I am Pregnant, Should I be Worried About the Recent COVID-19 Outbreak?
Dr. Kate Dudek • September 21, 2022 • 5 min read
Whilst being pregnant can be a time of eager anticipation and excitement, it can also be a time of increased anxiety and worry. Certainly, in the months leading up to delivery there is a lot to consider, from keeping yourself and your developing baby fit and healthy, to all the practical aspects that come with welcoming a newborn into your home. Needless to say, a global health pandemic, such as the coronavirus 2019 (COVID-19) outbreak, is probably the last thing in the world you want to have to consider right now.
So, how worried should you be? Does being pregnant make you more likely to catch COVID-19, or more susceptible to developing serious complications? What are the risks to your unborn baby? What should you do if you develop symptoms of COVID-19 whilst pregnant?
Am I more likely to catch COVID-19?
The short answer to this, and in fact to many of the questions involving pregnancy and COVID-19, is that we simply do not know. Consider that this is a virus that has only been in existence since the very end of 2019; whilst the number of reported cases has grown exponentially over a remarkably short time; there is still not enough data available from existing cases to enable researchers to perform detailed risk analyses.
At the moment, what we do know is that with the rapid, progressive spread of COVID-19 globally, pregnant women are, and will continue to be, affected. Pregnancy can alter the body’s immune system and consequently the way in which it responds to viral infections. This means that pregnant women occasionally experience more severe symptoms. However, guidelines released by the UK-based Royal College of Obstetricians and Gynaecologists (RCOG), state that pregnant women are no more likely to contract COVID-19 than the general public.
Will my symptoms be more serious if I am pregnant?
The RCOG states that the majority of pregnant women who develop COVID-19 will experience mild or moderate cold or flu symptoms. They suggest that most pregnant women will not become severely unwell. Furthermore, the World Health Organisation (WHO) does not mention pregnant women as a high risk group:
“……evidence to date suggests that two groups of people are at a higher risk of getting severe COVID-19 disease. These are older people; and those with underlying medical conditions”.
WHO Situation Report 51, 11th March 2020.
Despite this, on 16th March 2020, pregnant women in the UK were placed in the category of ‘vulnerable people’, meaning that they should adopt stringent social distancing practices to reduce their risk of infection. There is no data from the current outbreak, but other related coronavirus infections, such as severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), did cause serious illness in some pregnant women. Adding pregnant women to the category of vulnerable people is a precautionary, preventative step aimed at reducing the risk of severe infection, on the basis of the limited data we have thus far.
It is imperative, therefore, that pregnant women take all necessary steps to avoid infection:
- Wash hands regularly and thoroughly.
- Adopt stringent personal respiratory hygiene approaches. Cover your mouth when you cough or sneeze. Avoid touching your eyes, mouth or nose.
- Avoid coming into contact with those who are unwell, particularly if they have tested positive for COVID-19.
I have been diagnosed with COVID-19, am I more likely to experience complications in my pregnancy?
This is another question that is very difficult to answer with the limited data we currently have available to us. However, data on other viral respiratory illnesses has suggested that pregnant women are at higher risk of obstetric complications, than their non-infected counterparts. Infection with SARS-CoV or MERS-CoV during pregnancy did increase the possibility of complications; for example, SARS has been shown to restrict foetal growth and MERS has been implicated in cases of placental abruption.
There is no evidence that COVID-19 increases the risk of miscarriage, and data on the other coronaviruses has been inconclusive in terms of identifying a direct link. However, COVID-19 might increase your risk of premature delivery. This is evident in the preliminary data to come out of China, but it is not yet clear whether these were induced deliveries, performed to enable better management of the expectant mother’s symptoms.
What are the risks to my unborn child if I develop COVID-19?
Vertical transmission is the name given to an infection that passes from the mother to the child whilst the child is in the womb (in utero). There are very few reported cases of newborns testing positive for COVID-19. A recent case made it into the UK press of a newborn and his mother both testing positive, and there are reports of a similar case in China, earlier on in the outbreak. It is not yet known whether either baby developed the condition in utero, or whether the hospital environment, or exposure to the mother’s coughing at birth, resulted in viral transmission. Regarding the UK case, it is also not known whether the infant went on to develop any COVID-19 symptoms; in general, children appear to experience only mild symptoms.
