Pregnancy and upcoming birth is an amazing but also an anxious time for anyone. Particularly so given our current situation with COVID. So, we turned to our co-founder and front-line consultant gynaecologist Mahantesh Karoshi to get the latest on COVID and pregnancy, plus what his team are doing and seeing when it comes to birth. The good news? A lot of it is surprisingly reassuring… 

A six month delay in fertility treatment is not as bad as you think: 

The good news is that a six month delay to fertility treatment should not materially impact the outcome. The other good news is that there are things you can do during this time to preserve your egg quality and quantity backed by the latest research. Click here for more.

Bottom line: as disappointing as it is, this delay should not impact the outcome materially so try not to feel too disheartened.  To read more detail around COVID and fertility treatment click here. 

A COVID infection should not impact your fertility: 

Of course this is a new virus and we have a lot to learn. However, based on what we currently know, if you suffer with a COVID infection it is not known to impact your AMH or fertility.

What to do if you’re pregnant and concerned about COVID: 

The reality is that reducing your chances of infection will reduce chances of complication. Social Distancing is no joke, do not take it lightly. The government has put in place these regulations for a reason. Social distancing plus regular thorough hand washing can go a long way to reducing your risk of infection.

Pregnant women do not appear to be at a greater risk of COVID infection: 

A pregnant woman’s immune system is different vs pre pregnancy. Click here for more. Some bugs such as H1N1 and SARS did impact pregnant women more. The good news is that COVID does not appear to impact pregnant women more. That being said, there are some statistics out there that suggest as many as 60-70% of the population will contract the virus. However, the good news is that so far the data suggests that if your underlying health is generally ok there are unlikely to be serious complications. Those at greater risk are those who suffer with asthma, obesity and diabetes. Make sure your doctor knows if these conditions impact you.

Consultations and appointments in our new era: 

Currently 90% of face to face consultations have now been stopped to protect women and their babies. However, scans they are going ahead as scheduled. Where they are not is because women themselves are choosing to reduce the number of scans/interactions they have. This has been patient led rather than by us. 

One partner is allowed in for the birth: provided they display no COVID symptoms:

Previously anyone could come to the hospital for birth. However, at this time there is strict security in place. At this time you are only allowed one person into the labour ward provided they display no COVID symptoms.

We are not performing mandatory C-Sections for COVID positive mothers: 

Whilst in China they were performing C-Section deliveries on women who were COVID positive (click here for more) we are not taking the same approach. C-Sections are only reserved for where there is a medical need as at this point the data is not showing justification of a C-Section delivery just simply because the mother is COVID positive. 

The virus can be transferred to a new baby, but, generally speaking babies are not reacting too badly to it: 

There is still a lot we do not know about this virus. There is some research that suggests the virus is not transferred in utero, however if a mother is COVID positive it is likely that a new baby will pick up the infection, this will be closely monitored however. All women are still encouraged to breastfeed. In most cases we have seen so far babies have been fine. If there are any signs of distress then the baby will be tested day 3 and day 5 for COVID. If positive, at that point the baby may need to be moved to a neonatal unit for 14 days. 

The good news: 

At this point the majority of babies and children do not appear to have severe immune reactions that characterise a severe COVID infection. Principally as their immune systems are not as well developed. These severe immune reactions are  known as ’Cytokine Storms’. The fact that babies and children do not commonly appear to experience this is good news.

Here’s why no Cytokine Storm is a good thing: 

A Cytokine Storm is what appears to cause a severe reaction to the COVID infection. When the virus gains entry to the bloodstream the body’s defence system: white blood cells/Lymphocytes will attack. As the cells die there is a release of what are known as Cytokines (which are actually signals to the rest of the body’s immune system to come and assist). These chemicals however in large doses can damage surrounding tissue (in the case of COVID the lungs). That then causes the inflammatory process which causes major problems. Click here for more. 

For those who are worried about picking up COVID on a labour ward: 

There are a number of precautions in place to protect people including full vigilance of the signs and symptoms (37.8 degree fever and a dry cough). Anyone suspected of having the infection will be tested. When we treat women with COVID infections as doctors we use full PPE. Even without COVID symptoms we are wearing face masks and visors. Keeping ourselves and reducing transmission is of course our priority. 

Can a severe COVID infection lead to a premature birth? 

At this point it is hard to answer. I would however say this would be the minority of cases. The reality is that the medical teams are getting bolder now and are sitting tight rather than rushing in to deliver a baby early. We are closely monitoring pulse and oxygen saturation and we are very careful to assess changes. The evidence so far is showing that if you sit tight, give oxygen and closely monitor the situation premature birth won’t be the outcome. 

Does COVID increase the risk of birth complications? 

Yes, however, we are very cognisant of this and therefore are carefully monitoring. We do know that it can impact coagulation (blood clotting) which can increase risk of significant bleeding around birth. However, as a result we carefully monitoring things like platelet count and are really on top of it. The reality is that this will impact only a minority of women and we are extremely vigilant at the moment of this risk. 

Can you prevent a severe COVID reaction? 

The evidence is starting to suggest that those who have a high intake of Vitamin C (1000mg/day) and adequate Vitamin D3 (recommendation for pregnancy is at least 400 iu for supplement, 20 mins sun exposure for light skin or 40 mins exposure for darker skin) are less likely to face a severe reaction to COVID infection (note: at this stage there is no evidence that it will prevent COVID infection more that it can reduce the chance of a severe reaction ie. a Cytokine Storm). Click here as to why Vitamin D should be high on the list of every pregnant woman’s agenda. 

For more from Mahantesh check him out on Instagram @gynaecologist_london.

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