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What is the risk to pregnant women and their fetuses from COVID-19? Does the virus pass through the placenta or through breastfeeding? The first studies on the subject are quite small, but mostly encouraging







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In the nine months from fertilization to birth, all the organs and body systems of the fetus are formed. Thus, viruses and other contaminants that infect the mother during pregnancy can often impair fetal development and cause malformations. In addition, there are viruses that can cause premature birth, which involves many risks for the newborn.

However, not every virus or infectious disease endangers the fetus or the course of pregnancy. There are certain contaminants that we know may endanger the mother or the fetus, so it is common to check if pregnant women have been infected. Well-known examples of such contaminants are the CMV virus and the parasite Toxoplasma, which is transmitted, among other things, to cat feces. When an unfamiliar virus appears, such as the new corona virus SARS-CoV-2, which causes COVID-19 disease, the degree of risk for pregnant women is one of the first things to check about.

Danger to the mother?

The fetus is a kind of foreign body in the womb of the pregnant woman. So that the mother’s immune system does not attack him, she undergoes changes that weaken her responses to “invaders”. As a result, pregnant women are more vulnerable than others to the onset of infections that would not normally endanger them. With the arrival of the corona plague in our lives, therefore, questions arose about contracting the virus during pregnancy – for example, whether special protection is needed, and whether routine follow-up of pregnancy should still be continued, despite the risk of infection.

Since it is a new virus, little is known about its effect on pregnant women. There are no signs that pregnant women are more likely to be infected with the corona virus than others, but a pregnant woman infected with SARS-CoV-2 is at increased risk of being hospitalized and needing respiratory assistance. The chances of recovery of pregnant women are the same as those of other women.

In addition, the Center for Disease Control and Prevention in the United States (CDC) has established That there is no evidence of an increased risk of fetal malformations Or abortion in pregnant women infected with the corona virus. In contrast, the American Association of Gynecology and Obstetrics suggests, based on information about other corona viruses such as SARS and MERS, that there may be an increased risk of certain complications, Like preterm birth, in infected pregnant women. However, this information is very limited, and it is possible that in the few cases that the infection was documented, it was not the cause of the premature birth.

The virus and the fetus

Several studies have attempted to examine the risk of an infected pregnant woman transmitting the virus to the fetus or newborn baby. However, these are small studies that have examined very few patients and therefore do not allow the question to be answered unequivocally.

A study conducted at the site of the original outbreak of the plague in the Chinese city of Wuhan, published in The Lancet, followed nine pregnant women who contracted the virus and contracted COVID-19. None of the babies born to them were found to be infected with the virus. No signs of the virus were found in their amniotic fluid or breast milk.

Another study At the University of Augusta in Georgia, USA, he reviewed publications in the medical literature on 38 pregnant women infected with the corona virus and also found that none of the newborns became infected. Further research Mohan brought up a less optimistic picture: three of the babies of 33 pregnant women infected with the virus also contracted it and even showed symptoms of illness. It is not clear whether the newborns became infected in the womb or after birth, as the tests were done a few days after birth. However, the possibility of transmitting the virus from mother to fetus during pregnancy was not ruled out.

New research Recently published by a team of researchers from France first presented a case where the fetus contracted the SARS-CoV-2 virus from its mother through the placenta during pregnancy. The mother became infected with the virus during the last trimester of her pregnancy and developed a serious illness, which included nerve damage and a relatively rare condition of viremia – the presence of viruses in the bloodstream. The newborn also suffered from virulence and neurological symptoms similar to those that sometimes occur in older corona patients. Very many corona viruses were found in the woman’s placenta.

Pregnancy
In some countries it has been decided to interrupt the follow-up meetings or replace them with video or telephone calls. | Photo: Syda Productions | shutterstock

Tests and follow-ups

Another question concerns the need for follow-up and tests during pregnancy, as they require going to the clinic and thus risking infection from other people. Pregnancy follow-up is important for ensuring the health of the mother and fetus, and in Israel so far no tests and follow-ups have been waived. In other countries it has been decided to interrupt the follow-up appointments or replace them with video or telephone calls.

Many women are afraid to stay in the hospital after giving birth, for fear of contracting the coronavirus. First, it is important to remember that the hospitals in the country work to isolate corona patients in separate wards, away from the rest of the patients. In some maternity wards in Israel, mothers are allowed to shorten their length of stay, provided that the medical condition of the mother and baby is good and the birth went without complications. Restrictions were also placed on the number of attendants allowed during childbirth and tests during pregnancy, and on the number of visitors allowed after delivery, in order to minimize the possible exposure of mothers and newborns to the corona virus.

Pregnant women suffering from previous background illnesses are of course still there At increased risk For a serious illness. These include women who suffer from respiratory diseases such as asthma, who undergo medical treatments that suppress the immune system, who have high blood pressure, diabetes and more. It is important in such cases to take the recommended precautions for the at-risk population, and strive to reduce the risk factors that can be controlled, such as balancing diabetes, stopping smoking and so on. It is not yet clear what the risk of infection, serious illness and death from COVID-19 is in women who are at risk of pregnancy due to gestational diabetes, preeclampsia and other causes.

nursing
It is recommended for the mother to wear a mask while breastfeeding and to wash her hands thoroughly beforehand | צילום:
Pixel-Shot, shutterstock

Another important issue is breastfeeding. Collected findings currently show that even if the mother is ill with COVID-19, the virus does not pass to the baby in breast milk. However, breastfed infants may also be infected because of the physical proximity to their mother. To protect the baby as much as possible, it is recommended that the mother wear a mask while breastfeeding and wash her hands thoroughly beforehand. Another option is to pump breast milk for the baby and let another person feed it from a bottle. It is important to wash your hands before pumping and before touching the bottle or pump.



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