Experts are of the opinion that the third wave of COVID-19 will affect the young. Against this backdrop, Dr Ankita Chandna, Sr Consultant, Obstetrics and Gynecology, Max Hospital speaks to BW Businessworld about the effects of COVID-19 on pregnancy. Excerpts:
Did we see an increase in pregnancies during the pandemic?
Last year, a UN study indicated a post-pandemic baby boom for India with 20 million births in nine months. There has been a baby boom not only in India but also in surrounding countries like China, Indonesia and Pakistan as well. There have been a large number of unwanted births due to fear of going to hospitals for advice during the pandemic, the lack of availability of contraception and medication in the market.
When the mother is COVID-19 positive how does it affect the foetus?
AC: This is an important aspect that we have been studying since the last year of the pandemic. It has been noted that the first phase of Covid-19 was a little milder and therefore, its effect on pregnancy wasn’t that significant. There were incidences of pre-term births but overall, the impact wasn’t much, especially since we didn’t see any cases of vertical transmission to the baby through the placenta. The second wave, however, has a more pathogenic stream and because of that, problems for pregnant mothers has increased threefold. As a result, a 30 percent rise in morbidity has been seen in the patient. Essentially, there has been an increase in admission requirements - not just general care but even ICU admissions, even the requirement for ventilators has gone up and this is all due to Covid-19 pneumonia especially when women are immuno-compromised. The pathogenicity of the virus is more in the second wave, which has thrown up not only maternal problems but also an impact on the baby - there has been a rise in pre-term births and also stillbirths.
If the mother has COVID positive symptoms and the child is born without any complications, is there a chance that the child will later develop some complications? And if so, what are the kinds of complication they can develop?
Currently, evidence is still lacking on this, and studies are being carried out. The lancet publication highlights studies done with over 6 million women who were Covid positive, and its consequences on the baby have been documented - these have shown that the baby is not getting infected directly through the placenta.
It has been noticed that babies are suffering from a condition called multisystem inflammatory syndrome, which appears to be linked to COVID-19. This condition is on the rise, it has been reported that in 10-15 percent of cases it happens within 2-4 weeks of Covid infection that the baby acquires after birth. The inflammatory process affects not only their lungs but also the heart, kidneys and the brain, which causes a sudden drop in the blood pressure, there is fever which is persistently present and there is body ache and a rash. The heart dysfunction is quite pronounced, and these patients have a more serious outcome and need proper care and hospital admission.
Is vaccination safe for pregnant ladies and lactating mothers?
This COVID storm which we are facing is due to the lack of vaccination globally. Vaccination is the need of the hour. In regard to pregnancy and the lactating mother, we know they are a vulnerable group however, sufficient metrics are not available for the safety of Indian vaccines like Covishield and Covaxin, which is why the Government of India has not yet approved the vaccine for pregnancy. Although, in the United States, Pfizer and Moderna have been given to more than 90,000 pregnant women without any potential serious effect.
The Federation of Obstetric and Gynaecological Societies of India is in talks with the Ministry of Health to start vaccination even in pregnancy because the benefits seem to outweigh the risks involved. For now, they have sanctioned and approved it for the lactating mothers – this began from the 13th of May onwards.
What percentage of children would definitely contract COVID-19 from a mother who is positive?
We have understood that there is no vertical transmission from the mother to the child during pregnancy through the placenta, but after birth, if the mother is COVID positive there is a 70 percent chance of the baby contracting the illness if they don’t follow the guideline of the proper preventive care. However, we are anticipating that during the third wave, the incidence of this infection is going to be much higher in children. In India, the population below 16 years of age is around 40 crore, which should be vaccinated and for the children below 10 years, the parents should be vaccinated.
If a child contracts covid after birth so do you think the complications in terms of treating the child are more as compared to when you are trying to treat an adult?
Neonates are susceptible to severe illness because their immunity is not good, and they have short respiratory tracts, and the lungs are not that mature. Therefore, the severity of illness, the need for a ventilator is more.