November, 2020
NIJZ
The NIJZ (National Institute of Public Health https://nijz.si/) has published an analysis of the potential effects of COVID-19 on pregnant women and pregnancy.
Infection Pregnant women are infected as often as the general population
Symptoms The illness in pregnant women usually takes the form of a mild flu/cold, mainly with fever (40%) and cough (39%), less commonly dyspnoea, muscle aches, headache, change in sense of taste and smell or gastrointestinal problems.
Risk factors A major meta-analysis co-funded by WHO, called PregCOV-19, showed that pregnant women are more likely to be hospitalised than non-pregnant women of the same age and more likely to require mechanical ventilation Mortality was the same in pregnant and non-pregnant women. According to the UK perinatal database UKOSS, a more severe course of disease is more common in the third trimester (81%).
Vitamin D deficiency Vitamin D deficiency is known to be associated with increased inflammation in acute respiratory distress syndrome and with cytokine storm. Winter flu epidemics are associated with seasonal fluctuations in vitamin D. However, all pregnant women are recommended to take 400 IU vitamin D per day.
Vertical transmission of disease Vertical transmission (mother-to-child transmission in utero or during delivery) cannot be excluded in COVID-19 infection. Current data suggest that neonatal infection with COVID-19 is possible but rare, independent of mode of delivery (vaginal, caesarean section), breastfeeding or isolation from the mother after birth.
Impact on the fetus No data on increased risk of miscarriage. There is currently no evidence of fetal birth defects due to SARS-CoV-2 infection.
Childbirth Infection of a pregnant woman with COVID-19 is associated with a 3-fold increased risk of preterm birth. Pregnant women with COVID-19 infection have an increased risk of caesarean section, especially in symptomatic parturients.
Vulnerable groups of pregnant women We need to be aware that the coronavirus epidemic (isolation, stress, financial instability, etc.) increases the risk of perinatal anxiety, depression, drug and alcohol abuse and domestic violence. Signs should be looked for and appropriate action should be taken. Increased levels of intimate partner violence are also reported at this time, both here and abroad.
Recommendation for pregnant workers Pregnant women should be protected because of the risk of more severe illness, premature birth and increased risk of caesarean section. Pregnant women can carry out their work with appropriate protective equipment. The recommendation is individually adapted according to the workplace and associated diseases.
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The project is part-funded by the Ministry of Labour, Family, Social Affairs and Equal Opportunities and the European Union through the European Social Fund. The operation is financed under the Operational Programme for the Implementation of the European Cohesion Policy 2014-2020, Priority Axis 9 “Social inclusion and reducing the risk of poverty”, Priority Investment 9.1 “Active inclusion, including the promotion of equal opportunities and active participation, and improving employability”, Specific Objective 9.1.2 “Empowering target groups to move towards the labour market”.
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