COVID-19 and pregnancy: what we know about what happens to your immune system

It’s possible that changes to the immune system during pregnancy protect parent and child from COVID-19.
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April Rees, Swansea University and Catherine Thornton, Swansea University

Any new infectious disease poses unique challenges to people who are pregnant during an outbreak. The effects of Sars, Zika and influenza in pregnancy highlight the potential immediate and longer term detrimental health outcomes a virus can have for both mother and baby. These risks include premature delivery of the baby with Sars, birth defects with Zika and greater risk of severe influenza.

Should we be as worried about pregnancy and COVID-19? There are a number of things we need to think about. These fall into two broad areas related to the effects on the foetus and the effects on the pregnant person themselves.

In both cases we need to think about the immediate effects during the pregnancy as well as the longer term health effects for both parent and child. The early evidence we have shows that changes to the immune system during pregnancy could be somewhat protective against the disease.

The parent

Early data from pregnant women with COVID-19 indicates that the disease is linked to premature birth and changes to the placenta that might reflect altered blood flow. This suggests that virus-associated disruptions do occur between parent and foetus.

However, these studies were of women with severe cases of the disease. We know very little about the effect of mild disease or asymptomatic infection in pregnancy. Understanding this is critical, as studies have highlighted that asymptomatic and mildly infected pregnant women far outnumber those requiring hospitalisation for COVID-19.

This indicates that pregnant people are not more susceptible to severe COVID-19, which was one of the greatest concerns at the beginning of the pandemic and led to them being categorised as vulnerable.

The apparent protective effect of pregnancy against severe disease might simply reflect the different immune responses to severe COVID-19 seen in men and women, and the fact that more men than women die from the disease in general. However, we do not see the same response in pregnancy with other viruses, such as influenza, suggesting something else is at play with SARS-CoV-2.

The foetus

So far, it seems that the foetus is very well protected from the passage of SARS-CoV-2 from mother to child (known as vertical transmission) and such passage, while possible, seems to be uncommon. This might be down to the natural features of the placenta, which produces molecules that stop the virus binding to placental cells. It could also be that the placental membranes limit infection by the virus.

Of course, it is very difficult to study the placenta prior to birth. Alternative measures, such as analysing cellular debris released from the placenta (known as extracellular vesicles) which can be found in a sample of the mother’s blood, are really needed to find out what features of the placenta might protect the foetus from infection and what effects the virus has on the placenta.

Any antibodies that a mother infected with SARS-CoV-2 makes will pass to the foetus across the placenta (known as passive immunity). This provides short-term protection from many infectious agents for the last months of pregnancy and for some months after the baby is born. These antibodies will also continue to be provided in breast milk if the baby is breast fed.

Babies can acquire antibodies against viruses via breastfeeding.
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Early studies from China have shown that antibodies that protect against COVID-19 are present in newborns of women who had such antibodies. This confirms that passive immunity, where a baby essentially inherits antibodies from a parent, occurs with SARS-CoV-2. We now need some larger studies to investigate whether anti-SARS-CoV-2 antibodies are present in human milk to better understand the role of these antibodies in neutralising the virus and protecting the baby.

Molecules other than antibodies can also pass from parent to foetus. Pregnant women with severe COVID-19 have many of the hallmarks of an inflammatory response that we see in other people with similar symptoms. This includes elevated levels of molecules such as interleukin-6 (IL-6), which indicates that the immune response has been activated.

There are a number of studies showing that maternal immune activation can have detrimental effects on the developing foetus. Such activation is associated with increased risk of respiratory, cardiovascular, neurodevelopmental and other disorders in the offspring. Whether SARS-CoV-2 will have such long-term effects on the health of these children remains to be seen.

The role of the immune system

In a previous article, we discussed how the immune system changes during pregnancy, and it might be that unique features of this and other dynamic adaptations that occur with pregnancy provide protection from severe COVID-19.

Other examples of possible protective mechanisms include differences in the receptor molecules used by SARS-CoV-2 to invade human cells. Angiotensin-converting enzyme 2 (ACE2) is the best known of these viral entry receptors but CD147, CD26 and others also have this role.

All of these receptors undergo changes during pregnancy, which might contribute to resilience. These receptors also occur as soluble forms that can be measured in blood and breast milk and might act as decoy receptors, stopping the virus from binding to cells.

What next?

Elaborating on why both the pregnant person and their child seem to be relatively resilient to severe forms of COVID-19 might help us understand other disease processes and identify ways to combat the disease.