There have been a limited number of studies looking at mothers who were infected with the virus during the third trimester of pregnancy and went on to deliver healthy, non-infected babies. Naturally, to date, these studies only involve a very small number of cases and further work is definitely required. However, the take home message should be that whilst it is impossible to say that vertical transmission does not happen, the evidence to date suggests it is not inevitable and mothers who have the virus are not guaranteed to pass it on to their child.
The RCOG do not recommend Caesarean section (C-section) as standard for patients with COVID-19; a vaginal birth may still be possible, depending on the severity of the mother’s symptoms. If she is experiencing pronounced respiratory difficulties, a natural birth is likely to exacerbate things and her doctor will probably recommend a C-section. Birthing pools are not recommended for women who have tested positive for COVID-19.
What should I do if I start to develop COVID-19 symptoms during pregnancy?
First and most importantly, don’t panic. You will need to follow the guidelines stipulated by the country you live in. At this moment in time, different countries have different policies and recommendations in place. Maintain contact with your doctor or midwife; provided your pregnancy is otherwise low risk and not at a critical stage, they will probably want to postpone any scheduled antenatal appointments.
As time passes, an increasing number of doctors and midwives are likely to conduct appointments via video conferencing, even for those who do not have any COVID-19 symptoms. This will enable all patients to limit social contact.
If symptoms do become severe, you will likely be hospitalised and placed in isolation. Your baby will be closely monitored and a multidisciplinary team of specialists will construct an individualised management strategy, to ensure the best outcome for you and your baby.
Final note
These are unusual times and we still have much to learn and discover about COVID-19. Even the most simple questions cannot yet be definitively answered and rumours and speculation are rife. We have used the most trusted sources and evidence to bring you this information and will commit to updating regularly, as our knowledge and understanding grows.
At Nabta Health, we will present the facts as they stand today; we can attempt to offer reassurance and will stress the importance of continuing to look after not only your physical health, but also your mental health.
Take care.
Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause.
Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you.
Sources:
- Chen, Yan, et al. “Infants Born to Mothers With a New Coronavirus (COVID-19).” Frontiers in Pediatrics, vol. 8, 16 Mar. 2020, doi:10.3389/fped.2020.00104.
- “COVID-19 Virus Infection and Pregnancy.” Royal College of Obstetricians & Gynaecologists, www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/. Based on: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-covid19-pregnancy-guidance-2118.pdf.
- Favre, Guillaume, et al. “2019-NCoV Epidemic: What about Pregnancies?” The Lancet, vol. 395, no. 10224, 22 Feb. 2020, doi:10.1016/s0140-6736(20)30311-1.
- Mullins, E., et al. “Coronavirus in Pregnancy and Delivery: Rapid Review.” Ultrasound in Obstetrics & Gynecology, 2020, doi:10.1002/uog.22014.
- “Novel Coronavirus (2019-NCoV) Situation Reports.” World Health Organization, World Health Organization, www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.
- “Pregnancy & Breastfeeding.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html.
- Rasmussen, Sonja A., et al. “Coronavirus Disease 2019 (COVID-19) and Pregnancy: What Obstetricians Need to Know.” American Journal of Obstetrics and Gynecology, 24 Feb. 2020, doi:10.1016/j.ajog.2020.02.017.
- Schwartz, David A., and Ashley L. Graham. “Potential Maternal and Infant Outcomes from Coronavirus 2019-NCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections.” Viruses, vol. 12, no. 2, 10 Feb. 2020, p. 194., doi:10.3390/v12020194.
- Wang, Xiaotong, et al. “A Case of 2019 Novel Coronavirus in a Pregnant Woman with Preterm Delivery.” Clinical Infectious Diseases, 28 Feb. 2020, doi:10.1093/cid/ciaa200.
