COVID-19 continues to wreak havoc on humanity ever since the first case was confirmed on Dec 31st 2019 in Wuhan China. However, much scientist have done a commendable job in studying the different dynamics of the virus, its effects on pregnancy on both the mother and fetus remain largely unknown. Dr. Deborah Money, a professor in obstetrics and gynecology at the University of British Columbia’s faculty of medicine acknowledges that when it comes to COVID-19 and pregnancy, there’s a lot we don’t know!
One of the earlier cases of COVID-19 in Uganda was of an 8 months old baby who was believed to have been infected by his father but the mother was not infected although health workers allowed her to breast the baby while it was receiving treatment. In the same vein, another COVID-19 confirmed case was a pregnant woman, who later delivered a negative baby girl at Entebbe Grade B Hospital.
BBC on 21st May 2020 reported a two-day old baby who succumbed to corona virus in South Africa. The Health Minister Dr Zweli Mkhize confirmed that the mother had tested positive for Covid-19 and the child subsequently tested positive. “Sadly, we have recorded the first neonatal mortality related to Covid-19. The baby was two days old and was born prematurely’’, he said.
As cases of COVID-19 accumulate in Uganda, there is need to better understanding COVID-19 in pregnancy, to increase understanding of the epidemiology of COVID-19 in pregnancy. Previous studies on other viruses like H1N1(Swine flu), indicated that pregnant women are more vulnerable to some respiratory infections compared to their non-pregnant peers.
According to the WHO, there is limited data on the impacts of COVID 19 infection on pregnant women and at present there is no evidence that they are at higher risk of severe illness than the general population. WHO, further says that due to changes in their bodies and immune systems, pregnant women can be badly affected by some respiratory infections and therefore important that they take precautions to protect themselves against COVID-19, by reporting possible symptoms (including fever, cough or difficulty breathing) to their healthcare providers.
Early reports from China on COVID19 indicated that 30 per cent of babies born to mothers with COVID-19 were pre-term, with low birth weights. The later reports from the US COVID 19 taskforce refuted the report suggesting that those rates were much lower. However much we don’t think that COVID 19 directly affects the fetus, it may have indirect effects like impending its growth. More so there might be other lifelong impacts that still remain unknown.
Another dilemma comes on whether to separate mothers with COVID-19 from their babies at birth. In the U.S., babies born to mothers who have COVID-19 are immediately separated. In Uganda the current approach does not advocate for the separation but careful masking, handwashing in order to have the mom and baby remain together. This is because the period immediately after birth is very crucial in establishing the breast feeding, allowing the mother and child bonding and allowing promotion of mental health for both the mother and the baby. The Ugandan approach is supported by the known advantages of keeping the mother and baby together but with scanty information on whether the breast milk or other mother child contacts may or may not pose a danger to the baby.
The novel corona virus has presented different contradictions for example earlier studies in China didn’t find traces of the virus in semen of men who had tested positive, but according to the health line the recent study made by Chinese researchers has discovered traces of SARS-CoV-2 in the semen. However, this is not conclusive that the corona virus is sexually transmitted.
According to Dr. Matthew G. Heinz, hospitalist, internist, Tucson Medical Center, and former director of provider outreach in the Office of Intergovernmental and External Affairs, a part of the Department of Health and Human Services in the Obama administration, any viral infection replicates, circulates, and gets into a lot of tissue and to him it was not surprising that they had found SARS-CoV-2 in multiple different bodily tissues and fluids.
CDC does not list human breast milk as a body fluid to which universal precautions apply but human breast milk has been implicated in transmitting HIV and Hepatitis B infections from mother to infants and it therefore encourages wearing of gloves as a precaution by health care workers who are frequently exposed to breast milk.
WHO, says It appears ‘unlikely’ that COVID-19 would be transmitted through breastfeeding or by giving breastmilk that has been expressed by a mother who is confirmed/suspected to have COVID-19 and to date researchers continue to test breastmilk from mothers with confirmed/suspected COVID-19.
Implementation of COVID-19 preventive measures has caused unique challenges for pregnant women from disrupting antenatal activities, delivery from health centers and postnatal care. Further disruptions where caused in social networking activities that help women stay connected and supported throughout their pregnancy. Such social care is fundamental in helping expectant mothers navigate through the normal challenges of pregnancy and maintaining their mental health.
To unravel all these mysteries surrounding pregnancy and the pandemic, it is inevitable to conduct a national surveillance epidemiological survey to generate locally customized recommendations to improve outcomes associated with COVID 19 infection on Maternal Neonatal and Child Health
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The writer is a health equity enthusiast.