Coronavirus, otherwise called COVID 19, is sweeping across the world with a vengeance unparalleled in scale in our modern times. To describe the situation as an anxious and worrying time, is an epic understatement.
We don’t understand the virus and how it behaves, and in contrast to the flu virus, we can’t predict the numbers that will be affected, added to which, there is no cure. So, we have no choice, but to wait it out, and use the only protection we can, social distancing.
This is particularly so for those who have been identified as the at most vulnerable groups, and if you’re pregnant, you fall within this group.
Now, unlike the over 70s and those with long-standing health conditions, your chances of developing complications from Coronavirus are thought to be much less. But, any pregnant woman has what we refer to as an immunocompromised system, meaning that she isn’t able to mount the normal immune response you would expect to if you weren’t pregnant. This is an issue when it comes to viruses, because it means that a pregnant woman is not only more susceptible to getting one, but that if she does, there could be consequences to her health and the health of her baby.
So far, out of the limited number of case studies in China where women who have been pregnant got Coronavirus, the results have overall been reassuring. Most women were fine, as were their babies. A small number did go into preterm labour, but it isn’t clear whether this was as a result of the virus and infection, or whether preterm delivery was necessary for another reason.
Here in the UK, one mother required the use additional support as a result of developing complications, and a newborn tested positive for Coronavirus 36 hours after being born. However, it’s thought that the baby probably got this from the point of birth, or potentially during vaginal delivery when the baby is exposed to the mother’s microflora. The baby is doing well and seems to have suffered no consequences. Reassuringly, the results so far are good. But, we must remember we are dealing with small numbers here, and only with women in the third trimester, as the virus has not been around long enough for us to be able to tell the effect on the first and second trimester.
A similar Coronavirus that caused SARS had a much higher fatality rate for pregnant people (about 25%, according to the limited data available from the 2003 outbreak) than for the general population (about 10%).
Here’s what we know so far: the risk of vertical transmission from mother to baby seems unlikely, given that testing of the placenta in studies has not shown any to be affected by Coronavirus, and this is also the case for amniotic fluid which surrounds the baby whilst in the womb. In addition, breastmilk has also tested negative for Coronavirus, which means that mothers who want to, can continue to breastfeed and allow the additional benefit of antibody transmission in their breastmilk to their baby, to help boost immunity.
But there is a lot that we don’t know. Historically, some flu viruses and SARS have been capable of causing miscarriages and also growth restriction of the baby in the womb. This is why the RCOG now recommends if you are diagnosed with Coronavirus in pregnancy, you will have a follow-up scan of your baby 14 days later, to check for the latter. Also, having a high fever in early pregnancy may lead to potential birth defects or preterm labour, and we are at the moment, in the process of gathering evidence for this with the Coronavirus.
In truth, there are far more questions we can’t answer than we can, and that is why the government has recommended that all pregnant women spend 12 weeks socially distancing. And as we are all now forced to socially distance, pregnant women in effect should self isolate until we have more information available. Because we remain uncertain about the effect of virus in early pregnancy, the BFS has strongly recommended that all new fertility treatments stop at this time, and anyone with an underlying health condition should go so far as to avoid pregnancy even when under natural circumstances. It remains to be seen whether this should also apply to fit and healthy people, as the many unknowns are certainly going to lead to a lot of anxiety for anyone who is pregnant.
There is a lot about this virus that we can’t control and have no way of predicting, at the moment. But what we do have at our disposal is the ability to reduce our chances of getting it. There are several main ways to do this. Some involve personal hygiene and others creating a deliberate distance between yourself and anyone else who may potentially have the virus.
So, here is important advice to folLow:
- Wash your hands regularly and before and after doing anything. If you are breastfeeding, make sure you clean your hands before and after handling your baby.
- If you are coughing or sneezing, make sure you use a tissue and get rid of it immediately. If breastfeeding, consider wearing a mask to reduce the risk of respiratory spread to your baby.
- Clean all hard surfaces you come into contact with throughly with disinfectant. If you are using feeding equipment for tour baby, make sure this is cleaned properly after every use.