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Coronavirus disease 2019 ([COVID-19](https://nabtahealth.com/covid-19/)) has affected large parts of the world and has now reached pandemic status. As of the 22nd of May, the SARS-CoV-2 virus had spread to 188 countries with over 5 million cases and more than 300,000 deaths worldwide. This disease is caused by a respiratory virus called severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). More data is emerging on the variability of outcomes caused by COVID-19. The infection affects populations and individuals in different ways, and this seems to be dependent on a combination of biological, [socioeconomic](https://nabtahealth.com/glossary/socioeconomic/) or [sociodemographic](https://nabtahealth.com/glossary/sociodemographic/) factors, which may or may not be linked to underlying health conditions. 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Data gathered to date by Johns Hopkins University show that case-fatality rates range from 0-16% by country, suggesting that there are ethnic and [socioeconomic](https://nabtahealth.com/glossary/socioeconomic/) factors that contribute to the risk of dying from COVID-19. As more data emerges, and with further research, the clinical and scientific community will begin to understand the role that genetic, social, and cultural factors play in controlling the rates and outcomes of infection. To date, three main demographic factors present disproportionate risks as summarised below. #### **Gender** COVID-19 appears to adversely affect the male population more than the female. Men are at increased risk of developing moderate to severe symptoms once infected with the SARS CoV-2 virus. As a result, data published to date is showing that men are, on average, twice as likely to be critically hospitalised or die once infected by the virus. More research is required to understand how females are more protected from SARS CoV-2 than men, but it is possible to extrapolate this based on the fact that the X chromosome carries a number of important genes that have an important role in the regulation of the immune system. Therefore, the reduced susceptibility of females to the acquisition of symptoms associated with viral infection can be attributed to the X chromosome. In males, the presence of a single X chromosome, compared to the two copies that females carry, means that they can be more immuno-compromised under certain conditions. There are also lifestyle and cultural aspects which can put men in a higher risk category than women such as [smoking](#smoking) and alcohol. #### **Age** Individuals of any age can contract SARS CoV-2, with or without becoming symptomatic. To date, COVID-19 has affected significantly more individuals in the 65 and over age bracket, and less of the younger population. Studies have shown that advanced age puts individuals at a higher risk of experiencing severe symptoms once infected with SARS CoV-2; meaning that this age group is more likely to require hospitalisation. Age also correlates with the acquisition of non-communicable disorders such as [hypertension](https://nabtahealth.com/glossary/hypertension/), chronic renal disease and diabetes. In the context of COVID-19, over 70% of those who have been hospitalised with the infection over the age of 65 have at least one underlying health condition. In general, the ability of our bodies to regenerate slows down with age, and this applies to all organs, including the skin, gastrointestinal tract, liver and immune system. As a result, the older you are, the less likely your body is able to effectively or rapidly clear infections. Maintaining a balanced diet and partaking in regular exercise gives you a better chance of maintaining a healthy body to fight infections. This is particularly important if you are in the older population group. However, despite the clear correlation between age and disease severity, certain young adults and children can also experience critical symptoms following infection with SARS CoV-2 for reasons that are not yet well understood. Caution, protection and healthy lifestyle choices must be adopted by all. #### **Body Mass Index** Your body weight can be used as an indicator to determine how at risk you are of developing severe or critical COVID-19 symptoms. An optimal [Body Mass Index](https://nabtahealth.com/what-is-body-mass-index-bmi/) ([BMI](https://nabtahealth.com/glossary/bmi/)) is 18.5-24.9 kg/m2 and if you lie within this range, you are considered to have a healthy weight. People in this category have enough body fat to function effectively. Body fat, or adipose tissue, is an essential component of every organ and cell in our body; it has multiple roles, including insulation, energy storage, and the maintenance of hormones. Fat cells are also a source of [stem cells](https://nabtahealth.com/glossary/stem-cells/) which can differentiate into other cell types, such as bone and nerve cells, as required. These [stem cells](https://nabtahealth.com/glossary/stem-cells/) therefore, have regenerative capabilities which are able to replace damaged or otherwise compromised tissues in our body as needed. Overweight individuals with a [BMI](https://nabtahealth.com/glossary/bmi/) above 25 kg/m2 and obese individuals with a [BMI](https://nabtahealth.com/glossary/bmi/) above 30 kg/m2 are at higher risk of developing multiple health disorders, such as