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COVID-19 AND PREGNANCY

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Sir,

Pregnancy is a special time for a woman; it also can be an especially difficult and dangerous time. The miracle of childbirth is no walk in the park.     Although a woman’s body is obviously different from a man’s, it is less obvious a woman’s immune system is also different. When a woman is pregnant, her body’s selenium resources are redirected away from maintaining immune vigilance against invading microbes and towards facilitating the rapid development and growth of new foetal cells. Like all human cells, every new foetal cell requires selenium.

The immune system evidently sacrifices to provide part of the extra selenium the unborn child needs to grow. Thus, a pregnant woman has a slightly higher need for selenium in her diet when pregnant; and an even higher requirement when breastfeeding. When nursing, she is giving away part of her immune system to her infant in the white blood lymphocyte cells in breast milk. That means her immune defences may be slightly lowered.

Immunity

Another amazing aspect of maternal immunity is that a pregnant woman’s immune system is delicately sensitive that if the foetus is not developing correctly, is malformed or has a genetic defect, it responds and triggers a spontaneous abortion – miscarriage. A miscarriage is usually a blessing in disguise, otherwise a defective baby would be born. The hypersensitive maternal immune response may also hold one key to understanding autoimmune disease and why women suffer autoimmunity twice as often as men.

When COVID-19 suddenly burst on the world scene, I immediately recognised it would be a hazardous time for women to become pregnant and wrote an advisory about that. It would be best to delay pregnancy, if possible, until the pandemic subsides. When viruses infect cells, they commandeer the cell’s nucleus, its protein production factory. Viruses often damage cells’ DNA, our hereditary genetic code. Damaged DNA often leads to birth defects, childhood cancers, or babies born with developmental problems or lifelong diseases. The earlier in pregnancy viral infection strikes, the greater the chance for birth defects or congenital disease in the child. In the third trimester the danger lessens, but still exists.

Most women know if they are infected with measles virus during their first or second trimester, the child will likely be born deaf. An even more striking example of birth defects are those associated with Zika virus. Like SARS-CoV-2 (SARS-2) and Ebola, Zika originated in flying mammals – bats. Not all viruses can cross the maternal placenta; Zika can. Once inside, Zika attacks the cells of the developing foetal nervous system; that stunts the development of the brain. If infected early enough, the baby will be born essentially without a brain. This often prompts a physician to perform a late-stage abortion to prevent an encephalitic baby being born with no capacity to function as a human.

Viruses attack various cells based on the molecular key the virus possesses to a particular cellular receptor, the entryway into cells. COVID-19 is especially destructive because it carries the key to a very common receptor, the ACE-2 receptor, found in many cell types; that is a major reason SARS-2 is so destructive, affecting so many systems in the body. COVID-19 presents a panoply of challenges in pregnancy.  

Early in the pandemic it had not been well-established if vaccination was 100 per cent safe for pregnant women. Due to a surfeit of caution, pregnant women are usually not allowed to participate in clinical trials of new vaccines or medications. As a result, only about a third of pregnant women in the US were fully vaccinated; this was well below the national average. Now it has been conclusively established that vaccines are absolutely safe for both the expectant mother and the foetus. They provide three-for-one protection – for the mother, foetus, and newborn infant. Of course, vaccination is not a guarantee against infection. Critically, vaccines are highly protective in preventing severe illness and death.

Protective

With the Omicron variant, vaccines are much less protective against initial infection, but still provide great protection against more serious outcomes. Vaccines usually greatly reduce the chance of infection with most variants, but not so much with the highly contagious Omicron. When breakthrough infections of any variant do occur, they tend to be milder and shorter in duration if one is vaccinated.

COVID-19 is especially dangerous late in pregnancy, and the post-partum period after birth. Statistics vary by country depending on base rates, but in South Africa deaths among pregnant women increased 35 per cent to 40 per cent in the initial waves of SARS-2. As with others, the risk of severe COVID-19 outcomes is higher among those with comorbidities such as diabetes, high blood pressure and obesity. In the US COVID-19 related maternal mortality is approximately 70 per cent higher in pregnant women than in non-pregnant women.

The COVID-19 risks to pregnancy include more miscarriages, stillbirths, and preterm births. According to the July 2021 medical journal Lancet Regional Health – Americas, overall, there is a 10 per cent increase in early births, a 40 per cent ncrease in preterm births and a 60 per cent increase in very preterm births. The immune reaction to SARS-2 also increases chances of childhood developmental disorders, including delays to foetal development of the heart and lungs. In a small percentage of cases COVID-19 damages the placenta, reducing the oxygen supply to the foetus. That may trigger foetal death or a stillborn birth. The risk of stillborn birth increased 50 per cent early in the pandemic; then it rose to four times normal with Delta.  

Pregnant women are three times likely to become severely ill and require intensive care compared to non-pregnant women. One study reported that five per cent of pregnant women are hospitalised, two per cent land in the ICU, with at least one per cent requiring ventilation. Delta variant increased the rate of death from just one-half-of-one per cent to 2.5 per cent of pregnant women in America with COVID-19, a 500 per cent increase. These statistics vary greatly by country. What appears constant is that approximately 75 per cent of pregnancy-related deaths from COVID-19 occur in the weeks following childbirth. As has been demonstrated with other deadly viral infections, a high daily dose of selenium should greatly reduce that mortality rate.  

With COVID-19, and now Omicron, it is too soon to know what the future holds for children born during these pandemic times. Will different variants provoke different long-term effects? No one knows. It may be years before long-term damage to childhood development can be finally determined, or if lifelong diseases result from pregnancies during this pandemic. Every mother wants a perfect child. No mother wants to suffer the ultimate price in childbirth or shortly thereafter. Boosting maternal reserves of protective selenium will not prevent all possible problems in pregnancy, or all deaths. It should significantly reduce them – COVID-19 or no COVID-19.

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