How the second wave changed our understanding of COVID-19 in pregnant women

The impact of COVID-19 on pregnant women is worse because of the significant changes to physiology that come with pregnancy, says Dr. Wahida Suresh of BirthRight by Rainbow Hospital in Chennai.
How the second wave changed our understanding of COVID-19 in pregnant women
How the second wave changed our understanding of COVID-19 in pregnant women
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Heading into the COVID-19 second wave in early 2021, OB-GYN doctors across India, including Dr Wahida Suresh of BirthRight by Rainbow Hospital, were confident that pregnant women will not suffer too much if they were to be infected with the virus. After all, the first wave had been comparatively kinder to pregnant women. Even if infected, both hospitalisations due to severity and mortality were low among pregnant women during the first wave. “We had to take many more precautions to deliver the child, but the impact of the virus on the women and the child was manageable,” she recounts. 

But the second wave changed everything.   

“Our understanding of COVID-19 and pregnancy completely changed with the second wave,” explains Dr Wahida, who is the Lead Consultant – Obstetrics and Gynaecology at BirthRight by Rainbow Hospital in Chennai. “In the first wave, there was some thinking that the hormones related to pregnancy may offer some protection from COVID-19. However, in the second wave, there were several cases of women becoming critical and needing intensive care, and in some cases the infection becoming lethal,” she explains.

Amid predictions of an imminent third wave of the COVID-19 pandemic, pregnant women and their families are a worried lot. The second wave, driven by the more virulent Delta variant, included significant numbers of women contracting the illness and experiencing severe complications during pregnancy or soon after delivery. As a result, there is growing concern for how pregnant women’s health can be safeguarded when numbers spike up again.

Doctors advise that there is good reason to be cautious, as studies show that pregnancy is associated with increased risk of severe illness with COVID-19. However, exercising caution should not translate into panic and falling prey to myths and misconceptions about the virus’s impact on pregnant women, says Dr Wahida.

COVID-19 risks for pregnant women

The overall risk of COVID-19 for pregnant women is low. However, in a minority of cases, the infection can result in complications.

The risks of COVID-19 for pregnant women are increased because of the significant changes to physiology that come with pregnancy. “The heart, the lungs, the entire physiology goes through change. For example, the blood volume expands and the heart has to pump 6.5 litres of blood instead of the normal 4.5 litres for non-pregnant women,” explains Dr Wahida.

One of the most significant changes that comes as the pregnancy progresses into the third trimester is reduced lung capacity. “As the baby grows, the diaphragm is pushed upwards, thus reducing the lung volume. As COVID-19 affects the lungs, this increases the risks of respiratory problems,” explains Dr Wahida.

Complications can also arise when patients have pregnancy-related complications such as gestational diabetes, hypertension and so on.

Precautions, not panic

As with the general population, says Dr Wahida, it is important for pregnant women to be careful about precaution measures such as mask use, physical distancing and sanitisation. It is also vital for them to focus on maintaining their immunity, she adds.

While there are risks associated with pregnancy, says Dr Wahida, it is important for pregnant women who test positive to take a measured approach to their illness.

Rainbow Children’s Hospital in Chennai. 

“If patients test positive, it does not mean that they must immediately rush to the hospital. They should keep their gynaecologist informed and monitor factors such as oxygen saturation. If there is deterioration of symptoms, such as unrelenting or spiking fever, breathlessness or low oxygen saturation, then they should go into the hospital for their condition to be closely monitored, she explains.

Otherwise, pregnant women should focus on maintaining their physical and mental health. “We continue to tell patients to eat well and maintain their health. If they test positive, they should isolate but continue to follow recommended exercise patterns, do breathing exercises such as pranayama, and keep themselves mentally alert and happy,” says Dr Wahida.  

Dr. Wahida Suresh

No need to fear breastfeeding

One of the major myths that has emerged regarding COVID-19 and pregnancy is that women who have contracted the virus should not breastfeed their children. However, there is no evidence of virus transmission through breastfeeding. On the other hand, breastfeeding plays a very important role in maintaining the baby’s immunity in the first six months. Hence, it is vital that breastfeeding should continue with precautions, says Dr Wahida.

“If the mother wears a mask and sanitises her hands before each feeding, she can continue to breastfeed. If she is very worried, she can also reduce direct contact by pumping breastmilk for the child to be fed,” she says.

Vaccines are vital

While there was a long debate before the government allowed vaccination for pregnant women in July this year, Dr Wahida says that BirthRight by Rainbow Hospital has been pro-vaccination for pregnant women much before this.

“Vaccines are completely safe for pregnant women. Even if they develop some mild side-effects such as fever, it is perfectly safe for them to take anti-fever medications to manage these temporary side-effects,” she explains.

One of the major benefits of vaccination during or after pregnancy is also that the antibodies produced get passed onto the child, providing the child early immunity from infection.

The prospect of contracting COVID-19 during pregnancy can seem daunting and frightening. However, with proper management under the guidance of doctors, many risks and complications can be caught early and treated. Exercising due caution with regard to patterns such as mask use, physical distancing, and hand hygiene can help reduce the possibility of infection and timely medical care can ensure that women who do contract the virus, as well as their infants, are not affected severely.

This article was created by TNM Brand Studio in association with BirthRight by Rainbow Hospital.

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