cardiovascular disease, stroke, and cancer. They are also more likely to be severely or chronically symptomatic if infected by SARS CoV-2. Having an excess of body fat means you are likely to be in a chronic state of low-grade [inflammation](https://nabtahealth.com/glossary/inflammation/), which can impair your immune system’s response to infection. If infected, the obese are more likely to be hospitalised because their bodies are unable to fight the infection effectively, either as a direct correlation of excess body fat, or as an indirect correlation with the other health disorders that accompany obesity and which put individuals at a higher risk. If you have a [BMI](https://nabtahealth.com/glossary/bmi/) below 18.5 kg/m2 you are classed as being underweight, meaning that your body is not storing enough body fat, giving you less overall protection. Being underweight weakens your immune system and puts you at increased risk of developing severe COVID-19 symptoms. Individuals who are underweight may be malnourished, and as a result may lack some of the essential nutrients, vitamins and minerals necessary for their cells and organs to function properly. This makes them more vulnerable to any external challenges or insults, such as complications arising from infection with a virus. Obese, overweight and underweight individuals should consider contacting a local healthcare provider and a nutritionist who can help them make a healthy and monitored weight loss or gain plan. #### **Underlying health conditions** COVID-19 has shown selectivity towards vulnerable individuals with underlying non-communicable disorders (NCDs). Some of the most prevalent NCDs include type 2 diabetes, [hypertension](https://nabtahealth.com/glossary/hypertension/), cardiovascular disease, chronic lung conditions, chronic kidney disease, chronic liver disease and cancer. This trend is consistent world-wide, as more statistics on patients emerge from the clinical and scientific community at large. Here, we outline a number of NCDs which have been shown to impact responses to the infection, and explore why individuals with these conditions are at risk of more severe COVID-19 symptoms. #### **Diabetes mellitus** If you have diabetes, you are unable to properly regulate blood glucose levels due to insufficient insulin production or reduced insulin sensitivity. Lack of insulin, or the inability of cells to respond to insulin, results in high blood glucose levels which puts you in a hyperglycaemic state. Under normal conditions, one of insulin’s functions (it has many others) is to signal your body to activate white blood cells, which are the main cells in our blood and lymph nodes that fight infections. Therefore, when the body is unable to produce sufficient amounts of insulin, a dysfunction of the immune system may occur, putting the individual at risk. A compromised immune system will be less able to control the spread of, and manage the symptoms associated with, invading pathogens such as SARS CoV-2. Being in a hyperglycemic state puts pressure on one’s body, which can result in damage to multiple organs such as the heart, kidney and nervous system . Individuals with either type 1 or type 2 diabetes are, therefore, at higher risks of developing health complications such as the acquisition of [cardiovascular disease](#CVdisease), [renal disease](#kidney) and peripheral nerve damage which also in turn put them at a higher risk of being negatively affected by infections and other external pressures. If you are diabetic, it is important to keep taking your medications as required. Those who are on insulin replacement therapy should monitor their body’s sensitivity to insulin which may determine the appropriate dose of insulin to take in order to avoid being in either a hyper- or hypo-glycaemic state. 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When combined with [arrhythmia](https://nabtahealth.com/glossary/arrhythmia/), which is a common feature seen in vulnerable individuals infected with SARS CoV-2, it puts pressure on the heart and affects how well it functions. There are recent findings that suggest that blood clotting events which are a characteristic of COVID-19 disease progression, are also responsible for some of the cardiovascular events observed in individuals who have died from the infection. This is supported by evidence suggesting that individuals who are on blood thinning medication have significantly improved survival rates compared to those who are not on medication. It is well established that [inflammation](https://nabtahealth.com/glossary/inflammation/) contributes to cardiovascular disease progression. Perpetual [inflammation](https://nabtahealth.com/glossary/inflammation/) can also damage the heart muscle and exhaust the immune system. Having a compromised heart and a dysfunctional immune system are likely to be the main contributory factors leading to cardiac failure in COVID-19 patients. #### **Chronic Lung Conditions** Having long-term conditions that result in recurrent [inflammation](https://nabtahealth.com/glossary/inflammation/) in the lungs such as asthma, Chronic Obstructive Pulmonary Disorder (COPD), and [cystic fibrosis](https://nabtahealth.com/glossary/cystic-fibrosis/) (CF) make individuals more susceptible to respiratory lung infections. The lungs are home to specialised white blood cells which help to protect them from inhaled