The cumulative number of positive Covid-19 cases in Malaysia exceeded more than 460,000 as of May 16 (2021).
There is a dearth of local information on Covid-19 in pregnancy, apart from four cases in Hospital Sungai Buloh, which were highlighted in a case report published in Universiti Teknologi Mara Faculty of Medicine’s Journal of Clinical and Health Sciences in January (2021).
The information in this article is from international sources.
Whether it applies to the Malaysian setting in toto, only time will tell.
The current evidence from the United Kingdom suggests that the likelihood of the pregnant getting Covid-19 are similar to that of other healthy adults.
About two-thirds of the pregnant with Covid-19 have no symptoms (i.e. are asymptomatic).
Most of those who have Covid-19 have mild symptoms like that of the common cold or flu-like symptoms.
However, a small number can get moderate to severe disease.
Pregnant women with Covid-19 may be at increased risk of severe disease compared to the non-pregnant, especially in the last trimester (three months) of pregnancy.
As a precaution, the pregnant has been included in the list of those at moderate risk in most countries.
Effects on pregnancy
University of Montreal, Canada, epidemiologist Assistant Professor Dr Wei Shu Qin and her colleagues conducted a review of 42 studies of Covid-19 in pregnancy published up to Jan 29 (2021).
It included 42 studies that involved 438,548 pregnant women.
Compared to those without infection, Covid-19 was associated with:
- Pre-eclampsia (Odds ratio or OR of 1.33)
- Preterm birth (OR 1.82)
- Stillbirth (OR 2.11)
- Intensive care unit (ICU) admission (OR 4.78)
- Lower birthweight (mean difference of 68.96g), and
- Neonatal ICU admission (OR 3.69).
OR is a measure of association between an exposure and an outcome.
For instance, in the data above, the odds of a pregnant woman with Covid-19 having a stillbirth are 2.11 times that of an uninfected pregnant woman.
However, Covid-19 was not associated with gestational diabetes, Caesarean section, postpartum haemorrhage or neonatal death, compared to those without infection.
When compared with mild Covid-19, the severe form of the disease was strongly associated with:
- Pre-eclampsia (OR 4.16)
- Preterm birth (OR 4.29)
- Gestational diabetes (OR 1.99),
- ICU admission (OR 15.46)
- Mechanical ventilation (OR 19.31)
- Caesarean section (OR 2.58)
- Low birth weight (OR 1.89), and
- Neonatal ICU (NICU) admission (OR 3.95).
Compared with asymptomatic Covid-19, symptomatic disease was associated with increased risk of preterm birth (OR 2.29) and Caesarean section (OR 1.57).
However, symptomatic Covid-19 was not associated with gestational diabetes.
Information about almost all pregnant women hospitalised with Covid-19 in the UK is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).
Analysis of UKOSS data from March 1 to Aug 31, 2020, involving 1,148 hospitalised pregnant women with confirmed Covid-19, revealed that 63% were symptomatic.
The estimated frequency of hospitalisation for those with symptomatic Covid-19 was 2.0 per 1,000 pregnancies, and 1.2 per 1,000 pregnancies for those without any symptoms.
Compared to the uninfected pregnant, those hospitalised with symptomatic Covid-19 were more likely to be:
- Overweight or obese;
- Black, Asian or from other minority ethnic groups in the UK, and
- Have a relevant medical co-morbidity (concurrent illness).
Compared to the pregnant without Covid-19, pregnant women hospitalised with Covid-19 symptoms were more likely to be admitted to the ICU, but the absolute risk of poor outcome was low.
Caesarean sections and NICU admission were increased regardless of symptom status.
Iatrogenic preterm births (i.e. caused by medical examination or treatment) were more common in the symptomatic.
The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status, but the numbers studied were small and might not reflect the real situation.
It is currently unclear whether pregnancy impacts on the post-acute Covid-19 syndrome, commonly termed “long Covid”, and if so, the nature of the impact.
Effect on baby
There have been no reports of Covid-19 affecting fetal development so far.
There are also no reports that infection in early pregnancy increases the likelihood of miscarriage.
Transmission of the SARS-CoV-2 virus from mother to fetus during pregnancy (known as vertical transmission) appears to be uncommon.
Whether a newborn baby gets Covid-19 does not appear to be affected by the mode of delivery, breast or bottle feeding, or whether the baby rooms in with the mother.
There have been some reports of newborn babies developing Covid-19 soon after birth.
These babies have been well in most of the reported cases.
The likelihood of preterm birth, i.e. before 37 weeks of pregnancy, is increased two to four times in instances where the mother has severe Covid-19.
In most of the cases, preterm delivery was recommended for maternal reasons.
As is the case with all preterm babies, there is increased likelihood of breathing, feeding, temperature control, gastrointestinal, metabolic and other problems.
The earlier a preterm baby is delivered, the greater the likelihood of problems.
Take home messages
It is crucial to avoid anyone who has symptoms suggestive of Covid-19.
It would be prudent for all pregnant women to adhere to the non-pharmacological interventions of:
- Physical distancing, particularly in their third trimester
- Wearing face masks
- Frequent handwashing with soap and water
- Avoidance of crowds, confined spaces and close contacts
- Proper coughing and sneezing etiquette
- Staying home, and
- Seeking medical attention when unwell.
It is important to stay healthy by being active with regular exercise, as well as consuming a balanced diet, folic acid and other prescribed medications.
The adherence to antenatal appointments, planned investigations and prescribed medications are essential in ensuring that the pregnancy progresses as planned.
In the event that there is any concern, real or otherwise, it would be prudent to consult the attending doctor.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email firstname.lastname@example.org. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.