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There are a lot of questions regarding whether pregnant women or a breastfeeding or nursing mother are at higher risk for the coronavirus infection or not.

coronavirus, coronavirus pandemic. coronavirus outbreak, breastfeeding, coronavirus infection

Coronavirus!! What Pregnant And Breastfeeding Mums Need To Know

  •  I would like to say there is not much information available on how the new coronavirus affects pregnancies.
  • At present there is also no evidence that they are at higher risk of severe illness than the general population,
  • However, due to physiological changes in their bodies and in their immune system, you know that pregnant women can be affected by some other similar respiratory infections too.
  •  I think logically it may appear that the pregnant women would be  at higher risk of complications from the coronavirus than a non-pregnant ones but it not proven at present.
  •  Pregnant women who have other health status like gestational diabetes mellitus, hypertension, obesity or respiratory problems, they need to be extra vigilant.
  • So, it is therefore important for them to take strict precautions to protect themselves against coronavirus.
  • And report immediately when they have possible symptoms like fever, cough, difficulty in breathing or any other to their obstetricians.
  •  Research is still going on and WHO will guide us and update us about the information.

Another important thing is strict precautions means what they should do. 

  • So, basically, same precautions should be taken when she is not pregnant, like a non-pregnancy state.
  • They can protect themselves by washing their hands frequently and  properly with soap and water or an alcohol-based hand rub for minimum 20 seconds by keeping space of minimum 1 meter while communicating with others.
  • At home they should keep a distance of 1 meter, avoid touching their eyes, nose and mouth.
  •  They should practice respiratory hygiene, means they should cover their mouth and nose with their bent elbow, handkerchief, or tissues while coughing or sneezing and then used tissues should be disposed of properly and immediately
  • If they have a fever, cough or difficulty in breathing, they should immediately seek medical care and must call a health facility before going so that they will follow  the directions given by the local health authority to whom they are approaching.
  • They should also take good nutritious food to build up their immunity
  • and pregnant women affected by COVID-19 and who have recently delivered should attend their  routine care as per the schedule as per the advice,as per the appointment given by the obstetrician Another

Important thing, question or worry is that can it affect the fetus.

  • primary research suggests that it is not likely to be transmitted  from a mother to her baby through the womb.
  • As per the two reports, including 18 cases published in China, there was no transmission of the coronavirus in the mother’s amniotic fluid, cord blood or breast milk in all newborns who were delivered by cesarean sections, tested negative for the coronavirus
  • However, two cases of neonatal infections have been documented in one case.
  • In one case, the diagnosis was made at day 17 of the life after close contact with the infant’s mother and a maternity matron,  both were infected in that case with the virus and in the other case it was diagnosed 36 hours after birth.
  • It is not clear , it was transmitted across the placenta or it was through the mother or it was or if the infant got the virus shortly after the birth from the mother.
  • There is no convincing evidence that coronavirus infection can affect fetal growth in utero,
  •  But other similar viruses have been in the past shown to cause fetal growth restrictions and therefore an extra sonography scan 14 days later is advisable as a precaution in pregnant women having confirmed Coronavirus infection.

One more query or cause of worry is whether COVID positive pregnant women wil l always be undergoing caesarean section.   

  • So, answer is no because WHO have not confirmed it and there is no other guideline advice.
  • Caesarean section should only be performed if required and it should be performed only when it is medically required.
  • So the obstetrician will decide whether in that particular case caesarean section is required or not.
  • There is currently no evidence to consider a caesarean birth to be safer than a vaginal birth   ,
  •  However, if the respiratory condition, we know that in this virus, there can be  a respiratory problem and if the respiratory condition like breathing or any other condition or any other problems suggest that urgent delivery is needed, a caesarean birth maybe considered by an obstetrician and maybe recommended.
  • So as per the WHO at present more deliveries should be individualized and based on obstetric indication medical reasons and a woman’s preference after proper counseling

 last important question this would address is again the query regarding breastfeeding. 

  • The new coronavirus is also not found in the breast milk of mother to confirm the COVID-19 or under investigations when the patient is under investigation.
  • As breast milk  is the base source of nutrition and immunity, for the infant, so it is always encouraged by the WHO but there are different guidelines, different recommendations by some other colleges that they should be separated but otherwise most of the recommendations are in favor and they are encouraging breastfeeding.
  • Women with coronavirus can breastfeed if they wish to do so.
  • Mother should practice only thing is here also they should take some extra precautions.
  • We can say strict precautions to save the baby from the transmission of the coronavirus infection
  • Mother should practice respiratory hygiene by wearing a mask and not sneezing in front of a baby during feeding.
  • Pregnant women should wash her hands before and after touching the baby.
  • All surfaces should be kept clean and disinfected they have touched.
  • A mother with confirmed COVID-19 infection or who is symptomatic with this could keep expressing breast milk with manual or electric breast pump.
  • The mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper cleaning after each use.
  • If she is too unwell to breastfeed her baby due to coronavirus infection or other complications, she can be supported to safely provide her baby with breast milk by expressing the milk or any other way So,
  • breastfeeding is not that much most of the recommendations are in favor of the breastfeeding but if the doctor or neonatologist thinks it is better to separate them as per the advice or as per the situation they can decide.
  •  But otherwise, the guidelines or most of the recommendations with the proper precautions.
  • If patient is to take the proper precautions to prevent the transmission, they can give breastfeeding.

So, at the end I would like to say we should not panic. And we should know that it is preventable by self-discipline.

  •  By following strict and preventable precautions and when they follow the precautions have the symptoms they should immediately report to the obstetrician.
  •  If by chance they are in labor or caesarean section or any operation decided for, is decided for the patient or the fetus then during labor and during operation, theatre personal protective equipment and separate dedicated labor room and operation theatre are required to prevent the transmission to healthcare providers and the baby.
  • So care should be exerted and mother should exert the proper care and healthcare providers should guide them for breastfeeding.
  • They should take proper care to prevent the coronavirus transmission to the baby.

Conclusion

I think if we follow this then there is no other report to threaten a pregnant women. 
They should not be so much afraid, of course proper precaution, proper preventive measures, immediate reporting to the doctor and immediate care is required. They require a   quality care and sometimes they also require a critical care also.

  • This is just a suggestion and a very small trial and
  •  it is not any guideline and there is no recommendation of WHO or RCOG or even government of India .
  • So it is difficult to say at present but of course when the patient is having malaria and if she requires chloroquine then with proper counseling, deep chat and care with certain medications.
  • We have to look at the balance of the interest of both mother and fetus
  •  Sometimes we have to give some medicines
  • But if it is genuinely required or otherwise in such cases it is just by suspecting or just by thinking for the prevention, it should not be recommended at present.

But after all at present the situation is more important and the doctor will decide whether it should be given or not in that particular case. If she is critical, if she has any serious complications then doctor may think on it but just for prevention at present.  Tomorrow there can be more studies We may have some data and then we can talk on it….



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