pathogens and toxins under normal circumstances. However, individuals who have compromised lungs, either due to perpetual [inflammation](https://nabtahealth.com/glossary/inflammation/) or abnormal function of the epithelium in the lungs, may result in a state of immune and tissue exhaustion and damage; making the lungs more vulnerable to infection or challenge. In addition, controlling lung [inflammation](https://nabtahealth.com/glossary/inflammation/) in individuals with chronic or acute asthma may require the individual to use [immunosuppressive medications](#immunosuppressive) such as steroids, which will dampen the immune response and make them more vulnerable to infection. In general, the more chronic the condition, the more likely that a person is compromised, either due to long term medication use or as a result of the pressure the disease poses on lung tissue. Individuals with CF are at a high risk of developing other lung complications because the disease is caused by a genetic dysfunction which affects the level of salt in cells. This leads to water imbalance which can clog up highly vascular organs such as the lungs and digestive tract. In the lungs, this affects the air flow in and out of the lungs, resulting in respiratory distress. 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Individuals with progressive, aggressive or metastatic disease requiring treatment should take extra caution to protect themselves and self-isolate. See [immunosuppressive treatment](#immunosuppressive) section for further information. #### **Liver Disease** Having chronic liver disease may put you at risk of experiencing severe symptoms once infected with SARS CoV-2. Compromised blood liver functions are a common feature in individuals who are critically hospitalised with COVID-19. The liver is an essential [detoxifying](https://nabtahealth.com/glossary/detoxifying/) organ. Its primary function is to filter blood from the digestive tract and the rest of the body. The liver also stores and releases glucose as needed, makes [cholesterol](https://nabtahealth.com/glossary/cholesterol/), and stores [iron](https://nabtahealth.com/glossary/iron/). The liver holds certain types of white blood cells, and supports immune function by clearing infections. Liver disease involves a process of progressive destruction and regeneration of the liver, often leading to scarring and permanent damage. This progressive liver damage often causes a dysfunction in [metabolism](https://nabtahealth.com/glossary/metabolism/), leading to [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) or impaired insulin production (see [diabetes](#diabetes) section). This in turn affects the immune system and the ability of the body to clear infection, thus hindering the way the body responds to infectious pathogens such as SARS CoV-2. #### **Kidney Disease** As more data emerges on the clinical characteristics of individuals who have been hospitalised or who have died from COVID-19, it is becoming apparent that the most affected organs, after the lungs, are the kidneys. Kidney disease occurs when the kidneys are unable to filter out water and waste from the blood effectively. The filtration of waste products is a natural part of the metabolic process; therefore, factors such as medication, environmental pollution and infection that add to waste generation, also add to the pressure on the kidneys to work efficiently and effectively. Kidneys have historically been thought of as organs that are unable to regenerate, but new research shows that they do have regenerative capabilities, but this process is likely to be slow. As cellular turnover slows down naturally with age, and because age is directly associated with acquisition of kidney disease (see [age](#age) section), recent reports from the USA show that most of the COVID-19-related deaths to date in individuals over 65 have concurrent kidney failure as the main cause of mortality. If compromised kidney function means that the body is not able to effectively filter invading pathogens and toxins, infection with SARS CoV-2 will put additional pressure on the kidneys, potentially leading to kidney damage and toxic shock which will require immediate hospitalisation. Individuals with NCDs such as kidney disease should take their conditions very seriously and talk to a designated healthcare provider about putting appropriate measures in place to protect themselves. Maintaining good hydration and a healthy lifestyle is key. ### **Other factors** #### **[HIV](https://nabtahealth.com/glossary/hiv/)/ AIDS** Testing positive for Human Immunodeficiency Virus ([HIV](https://nabtahealth.com/glossary/hiv/)) does not make you more susceptible to developing severe COVID-19 symptoms, provided you are on effective [antiretroviral](https://nabtahealth.com/glossary/antiretroviral/) treatment. However, if you are not on appropriate treatment, the [HIV](https://nabtahealth.com/glossary/hiv/) virus is free to attack your immune system, putting you at a higher risk of developing AIDS. AIDS stands for Acquired Immuno-Deficiency Syndrome. As the name indicates, this is a progressive condition that results in destruction of the immune system. Without a functioning immune system, you will become immunocompromised, meaning that it will be more difficult for your body to fight an infection. This increases the likelihood of you experiencing more severe symptoms, should