Coronavirus in pregnancy: current knowledge and background information

Lesedauer

ca. 9 Minuten

Datum

Stand: 3.3.2020

With the spread of the coronavirus in Germany, the concern is also growing in this country. We have compiled important information about the coronavirus for you.

Coronavirus in pregnancy

So far, it has become known that embryos are apparently protected in the womb from infection with the novel SARS corona virus 2 (Sars-CoV-2). A small observational study from China argues against infection of the unborn child, as reported by the research team in the journal The Lancet (Chen 2020). The researchers concluded that SARS-CoV-2 cannot be found or transmitted in amniotic fluid, umbilical cord blood or breast milk. There are also no negative effects on the newborn, according to the study results. A total of 9 women studied from the Chinese city of Wuhan had contracted pneumonia triggered by Covid-19 in the 3rd trimester of pregnancy. The children were all born healthy by cesarean section and had not become infected. However, the study authors emphasize that it is not yet clear how the new coronavirus affects the early stages of pregnancy. Also, whether the virus can be transmitted to the child during a vaginal birth remains an open question. Further observational studies with significantly larger numbers of cases are needed to determine this.

The concern that the coronavirus could be transmitted from mother to unborn child stems from reports of a newborn who tested positive for covid-19 within 36 hours of birth. However, it had contracted the virus from the mother via droplet infection only after birth.

Disease symptoms

Infection with the novel coronavirus can lead to symptoms of illness such as cough, runny nose, headache, scratchy throat and fever. In rare cases, affected individuals also suffer from diarrhea. In the cases reported from China so far, four out of five courses of illness have been mild. In a small proportion of patients, the virus can be associated with a more severe course, leading to respiratory problems and pneumonia. However, deaths have so far occurred mainly in patients who were older and/or had previously suffered from underlying chronic diseases. No deaths have yet occurred in Germany. According to a Chinese study, 80.9% of those infected experienced a mild course of the disease. The data come from the Chinese Center for Disease Control and Prevention (Görmann 2020). Since the symptoms of coronavirus and influenza are hardly distinguishable, so far one should stay in a risk area or contact with infected persons has been decisive for a coronavirus test. Samples are taken from the upper and lower respiratory tract. This is done over several swabs, for example.

Transmission

Coronaviruses are transmitted primarily by droplet infection. When an infected person exhales, sneezes or coughs, he or she spreads microscopic droplets in the air that may contain the virus. Smear infection is also possible: if someone sneezes into their hands and then touches a doorknob, for example, they can infect someone who subsequently picks up the same doorknob and then touches their hand to their mouth, for example. Good hand hygiene is therefore an important part of prevention.

Who is particularly at risk?

The findings to date on the novel coronavirus show that people over 60 years of age and the chronically ill are particularly at risk. They belong to the so-called vulnerable groups. Children and healthy adults usually develop only mild symptoms such as a cold and mild fever or do not even notice that they have been infected. This is also the reason why the virus can spread so rapidly. Men seem to be affected slightly more often than women. According to a report in the New York Times, women generally have better immune defenses, so women seem to be better able to fight respiratory illnesses (Rabin 2020).

Are children also affected?

Children are hardly affected by the disease, but they can probably be infected and also transmit the virus. Disease with Covid-19 in children usually appears to be very mild. This clearly distinguishes the new pathogen from influenza and other respiratory diseases, which are often particularly risky for children. Kindergartens and schools are in close contact with the relevant authorities.

How can I protect myself from infection?

Pregnant women should follow the same precautions that the Robert Koch Institute recommends as protection against flu infections for the entire population: First and foremost, this includes frequent, thorough hand washing and refraining from greeting people with a handshake. It is also important to follow the correct “cough and sneeze etiquette” (always sneeze and cough only into the crook of your arm or into a handkerchief, never into your hand) and to keep your distance (1-2m) from people suspected of being ill. The World Health Organization (WHO) recommends avoiding touching the eyes, nose and mouth. This can prevent the virus from entering the body through the mucous membranes. However, these measures are advised everywhere and at all times in view of the flu epidemic. In addition, it is advisable to ventilate rooms frequently and not to touch elevator buttons, (daycare) door handles, etc. with bare fingers during the period of infection. Experts consider the wearing of normal breathing masks to be less useful.

Keep calm, avoid panic

The virologist Prof. Drosten explained at the Federal Press Conference on March 2, 2020: “There are many mild cases. It’s basically like a cold.” For individuals, therefore, the disease is not a major problem if they do not belong to a risk group, he said. Influenza viruses, which cause viral flu in our country, were responsible for about 25,000 deaths in the great flu wave of 2017/2018, because pneumonia can also threaten here in severe courses. Nevertheless, no one panics here anymore – we have simply become accustomed to the danger. So much so that many pregnant women forego a flu vaccination despite the recommendation of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute. During pregnancy, however, influenza can increase the risk of growth retardation and miscarriage or premature birth in the unborn child. Unvaccinated pregnant women can still get vaccinated against influenza at this time, which could prevent coronavirus and influenza from “coming together.” Ask your gynecologist for advice on this. Information on influenza vaccination during pregnancy from the Professional Association of Gynecologists can be found here.

