Pregnancy and Covid-19: what is known so far?

Pregnancy is a delicate period, in which there is a state of partial suppression of the immune system, making pregnant women more vulnerable to viral infections. It is suggested that infection with Covid-19, in addition to substantial mortality in populations at risk, may have considerable consequences for pregnant women. World Health Organization guidelines and the Center for Disease Control and Prevention (CDC) for the management of Covid-19 include recommendations for the entire population based on previous epidemics (SARS and MERS) which include: washing your hands frequently, use of alcohol gel, keep a distance of at least one meter between people, avoid touching your mouth, nose and eyes, cover your face when sneezing, avoid agglomerations and closed places, and contact the health system for guidance on how to proceed in the presence of symptoms. To date, no deaths in pregnant women have been reported. The evidence is based on very limited data and it does not indicate that the virus has spread through the vaginal route or transplacental transmission, as analyzes of samples were negative for Covid-19 from the amniotic fluid, umbilical cord blood, smear of the neonatal throat and breast milk, available in the few patients who, during this period, were pregnant or gave birth. This number of analyzes is not representative for any statement. There is very little data, but these suggest that there is the addition of a certain risk when the infection occurs in the third trimester of pregnancy. In other infections with other viruses in the same family as Covid-19, such as influenza, increased risks of developing disease severity, prematurity and pregnancy losses have been reported, but experts cannot say with certainty whether the same it will be true for Covid-19, or whether it would be iatrogenic or spontaneous. Therefore, it is important that pregnant women and their families, as well as the general public and health care providers, receive the most accurate information possible. Here are some practical information for the management of Covid-19 in pregnancy: Recommendations for pregnant women: 1) Avoid unnecessary travel, crowded places, public transportation, contact with infected people, maintaining hygiene; 2) If possible, social isolation; 3) Given the susceptibility to develop anxiety and depression, seek psychological support to avoid unwanted outcomes; 4) In case of symptoms, contact the doctor who has monitored the pregnancy and follow his/her orientations; 5) In case of confirmation of coronavirus infection, the pregnant woman must be isolated in a ward with adequate facilities and multidisciplinary experience to manage obstetric patients, and treated according to their severity;     5.1) Adequate rest, hydration and electrolyte balance, and nutritional support according to the gestational phase must be ensured. So far, the treatment of pregnant women has been very similar to that of other patients, with the use of antivirals already known to be relatively safe in pregnancy. The same regarding to the use of antibiotics and corticosteroids (if necessary). It is not known whether Covid-19 increases the risk of spontaneous abortion and the birth of death, so there is no indication that pregnancy should be terminated in case of contamination by Covid-19. The time of delivery should be individualized based on the severity of the disease, existing comorbidities, obstetric history, gestational age, and fetal condition. The monitoring of the mother and fetus must be constant, and any decision-making must be done with maternal consent. According to the literature, it is suggested that transplacental transmission is unlikely in late pregnancy close to term, but infection can occur in newborns through close contact. Of the cases described in the literature, the infection occurred late, after 36 hours and 17 days after birth. Thus, there is an indication of early clamping of the umbilical cord and temporary separation of the newborn for at least 2 weeks to minimize the risk of viral transmission by an infected mother. The newborn should be treated in an isolation ward and carefully monitored for any signs of infection. During this period, he/she must be fed by the mother's pumped milk. The virus has not been detected in breast milk, so if there is isolation from the mother, she can still pump milk and a healthy third person can offer it, both following hygiene rules for pumping and supply.

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LIANG, Huan; ACHARYA, Ganesh. Novel corona virus disease (COVID‐19) in pregnancy: What clinical recommendations to follow?. Acta Obstetricia Et Gynecologica Scandinavica, [s.l.], p.1-4, 5 mar. 2020. Wiley. http://dx.doi.org/10.1111/aogs.13836.

MELISSA JENCO. American Academy Of Pediatrics. Experts discuss COVID-19 impact on children, pregnant women. 2020. Disponível em: https://www.aappublications.org/news/2020/03/12/coronavirus031220. Acesso em: 16 mar. 2020.

CENTERS FOR DISEASE CONTROL AND PREVENTION. Pregnancy & Breastfeeding: Information about Coronavirus Disease 2019. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html. Acesso em: 16 mar. 2020.

ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS. Coronavirus (COVID-19) Infection in Pregnancy: Information for healthcare professionals. 2. ver. Londres, 2020. 35 p. Disponível em: https://www.rcog.org.uk/globalassets/documents/guidelines/coronavirus-covid-19-infection-in-pregnancy-v2-20-03-13.pdf. Acesso em: 16 mar. 2020.