you become infected with SARS CoV-19, of. If you have [HIV](https://nabtahealth.com/glossary/hiv/) you should already be under care of an appropriate healthcare provider who can properly monitor your condition. #### Smoking Tobacco smoke exposure increases susceptibility to respiratory tract infections such as COVID-19. Smoking is known to damage the lungs and airways which causes a range of severe respiratory problems (see [chronic lung conditions](#lung)), it also puts you at a high risk of developing lung cancer and [cardiovascular disease](#CVdisease), the latter is the risk factor most frequently seen in those individuals who have died from COVID-19. Smoking does not only directly affect you, it also puts those around you who are exposed to secondhand smoke at risk. In light of the current pandemic, there has never been a more important time to stop smoking, not only for your own health, but also to protect those around you. If you are using e-cigarettes or other ‘vaping’ devices, recent clinical and scientific evidence has suggested that these pose a similar threat to the health of your lungs and heart. E-cigarettes contain chemicals that are not present in traditional cigarettes, but which have additional health implications associated with them. E-cigarettes also carry an additional hygiene risk due to reuse of mouth pieces, which means you are more likely to expose yourself to pathogens, such as SARS-CoV-2, which can survive on a variety of surfaces. #### **Immunosuppressive medication or treatment** There are many medications, treatments and medical procedures that can temporarily reduce the ability of your immune system to fight infection. In this section, we will provide a few examples; however, if you are on any medication or have undergone a medical procedure recently which makes you immune compromised, you should be in regular contact with your healthcare provider. They will be able to determine how vulnerable you are to acquiring severe or critical COVID-19 symptoms and advise you which steps to take to reduce your chances of catching this, or any, infection. * **Immunosuppressants** Drugs that suppress the immune system such as certain biologics (recombinant proteins) and glucocorticoids (steroids), inhibit white blood cells activity or function. These cells are the main fighters of infection in the body and, therefore, taking drugs that stop them from working effectively or reduce their numbers, affects the ability of the immune system to fight infection. This makes you more susceptible to severe symptoms following infection with SARS CoV-2. * **[Chemotherapy](https://nabtahealth.com/glossary/chemotherapy/)** One of the most widely used treatments for cancer is [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). The mechanism of chemotherapeutic agents is to destroy rapidly growing cells by damaging DNA and other factors involved in cell division. Because of its mechanism of action, [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) also attacks the highly dividing and healthy cells of the body such as the [stem cells](https://nabtahealth.com/glossary/stem-cells/) of the bone marrow. These [stem cells](https://nabtahealth.com/glossary/stem-cells/) are responsible for providing a continuous supply of the disease fighting, white blood cells. During and immediately after [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) your body is less able to defend itself against infection. Individuals who have certain types of [cancer](#cancer) may already be at an increased risk of experiencing severe COVID-19 symptoms; and if the same individual is also undergoing [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/), extra protection and caution should be considered. * **Bone marrow transplantation** is a procedure that aims to replace otherwise damaged or destroyed bone marrow with healthy bone marrow. The first step involves [radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) to partially or completely eliminate faulty [stem cells](https://nabtahealth.com/glossary/stem-cells/). The aim is to reintroduce healthier bone marrow via a transplant. As described above, the bone marrow is an essential source of infection-fighting white blood cells. The period between bone marrow elimination and transplant acceptance (i.e. the body adjusting to its new, healthier bone marrow) is around 6 weeks, and this can vary from person to person. During this critical time, a transplant recipient is at extremely high risk of acquiring infections. This includes infection with SARS CoV-2. #### **Living in a care facility or nursing home** Nursing home populations are at the highest risk of being affected by COVID-19 compared to the general population because they have a high proportion of [older](#age) adults who are often living with underlying chronic medical conditions which puts them at risk of experiencing severe or chronic symptoms if infected with SARS-CoV-2. To protect all who live and work in nursing homes and care facilities, regular cleaning and disinfection of common areas, appropriate [social distancing](https://nabtahealth.com/what-is-social-distancing/), and self-isolation measures where required, should be implemented. It is important that carers, who may carry the virus but may not be at risk themselves, also take the necessary steps to protect those residents who are considered high risk. This includes