Work from the UK Obstetric Surveillance System has shown that, as with the wider population, Asian and Black pregnant women are more likely to be admitted to hospital with SARS-CoV-2 infection. Therefore, we really need to consider the effects of ethnicity and other risk factors in our studies of COVID-19 in pregnancy.

This is especially important as these studies will support efforts towards the use of any vaccine in pregnancy.

April Rees, PhD Researcher in Immunology, Swansea University and Catherine Thornton, Professor of Human Immunology, Swansea University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus while pregnant or giving birth: here’s what you need to know

Hannah Dahlen, Western Sydney University and David Ellwood, Griffith University

Having a baby is stressful enough without a coronavirus (COVID-19) pandemic and all the associated misinformation.

If you’re pregnant and/or due to give birth soon, it’s best to get information from trusted sources such as the World Health Organisation, the Royal College of Obstetricians and the Australian Government Department of Health.

Here are the key take-home messages.

It’s a new virus

As COVID-19 is a new virus, we are learning more about it every day. As most pregnant women are young and generally healthy, they’re less likely to be severely affected (which is good news). But as there is also a baby to consider, the picture can be more complex.

A baby born recently to a mother in the UK with COVID-19 recently tested positive soon after birth but we are not sure whether it was infected in the womb (unlikely) or after birth (more likely).

As far as we know, the baby is fine and the mother is being treated. Other reports on babies with COVID-19 have also shown they had mild symptoms and a good recovery.

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Read more:
Coronavirus with a baby: what you need to know to prepare and respond

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From China’s experience to WHO advice

To date, much of our information on COVID-19 has come from China. This is where one of the first studies, involving just nine pregnant women with COVID-19, came from.

All these women had caesarean sections, none were seriously unwell and all mothers and babies recovered. The study found none of the babies appeared to get COVID-19 and there was no evidence of the virus in the baby, breastmilk or fluid surrounding the baby. It’s not clear why these babies were born by caesarean section. China has a very high caesarean section rate, which is not optimal, and this may have influenced how they responded.

The World Health Organisation’s new guidelines state:

there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester … WHO recommends that caesarean section should ideally be undertaken only when medically justified

Why pregnant women are not more susceptible to COVID-19

Pregnant women are generally more susceptible to viruses that cause breathing problems (like the flu). Their immunity is lowered, their lungs are more compressed and they need more oxygen.

However, this doesn’t seem to be the case with COVID-19. In an analysis of 147 women with COVID-19, only 8% had severe disease and 1% were in critical condition. That’s lower than the general population.

The lowered immune response of pregnancy, which is needed to stop a woman’s body responding to her baby as a health threat, may actually provide extra protection with COVID-19. COVID-19 seems to be more severe in people with an immune system working hard dealing with other health disorders.

With COVID-19, more men than women are affected and women are less likely to get severely ill and die. To date, the death rate is 1.7% for women and 2.8% for men.

However, as the pandemic spreads this may change. Women comprise the majority of the health workforce and caregivers will be in contact with more sick people.

Sneeze or cough into your elbow to reduce the spread of germs.
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How can pregnant women protect themselves and others?

Pregnant women should do the same things as the general public to protect themselves, including:

• covering the mouth when coughing (by coughing into the crook of your elbow)
• avoiding people who are sick
• asking people who are unwell to avoid visiting
• washing hands often with soap and water or an alcohol-based sanitizer and
• avoiding large gatherings.

It would be sensible not to travel overseas at the moment; you may have to self-isolate when you return.

Women who think they may have contracted COVID-19 can now consult their GP or other health professional with a bulk billed telehealth call (video call) rather than having to go in person.

Women who are pregnant or have new babies are given priority for telehealth services.

If you have been asked to self-isolate due to contact with someone with COVID-19, or have the illness, make sure you contact your midwife or obstetrician by phone and follow the advice of your health care provider.

What about going to hospital for antenatal visits and birth?

Keep going to appointments but don’t stress if you miss a couple, and early discharge might be a good idea if you’re able.

If you are booked into a birth centre or hospital, lots of precautions are in place to minimise the risk of infection. Birth will proceed as planned in the vast majority of cases and going home early would be ideal and may be encouraged if you and your baby are well.

Be aware some hospitals are restricting visitors and even support people, other than the partner, to try and reduce risk to the community.

Can the baby be infected with COVID-19 in the uterus?

The placenta is a very efficient filtering system and does an amazing job protecting babies from harm. The Zika virus was an exception to this.

There is no evidence of increased complications, though if a woman was very unwell (with high temperature or pneumonia, for instance) then the baby may be born prematurely.

This may be due to deliberate intervention by health professionals if the woman is very sick.

