accompanying person may also be required to take a RT-PCR test. The COVID-19 tests for pregnant women are the same as for everyone else and is taken through the nose or the mouth. Always wear a face mask, and if possible a face shield when visiting a hospital or doctor’s clinic.

For pregnant women who work outside the home, it’s advised to ask for work from home options. If this is not possible, discuss with the supervisor how you can minimize exposure to the virus, by perhaps choosing work hours in off peak times when it will be less crowded.

Managing COVID-19 during Pregnancy

Despite our best efforts we may still catch the coronavirus and get infected. In case you notice symptoms like fever, cough or a loss of smell or taste, you may have COVID-19. In this case, it is important to arrange for a COVID-19 test right away, and self isolate till the results arrive. Anyone in close contact for the past 48 hours also need to self isolate.

In most cases where patients have no symptoms or only mild symptoms, they are advised to stay home and rest. However, patients with more severe symptoms may need to get admitted in a hospital. Pregnant who stay at home should avoid contact with other people for 10-14 days. It is recommended for the family to stay home for 10 days to avoid spreading the infection.

If a pregnant woman tests positive for COVID-19, she may need to delay her routine scans and appointments. In case she has to meet the doctor, the hospital will have to make arrangements for it, like offering an appointment that’s before or after OP hours. In some places there may be dedicated centers to handle COVID positive pregnancies.

For the most part, babies of COVID positive mothers turn out fine, and there is no evidence yet of a woman passing the virus to her unborn baby. So far there is no evidence of the coronavirus causing miscarriages or being passed through breast milk.

Mental Health and Pregnancy during COVID-19

A study by the Brigham and Women’s Hospital in Boston found that the level of depression in pregnant and postpartum women had increased from 15% in the pre-pandemic era to 36% after the onset of COVID-19. Another international study found that anxiety and stress due to the pandemic had increased by 30-40% in pregnant women, although only 2% of them had actually been infected by the virus.

While anxiety has increased in the general public, pregnant women are more susceptible to mood swings and perinatal depression. Some signs of this are:

• Feeling sad for no particular reason
• Inability to sleep well or sleeping too much
• Loss of appetite
• Lack of interest in doing things that were previously joyful

Staying home for the most part and reduced human interactions can be a factor, as well as decreased physical activity and sunlight. It is important for pregnant women to focus on self care and emotional wellbeing, especially during the pandemic. Ensure phone calls and video chats with friends and loved ones who are aware. Engage in hobbies and get in some exercise. Studies show that at least 150 minutes of moderate physical activity a week can lower anxiety and depression in pregnant women. If nothing works or the symptoms are too severe, its best to seek professional help.

If you are considering getting pregnant, there is no need to delay it because of the pandemic. Getting vaccinated before getting pregnancy will lower the chances of COVID-19 infection and its complications. Whether you show symptoms of COVID-19 or not, watch out for any of these:

• Baby moving less than usual
• Any change in the baby’s movement pattern
• Any amount of vaginal bleeding
• Persistent headache
• Shortness of breath

If you experience any of these, rush to the hospital right away. Do not attempt home remedies. If you are unable to reach the hospital on your own, call for an ambulance.

Resources:

Centers for Disease Control and Prevention (CDC)

NHS UK

World Health Organization (WHO)

Ministry of Health and Family Welfare, Government of India

Harvard T.H. Chan School of Public Health