social distancing as much as possible and wearing appropriate Personal Protective Equipment (PPE). #### **Working in a healthcare environment** Being a doctor, nurse or an individual working in a hospital or clinic means that you may have regular exposure to patients who may have tested positive for SARS CoV-2 and, therefore, there is a risk of them passing the infection on to you. Take sensible precautions when handling infected patients; use PPE when at work, such as masks, a clinical coat/suit and gloves, and ensure that it is changed on a regular basis. Outside of work, take steps to protect yourself and those around you who may be vulnerable to infection. Use best practice for maintaining hygiene, including removal of potentially contaminated clothing whilst still at work, washing hands with soap and water, and disinfecting any other materials that may come in contact with others outside the hospital setting. #### **Contact with an infected or exposed individual / environment** Being in close contact with someone who has COVID-19, or someone who has been exposed to the SARS CoV-2 virus, puts you at high risk of infection, which is increased if you have other confounding factors, such as those mentioned in this article. Because the majority of individuals who are exposed to the virus do not display obvious symptoms, extra care to protect yourself should be taken if you are in a high risk category. Based on current data surrounding the length of time the virus remains in our bodies (the incubation period), you should self-isolate for at least 14 days from the time of potential exposure (Day 0) to minimise passing the infection to others. ### **Conclusion** As this article shows, many of the factors that result in an individual becoming ‘high risk’ occur as a result of underlying health conditions. Therefore, it is important to ensure that your current health status is under control and that medication, where required, is taken appropriately. Being aware of the signs of infection such as a fever, cough, shortness of breath, is key. Call ahead before visiting a health care provider or emergency department to alert them to the fact that you have been exposed to the virus. If you are in a country which has implemented tools to alert or monitor infected or potentially infected individuals, you may wish to adopt some of those tools to protect those around you and reduce the chance of cross contamination. The general recommendation is to limit hospital visits and contact with healthcare facilities where ever possible. If you have a chronic condition and require ongoing medical care or monitoring, provided your doctor is okay with it, consider using telehealth, electronic consultations and remote care, as appropriate. If you are considered high risk and require medications or a pharmacy visit, think about asking others who are less vulnerable to pick up what is needed. It is important to keep taking your medications as recommended. Nabta Health is committed to providing you with the most up to date, peer-reviewed, clinically- and scientifically-validated information on COVID-19 and other conditions. If you are not sure what your, or your loved ones’, risk factors are, Nabta Health has built a risk assessment questionnaire, which can be accessed from our Application. The Nabta App can be downloaded from our website ([www.nabtahealth.com](http://www.nabtahealth.com)). **References:** * [https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html](https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html) * Madjid, M., _et al_. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. _JAMA Cardiol._ Published online March 27, 2020. * Ruparelia, N., _et al._ Inflammatory processes in cardiovascular disease: a route to targeted therapies. _Nat Rev Cardiol_ 14**,** 133–144 (2017) * Libert, C.,_et al_. The X chromosome in immune functions: when a chromosome makes the difference. _Nat Rev Immunol_ 10, 594–604 (2010) * ue Tsai, Xavier Clemente-Casares, Angela C. Zhou, Helena Lei, Jennifer J. Ahn, Yi Tao Chan, O.C., et al. Insulin Receptor-Mediated Stimulation Boosts T Cell Immunity during [Inflammation](https://nabtahealth.com/glossary/inflammation/) and Infection. _Cell [Metabolism](https://nabtahealth.com/glossary/metabolism/)_ 28 (6), 922-934 (2018) * Muniyappa, R. and Gubbi, S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. _Am j physiol. Endocrinology and [metabolism](https://nabtahealth.com/glossary/metabolism/)_ 318(5), E736-E741. (2020) * Hanna, T. P. _et al_. “Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. _Nature rev clin oncol_ 17(5) 268-270. (2020) * [https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf](https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf) * Jafar, N., _et al_. The Effect of Short-Term Hyperglycemia on the Innate Immune System. _Am J of Med Sci_, 351 (2), 201-211 (2016) * Cheng, Y., _et al_. Kidney disease is associated with in-hospital death of patients with COVID-19. _Kidney int._ vol. 97 (5), 829-838 (2020) * Parohan, M., et al. Liver injury is associated with severe Coronavirus disease 2019 (COVID‐19) infection: a systematic review and meta‐analysis of retrospective studies. _Hepatol Res_. (2020) * [https://coronavirus.jhu.edu/map.html](https://coronavirus.jhu.edu/map.html) * Ishan, P., _et al_. Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. J Am College Cardiol. (in press) (2020).