- Avoid touching your face where possible.
- Spend the majority of your time at home away from anyone who may be a carrier of the virus. Ideally, you should not be leaving the house at all, unless you need to get necessary food shopping done, but ideally this needs to be done online or via someone else who can go out for you.
- Make sure you keep your antenatal appointments and scans but be aware that your appointments may be virtual where possible and over a telephone, in order to reduce the need for you to come to hospital and catch coronavirus from anyone else whilst you travel.
- Avoid public transport and if you need to travel to hospital for anything that is urgent, do so via your own transport or if necessary, an ambulance.
- If you develop any symptoms of Coronavirus, such as a fever or persistent cough, make sure you inform your midwife or maternity unit, so they are aware.
- If a member of your household becomes ill with symptoms of Coronavirus, you will need to isolate from them and use a different room, different meal times, cooking utensils, toiletries, etc.
- When labour starts and you come to hospital, you will only be allowed a single birth partner who should not have any symptoms of Coronavirus. It’s a good idea to consider an alternative birth partner should your original one become ill.
- Water births are discouraged because faeces may potentially contain the virus and it’s generally not considered safe.
- If you have symptoms of Coronavirus or have been diagnosed with it, and you go into labour, special precautions will be taken in hospital to isolate you and monitor your baby. There is currently no evidence to suggest you cannot have a vaginal birth if this is what you wish to have. The same goes for an epidural.
During the enforced lockdown, it’s important to keep yourself and your unborn baby healthy. Some tips for doing this are all part of The Conception Plan that lead to better outcomes for both mum and baby, and include:
Eating well: This means eliminating foods that have been influenced by hormones, pesticides, added preservatives, and chemicals and foods that are rich in sugar. Eat food in its cleanest most wholesome state possible, buying organic where you can and opting for a plant-based diet but if you’re going to eat meat, make sure it’s organic and lean where you can.
Exercising to help boost circulation to your reproductive organs and your immune system, and also to help you maintain a healthy body and mind. Exercise helps to reduce stress and keep weight within the normal range. You can leave the house once during the day to get outside in nature or try the many home workouts being offered. Just make sure they are approved for pregnant women and by an expert in this field.
Stopping smoking as this can adversely affect the health of your child and your pregnancy. You also need to minimise alcohol as it can affect your hormones and also the development of your baby. Studies show that those who consume too much alcohol tend to have weaker immune systems and are more at risk of infections.
Making sure you are getting at least 7 to 8 hours of sleep. Studies reveal that getting less than 6 hours a night can make you 4 times likelier to get an infection.
When using disinfectants around the house, trying to go for toxin-free versions that are equally effective, to reduce any toxic load to you and your baby.
If you are in the first trimester, make sure you are on folic acid and when pregnant, consider taking additional supplements such as Vitamin C and Vitamin D, both of these being shown to be important for immunity in some studies.
Managing your stress and keeping caffeine (which is a stress activator) to a minimum. Stress can lead to a hormone imbalance, reduce immunity and affect the organs in your body, leading to high blood pressure, problems with sleep and reduced sex drive. Try meditation, reading, doing a creative hobby at home and though you may not be able to see people outside of the house, make use of support forums and Facetime to connect.
Considering lockdown as an effective nesting season. For example, make having a mug of tea an occasion to look forward to, with your feet up in front of a good TV show, or tucked up in bed before you go to sleep. Herbal teas are rich in polyphenols that your gut bacteria love and matcha tea has an amino acid called L-theanine that can help to reduce stress and anxiety.
I hope all these tips help and just remember that though this will be an anxious time for many who are pregnant, we are collecting new evidence all the time and updating guidance leading to even better public health advice. Stay up to date with this, and I will be sharing much more in due course over on my social channels too as and when it’s released. In the meantime, offence is the best defence, so stay at home, stay safe and consider this as a time to invest in your own wellbeing and the health of your developing baby by adopting good habits and healthy routines.
Dr Larisa Corda is a leading fertility expert, gynaecologist and female health Dr. Stay up to date with her journey on instagram @drlarisacorda and her website www.drlarisacorda.com