In general, though, a COVID-19 diagnosis should not lead to a decision for an early birth, unless ending the pregnancy is thought to be beneficial to the mother due to her overall condition.

There is not enough evidence that COVID-19 increases miscarriage and it is too early to know other longer-term impacts on the baby.

What should I do after the birth?

The benefits of breastfeeding are so significant the WHO recommends this should begin within an hour of birth. Skin-to-skin contact should be supported immediately following birth if the baby is well.

Skin-to-skin contact should be supported immediately following birth if the baby is well.
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If the mother is too ill, she should be assisted to express her milk. Breastfeeding is particularly effective against infectious diseases because it transfers antibodies and other important immune factors to the baby. If the woman or the baby have an infection, the composition of breastmilk even changes to increase important components that help the baby fight infection. So, if you were thinking of giving up breastfeeding, perhaps continue until this pandemic ends.

WHO recommends women who have COVID-19 should wash their hands before and after contact with the baby, use a medical mask when near the baby if they have symptoms (such as coughing), and routinely clean and disinfect surfaces they may have touched.

What else can you do?

When the seasonal flu vaccine becomes available, get vaccinated. We know this can be protective during pregnancy. It is free for pregnant women and there are no risks to your baby from flu vaccine. You will not be protected from COVID-19 but you will get some protection from the flu (which can be very problematic for pregnant women). The last thing you want is to have the flu and COVID-19 at the same time.

Free flu vaccinations will be available from GPs mid-April but if women want them earlier, they can get them for a fee at the pharmacy from end of March.

Most of all, try and stay calm and talk to your midwife or doctor if you are getting very worried.

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Read more:
Coronavirus: 5 ways to manage your news consumption in times of crisis

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Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney University and David Ellwood, Professor of Obstetrics & Gynaecology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

ABORTION LAW REFORM PASSED IN AUSTRALIA: A DAY OF BETRAYAL

The passing of the infamous Abortion Law Reform Bill by the Victorian Legislative Assembly marks a day of shame in the history of human rights in the State of Victoria, says Ken Orr, the spokesperson for Right to Life New Zealand Inc. The first duty of the State is to protect the right to life of all of its citizens. It has a special duty to protect the lives of the weak and defenceless in society. The State has an overwhelming interest and duty to protect the lives of its future citizens. The unborn child is a member of the human family and is the weakest and most defenceless member of society. The Bill also denies the personhood of the unborn child. We should remember that it was the denial of the personhood of the Negro that gave the world slavery and the denial of the personhood of the Jew that gave us the holocaust. It is the denial of the personhood of the unborn that is giving us the abortion holocaust.

Human rights are conferred by our Creator, not by the State or by the community. The unborn child is a bearer of human rights. At conception the unborn child is conferred with an inalienable right to life. and should be accorded the respect due to the human person. The passing of this Bill entails the State withdrawing its legal protection for the human rights of the unborn child. It is now no longer a crime to kill an unborn child. This is a violation of the rights of the child. It is also a violation of the human rights of the mother who has a right to have the protection of the State for herself and for her child. The Bill is thus an attack on the dignity of women and of motherhood. The Bill is falsely touted as an empowering victory for women, it is not, it represents further oppression. A woman distressed with an unplanned pregnancy deserves from the community love, compassion and help, not assistance to destroy her child.

The Bill will encourage the further exploitation and abuse of women. Studies have linked abortion to increased substance abuse, suicide and psychiatric ill health. Studies conducted overseas reveal that 64% of women who have an abortion are coerced by the father of the child, family and friends. This Bill will further encourage men to coerce women into having an abortion against their will with threats of abandonment and violence in order to reject their responsibilities for the mother and the child they have fathered.

The Bill is also a violation of the conscience of doctors. The Bill makes it obligatory for a doctor whose conscience is opposed to abortion to refer the women seeking an abortion to another doctor who is prepared to destroy the child. The unborn child is a patient; a doctor has a duty to do no harm and maintain the utmost respect for human life from the moment of conception. This Bill is a threat to the lives of the unborn of every other State and New Zealand.

Report from the Christian Telegraph

AUSTRALIA: ABORTION ORDERED FOR 12-YEAR-OLD GIRL

In the Australian state of Queensland, doctors have been ordered to perform an abortion on a 12-year-old girl. The girl is thought to be about 18 weeks pregnant after a suspected rape.

Supreme Court Judge Margaret Wilson ordered the abortion using the drug misoprostol after medical advice that the pregnancy posed serious dangers to the mental health of the intellectually disabled girl.

Police are investigating the case and searching for the father of the unborn child who is thought to be living in Queensland.