Is Performing a C-Section Better Than Inducing Labour? [2024]
Is Performing a C-Section Better Than Inducing Labour, when it comes to giving birth, usually the preferred option is to let labour proceed naturally. However, there are times when it is not in the mother or baby’s interest for this to happen. When the health of either is at risk, or if gestation has exceeded [41 weeks duration,](https://nabtahealth.com/articles/doctor-tips-weeks-27-40/) then it is highly probable that an alternative strategy will need to be implemented. There are two options available, [inducing labour](../) or performing a [C-section](../). With an induction, the [uterus](https://nabtahealth.com/glossary/uterus/) is artificially stimulated to contract, and it is then hoped that labour will proceed as per a natural delivery. In contrast, a C-section is a surgical procedure, whereby a cut is made in the abdomen and the baby is removed that way, rather than via the [vagina](https://nabtahealth.com/glossary/vagina/). Sometimes the only safe option is to perform a C-section, for example if the baby is breach, or when an emergency situation arises. However, there are other times when you may be presented with a choice and if this happens, what is the correct answer? Unfortunately there is no definitive right answer. An induction can be at least as safe as spontaneous labour and, if performed in the week prior to the [due date](https://nabtahealth.com/glossary/due-date/), it is thought to reduce [the risk of](https://nabtahealth.com/articles/what-is-preeclampsia/) [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/) in the mother and respiratory distress in the child, possibly as a result of the [placenta](https://nabtahealth.com/glossary/placenta/) remaining fully functional. Unlike C-sections, inductions are not surgical procedures and thus, if all goes to plan, the recovery period is shorter. It is however, a big ‘IF’. [Induced labours](https://nabtahealth.com/articles/induction-of-labour/) are typically more painful, meaning more women will request stronger pain relief including epidurals, and there is a greater likelihood of assisted delivery, such as the use of forceps or ventouse. There is also an increased [risk of hyperstimulation](https://nabtahealth.com/articles/what-is-ovarian-drilling/) of the [uterus](https://nabtahealth.com/glossary/uterus/)., Uterine hyperstimulation causes more frequent, longer [contractions](https://nabtahealth.com/glossary/contraction/), which can [lead](https://nabtahealth.com/glossary/lead/) to complications such as foetal heart rate abnormalities and, in rare cases, uterine rupture. In a significant number of women, induction does not work and a C-section becomes necessary. The advent of the C-section was undoubtedly a medical revolution, instantly saving the lives of millions of women and children. However, C-sections bring with them all the risks of regular surgery, including blood clots, wound infection and bleeding. The recovery period is typically longer after a C-section than after a natural birth, driving restrictions are enforced and a scar remains, although this will fade over time. Whilst current guidelines stipulate that an induction should only be performed when [the risks of continuing the pregnancy](https://nabtahealth.com/articles/complications-during-pregnancy-polyhydramnios/) outweighs the benefits, with more women than ever requesting elective C-sections, the World Health Organisation has highlighted an urgent need for medical assessment efforts to address the risks of induced labour compared to elective C-section. Until such work is undertaken, it becomes a matter of individual circumstance, personal choice and ultimately weighing up what is best for you and your baby. **Sources:** * Grobman, W A, et al. “Labor Induction versus Expectant Management in Low-Risk Nulliparous Women.” _The New England Journal of Medicine_, vol. 379, no. 6, 9 Aug. 2018, pp. 513–523., doi:10.1056/NEJMoa1800566. * WHO Recommendations for Induction of Labour. World Health Organisation, [http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156\_eng.pdf?sequence=1](http://apps.who.int/iris/bitstream/handle/10665/44531/9789241501156_eng.pdf?sequence=1). Accessed on 23/01/2019. * _Inducing Labour. Clinical Guideline \[CG70\]_. NICE (National Institute for Care and Health Excellence), July 2008, www.nice.org.uk/guidance/cg70/chapter/Introduction. Accessed on 23/01/2019