At the start of the pandemic, pregnant women appeared relatively safe and most would pass COVID-19 asymptomatically. The reality turned out to be completely different. – Pregnant women are many times more likely to suffer from a severe course of COVID-19 and these are certain data – warns obstetrician, dr Jacek Tulimowski, gynecologist. Why is it like that? How do pregnant women get coronavirus? What are the consequences for them and for children? The specialist translated in an interview with Medonet.
- Pregnant women are more likely to be at risk of severe COVID-19
- The asymptomatic course of COVID-19 in pregnancy affects 79-80 percent. pregnant. However, 15 percent. infected has a severe course, in 5 percent. the use of a ventilator and ECMO is necessary
- Most often, severe COVID-19 occurs in the third trimester of pregnancy
- Complications of COVID-19 in pregnancy include increased risk of miscarriage and the birth of a child with IUGR. There are more consequences – you can read about them in our interview
- More information about the coronavirus on the Onet homepage.
For many years he was associated with the Clinic of Tumors of the Female Genital Organs of the Oncology Center in Warsaw. Currently, the place of work are private clinics “Tulimowski & Sterlińska”. In addition to professional work, he has been promoting medical knowledge in the media for many years: he is the editor-in-chief of the “Nowy Gynecological Gynecological” bimonthly, the creator of the “Dr Tulimowski Press Workshops” – training courses for journalists dealing with health issues, a consultant and expert of the Association “Journalists for Health” , television and radio programs about health. In 2020, honored with the title of Media Friend.
Monika Mikołajska / Medonet: At the beginning of the COVID-19 pandemic, it seemed that pregnant women were relatively safe. Most of them were believed to have COVID-19 asymptomatically. Unfortunately, the reality did not confirm this.
Dr. Jacek Tulimowski, gynecologist-obstetrician, editor-in-chief of the “New Gynecological Cabinet”: In fact, it was previously believed that pregnant women contracted COVID-19 as asymptomatic. This was due to preliminary analyzes carried out last March in Wuhan, China. Preliminary data suggested that pregnant women did not appear to be more vulnerable to the effects of coronavirus infection than the general population.
Unfortunately, these were early observations of nine pregnant women infected with SARS-CoV-2, delivered by caesarean section. Today we know that the reality is completely different. Pregnant women are many times more likely to be at risk of severe COVID-19, and for now these are some data.
Let’s compare the situation of a generally healthy 30-year-old woman and her pregnant peer. If both women become infected with the SARS-CoV-2 virus, clinical data show that the course of the infection and possible complications in a pregnant woman will be more dramatic than in a woman who is not pregnant.
What causes the severe course of COVID-19 in women expecting a baby?
Let’s start from the beginning. Pregnancy causes changes in the cardiovascular system in every woman. Heart rate is faster, the volume of circulating blood is greater, oxygen consumption increases. Changes also take place in the respiratory system of the pregnant woman. Total respiratory capacity decreases – the growing fetus makes the lungs somehow raised (high position of the diaphragm), the so-called hypoxia, i.e. physiological hypoxia (a state in which oxygen is not properly distributed to the cells of the body – ed.). There are difficulties in coughing up bronchial secretions.
Pregnancy also changes the immune system – the susceptibility to infections increases, and the course of infections is more severe. It is related to the so-called Immune adaptation – this physiological mechanism prevents the mother from rejecting the embryo.
And what exactly is COVID-19 like in a pregnant woman? When is she most at risk of being severely ill?
The available data show that the asymptomatic course of COVID-19 in pregnancy affects 79-80 percent. pregnant. Importantly, however, 15 percent. infected women is severe and requires oxygen therapy, in the remaining 5% the use of a ventilator and ECMO is necessary. In other words – 5 percent of pregnant women with COVID-19 may die due to the severity of the disease and complications. There is a known case of a pregnant woman in her thirties who, due to complications related to COVID-19, was connected to the ECMO. After giving birth, the woman died. It happened in Poland.
Most often, severe COVID-19 occurs in the third trimester of pregnancy. If complications are suspected during the infection, appropriate diagnostics and therapy are initiated. I would like to reassure you that lung computed tomography in a pregnant woman with COVID-19 does not harm the fetus.
What symptoms appear in a pregnant woman infected with SARS-CoV-2?
The most common ones are: fever above 38 degrees C, cough, shortness of breath, muscle aches, body aches, malaise, sore throat. Diarrhea and abdominal pain may appear. Importantly, a pregnant woman may experience congestion and swelling of the nasopharyngeal mucosa (it happens in the second and, above all, in the third trimester). This is called gestational rhinitis – can mask the symptoms of coronavirus infection. A runny nose that occurs then makes the woman unable to breathe through her nose – this may be a symptom of a physiological pregnancy, but very often it is also a symptom of early COVID-19.
SARS-CoV-2 infections also disturb laboratory tests. For example, these are too low levels of leukocytes in the blood serum (so-called leukopenia), too few lymphocytes, elevated liver enzyme tests or a reduced number of platelets.
You said the doctor that 5 percent. pregnant women with COVID-19 may be at risk of death. What factors increase this risk of death? We know that in the general population these include comorbidities.
Yes, this also applies to pregnant women. Every pregnant woman with comorbidities increases the risk of developing the disease, and thus the risk of severe COVID-19 is many times greater. The comorbidities include: diabetes, arterial hypertension, cardiovascular diseases, COPD, asthma, and allergies. The unfavorable course of coronavirus infection is also influenced by the age of the pregnant woman – over 35 years of age. Overweight and obesity are also a causative factor.
- COVID-19 or allergy? These diseases can be confused, but there are also differences. The doctor explains
What might the consequences of COVID-19 be for a pregnant woman? Simply put, what can the disease do to her and her baby?
In this matter, there are so-called certainty and question marks, complications for which we only suspect that they may arise. One of them is whether SARS-CoV-2 in pregnancy may pose a risk of developing malformations in the fetus. Research on this is ongoing.
A confirmed complication of COVID-19 in pregnancy is an increased risk of miscarriage, up to 2-4%. For women who lost a child, 2-4 percent. it’s a lot.
Let’s move on. In COVID-19, the risk of preterm labor increases to as much as 39%. About 10 percent the risk of having a baby with IUGR (low birth weight) syndrome increases. If a high fever appears at the beginning of the first trimester of pregnancy, and we know that it reaches 19-38 degrees C with COVID-40, the risk of developing malformations in the fetus increases. Moreover, according to recent studies, maintaining a high temperature of 38 – 39 degrees C accompanying SARS-CoV-2 infection after childbirth may result in the development of concentration disorders in children. The reason is hyperthermic damage to the midbrain neurons.
At the start of the pandemic, it was found that pregnant women do not pass the coronavirus infection to their baby. As before, this was due to preliminary analyzes from Wuhan. Today we know that this is not true. New research confirms that the virus is transmitted from a sick mother to her child. Moreover, we know that transplacental transmission of the virus is possible. The risk of pneumonia in the developing fetus also increases. Unfortunately, some newborns do not survive the coronavirus infection.
Figuratively speaking, complications related to COVID-19 act on a woman’s body like an atomic bomb. What I said should shake the arguments out of the hands of those who still claim covid doesn’t kill.
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- The female reproductive age has increased by two years. This could have health implications
- Well-being before childbirth – harbingers of the upcoming delivery
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