Health Hospital, School of Medicine, Shanghai Jiao Tong
University, Shanghai, China
Correspondence: Rui-hong Xue, E-mail:wfmcxrh@sjtu.edu.cn; Postal
address: No.910 Hengshan Road, Shanghai, China. Postal code:
200030. Work phone: +86-021-64070434
The author report no conflict of interest.
Word Count: 696
Funding: None
COVID-19 is still spreading rapidly around the world, with millions of
people losing lives. Pregnant women represent a uniquely vulnerable
group in any infectious disease outbreak because of their altered
physiology, susceptibility to infections, and compromised mechanical and
immunological functions. Pregnant women suffered from COVID-19 mean
worse pregnancy outcomes, both physically and mentally. COVID-19 may
increase fetal complications including miscarriage (2%), intrauterine
growth restriction (IUGR; 10%), and preterm birth (39%). What was
worse, more distress and psychiatric symptoms the infected pregnant
women would have than those who were assessed before the pandemic,
mainly in the form of depression and anxiety symptoms.
Pregnancy is the window for the future, COVID-19 may result in short and
long-term potential harmful to the mother and neonates. It has
significance to further emphasize the prevention of COVID-19 in
pregnancy.
In pregnancy, the evaluations of the safety the mode of delivery and
breast feeding mainly come from some case series. The limited sample
size limited statistical comparison between groups. In a case series of
13 pregnant women with COVID‐19, negative viral test results were
observed in vaginal secretion specimens, suggesting that a vaginal
delivery may be a safe delivery option. However, this case series did
not consider the risks of respiratory transmission of the virus from the
mother to the neonate during delivery or labor. Considering the above,
an analyses of neonatal outcome in 29 pregnant women with COVID-19 were
conducted, among which 12 of 13 hospitalized neonates presented with
radiological features for pneumonia through X-ray or CT screening, and
suggested that intrauterine or intrapartum transmission is possible.
Although a systematic review concluded that the rate of infection is no
greater when the baby is born vaginally, breastfed or remains with the
mother, the safety of mode of delivery among COVID-19 infected pregnant
women remains controversial and calls for prospective study.
Multiple COVID-19 vaccines are in phase 3 trials with efficacy assessed
as prevention of virologically confirmed disease. Vaccines have been
considered the promising way to effectively control the virus, however,
the effectiveness and safety of vaccines to be used in pregnant women
have been reported very few and need investigations. As reported that
respiratory syncytial virus vaccination in pregnant women did not meet
the prespecified success criterion for efficacy against RSV-associated,
medically significant lower respiratory tract infection in infants up to
90 days of life. On the basis of available data, and in line with the
precautionary principle, the risk of COVID‐19 in pregnancy should not be
downplayed to avoid falsely reassuring healthcare professionals and the
public and women should be advised to take necessary precautions to
avoid infection during pregnancy. However, it has been confirmed that
public health interventions could improve the control of the COVID-19
outbreak. The risks of respiratory transmission of COVID-19 from the
other to the neonate remain unclear and need further investigations.
Before that, the best suggestion in a non-effected population is still
physical distancing, face masks, and eye protection. The efficiency and
safety of vaccines to be used in pregnant women need urgent
investigations to satisfy people’s concerns and identify the indications
of vaccines to be used in the special group of people.
COVID-19 characters as strong infectivity, rapid and wide spread, and
have caused significant morbidity and mortality. Early failures in
prevention of the virus have resulted in Domino effect, and “it’s very
tough for countries right now in Europe and North America going back to
another phase of potential lockdowns”, as a WHO officer said. People
are exhausted and very tired. However, there are still many people who
refuse to have a mask at public around the world during the global
pandemic. In the 1902 paper, Ballantyne said, “as with the premature,
the ideal plan of procedure is prevention”, the similar principle
should be followed in COVID-19. Before the assurance of the
effectiveness and safety of COVID-19 vaccines to be used in pregnant
women, strong actions of protection and prevention to be taken in the
non-infected pregnant population is still the best suggestion. Only by
this, can we see the turning point in the rising curve. The vaccines to
be used in prevention of COVID-19 in pregnancy calls for action.