The Indian Council of Medical Research on Monday said the emerging evidence suggests that transmission of coronavirus from mother to baby before birth or during delivery is possible although the proportion of pregnancies affected and the significance to the neonate is yet to be determined.
The apex health researchbody also said there are no recorded cases of breast milk being tested positivefor COVID-19 at present, and no data suggesting an increased risk ofmiscarriage or early pregnancy loss in relation to the disease.
“…Emerging evidencenow suggests that vertical transmission (from mother to baby antenatally orintrapartum) is probable, although the proportion of pregnancies affected andthe significance to the neonate has yet to be determined,” it said.
However, it is unknownwhether newborns with COVID-19 are at an increased risk for severe complicationsand transmission after birth via contact with infectious respiratory secretionsis a concern, the ICMR said.
In a guidance formanagement of pregnant women during the pandemic, the apex body said hospitalsshould consider “temporarily separating” (separate rooms) the mother, who hasCOVID-19 or is a suspected case, from her baby until the mother’stransmission-based precautions are discontinued.
“Also, there is noevidence currently that the virus is teratogenic (causing developmentalmalformations). Long-term data is awaited,” the ICMR said.
It clarified pregnant womendo not appear more likely to contract the infection than the generalpopulation. “However, pregnancy itself alters the body’s immune system andresponse to viral infections in general, which can occasionally be related tomore severe symptoms and this will be the same for COVID-19”.
In other types ofcoronavirus infection (SARS, MERS), the risks to the mother appear to increasein particular during the last trimester of pregnancy. There are case reports ofpreterm birth in women with COVID-19 but it is unclear whether the pretermbirth was always iatrogenic, or whether some were spontaneous.
Pregnant women with heartdisease are at highest risk (congenital or acquired), the ICMR said, adding thecoronavirus epidemic increases the risk of perinatal anxiety and depression, aswell as domestic violence.
“It is criticallyimportant that support for women and families is strengthened as far aspossible; that women are asked about mental health at every contact,” itsaid.
The guidance states thatthe obstetric units should ensure appropriate isolation of pregnant patientswho have confirmed COVID-19 or are under investigation.
Healthcare providers shouldcreate a plan to address the possibility of a decreased workforce, potentialshortage of personal protective equipment, limited isolation rooms, and shouldmaximize the use of tele health for prenatal care.
ICMR said the guidance arebased on the limited evidence available to date about transmission of the virusthat causes COVID-19, and knowledge of other viruses that cause severerespiratory illness including influenza, severe acute respiratory syndromecoronavirus (SARS-CoV),and Middle East Respiratory Syndrome coronavirus(MERSCoV).
The recommendations are based on guidelines from international disease control agencies and publications and simplified for Indian context, the document stated.