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Pregnant Women Face Special Risks From COVID-19

It’s well known that pregnancy boosts the risk of serious disease from respiratory viral infections. During the H1N1 flu epidemic of 2009, pregnant women accounted for 5% of U.S. deaths, although they constituted about 1% of the population. One study found pregnant women with severe acute respiratory syndrome (SARS), which is caused by a virus that’s a close cousin of SARS-CoV-2, were significantly more likely to be admitted to the ICU and to die than nonpregnant peers.

Viral infections can be more severe in pregnant women in part because “the entire immune system is geared toward making sure not to create any antifetal immune response,” says Akiko Iwasaki, an immunologist at the Yale School of Medicine. “The mother has to compromise her own immune defense in order to preserve the baby’s health.”At the same time, the immune system is far from inactive in pregnancy, and “the really significant immune response to the infection certainly has the potential to cause complications,” says Carolyn Coyne, a virologist at the University of Pittsburgh.

To supply the fetus, pregnant women also need extra oxygen and blood to ferry it: up to 50% more by late pregnancy. This may multiply the stress that COVID-19 has been shown to put on the cardiovascular system. “The heart is already working for two,” Baud says. “And if you are a virus known to induce vessel change, inflammation, this will increase the workload of the heart even more.”Malavika Prabhu, a maternal and fetal medicine specialist at Weill Cornell Medicine, adds that later in pregnancy, “with so much blood going around and the organs more metabolically active, all that extra fluid can go in places it shouldn’t go—including filling your lungs with fluid.”

Finally, pregnant women’s blood has an increased tendency to clot, thought to be due to their need to quickly staunch bleeding after delivering a baby. But the coronavirus itself can have a similar effect. “COVID is thought to increase your likelihood of clotting, and then pregnancy further increases your likelihood of clotting,” Jamieson says.

Elevated dangers to the mother don’t end with delivery, according to work by Prabhu and colleagues in the journal BJOG last month. They followed all 675 pregnant women admitted for delivery at three New York hospitals during 4 weeks in late March and April. After giving birth, nine of 70 infected women, or about 13%, had at least one of three complications that doctors watch for after delivery: fever, low blood oxygen, and hospital readmission. Among 605 noninfected women, 27, or 4.5%, had one of these problems. “Many diseases are unmasked in the postpartum period. We learned that COVID-19 is one of those,” Prabhu says. She noted that 79% of the pregnant women who tested positive when admitted were asymptomatic.

pandemic (doctors)

EXTERNAL LINK

https://www.downtoearth.org.in/blog/health/pregnant-in-a-time-of-coronavirus-the-changing-risks-and-what-you-need-to-know-70125