Further procedure

According to the Robert Koch Institute, cases of infection with the new coronavirus have now been confirmed in almost all German states (as of 3/3/20). The massive efforts at all levels of the Public Health Service (ÖGD) have so far pursued the goal of detecting individual infections in Germany as early as possible and thereby delaying the further spread of the virus as much as possible. The aim in Germany is also to gain time to prepare as best as possible and to learn more about the characteristics of the virus. The aim is also to avoid, as far as possible, a clash with the wave of influenza currently underway in Germany. Containing the epidemic also remains a top priority for the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO). Concurrently, intensive research is underway to develop a vaccine against the coronavirus. However, 18-20 months is cited as the earliest possible time to develop a vaccine.

We advise everyone to remain calm above all else! Fear and panic release stress hormones, which also have a negative effect on your baby. Therefore, it is better to talk to your gynecologist about any fears you may have and get advice on protective measures. Be sure to wash your hands thoroughly and follow good “cough and sneeze etiquette.” Especially important: Choose your sources of information carefully! Especially in social media, a lot of fear is quickly stirred up, even fake news circulates! Therefore, please be sure to choose reputable sources, for example the constantly updated websites of the World Health Organization (WHO), the Federal Center for Health Education (BZgA), the Robert Koch Institute (RKI) and the Charité Berlin.

Relevant websites Overview

https://www.bzga.de/

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.infektionsschutz.de/

https://www.rki.de/DE/Home/homepage_node.html

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikobewertung.html

https://www.charite.de/klinikum/themen_klinikum/faq_liste_zum_coronavirus/

Note: Information provided in this blog post in no way a substitute for professional advice or treatment by trained and credentialed physicians.

Referenzen

Ausbreitung von Covid-19: Wie gefährlich ist das Coronavirus in der Schwangerschaft. In: t-online. https://www.t-online.de/gesundheit/krankheiten-symptome/id_87342884/coronavirus-ausbruch-wie-gefaehrdet-sind-schwangere-und-kinder-.html Zugriff: 3.3.2020

Brasch C. 2020. Coronavirus: Was jetzt für Schwangere wichtig ist. In: Eltern.de. https://www.eltern.de/schwangerschaft/coronavirus-was-jetzt-fuer-schwangere-wichtig-ist Zugriff: 3.3.2020

Bundeszentrale für gesundheitliche Aufklärung. Infektionsschutz. Antworten auf häufig gestellte Fragen zum Coronavirus.

https://www.infektionsschutz.de/coronavirus-sars-cov-2.html Zugriff: 2.3.2020

Chen H. et al. 2020. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. In: The Lancet. DOI:https://doi.org/10.1016/S0140-6736(20)30360-3

Deutschlandfunk. Prof. Dr. Christian Drosten (Institut für Virologie der Charité) im Interview vom  13.2.20. https://www.deutschlandfunk.de/virologe-zum-coronavirus-geringe-sterblichkeit.694.de.html?dram:article_id=470165 Zugriff: 2.3.20

Frauenärzte im Netz. Corona-Virus und Schwangerschaft. https://www.frauenaerzte-im-netz.de/aktuelles/meldung/corona-virus-und-schwangerschaft/ Zugriff: 2.3.2020

Frauenärzte im Netz. Impfung gegen Grippe in der Schwangerschaft.https://www.frauenaerzte-im-netz.de/frauengesundheit/impfschutz-impfungen/impfung-gegen-grippe-influenza-in-der-schwangerschaft/ Zugriff: 3.3.2020

Görmann M. 2020. Keine Panik – nüchterne Fakten. So gefährlich ist das Corona-Virus tatsächlich für uns. In: Merkur.de.

https://www.merkur.de/welt/coronavirus-deutschland-china-fakten-tote-infizierte-news-symptome-covid-19-sars-cov-2-sterberaten-zr-13566935.html Zugriff: 3.3.2020

Müller-Jung J. 2020. Die Seuche in unseren Köpfen. In: FAZ.net. https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/coronavirus-vor-was-sollen-wir-uns-fuerchten-16653022.html?utm_source=pocket-newtab, Zugriff: 2.3.20

Rabin C. 2020. Why the Coronavirus Seems to Hit Men Harder Than Women. In: New York Times online. https://www.nytimes.com/2020/02/20/health/coronavirus-men-women.html Zugriff: 3.3.2020

Robert Koch-Institut.  Aktuelle Einschätzung  zur Lage in Deutschland.https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikobewertung.html Zugriff: 2.3.2020

Robert-Koch-Institut. Fallzahlen nach Ländern. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html, Zugriff: 2.3.2020

Sars-CoV-2: Keine Übertragung auf Kind im Mutterleib. In: Ärzteblatt online. 2020. https://www.aerzteblatt.de/nachrichten/109348/Sars-CoV-2-Keine-Uebertragung-auf-Kind-im-Mutterleib Zugriff: 2.3.2020

Ständige Impfkommission (STIKO). Grippeimpfung für Schwangere. https://www.impfen-info.de/grippeimpfung/schwangere/ Zugriff: 2.3.2020

Sterblichkeit, Ausbreitung, Dauer: Top-Virologe räumt mit Zahlen-Wirrwarr um Corona auf.https://www.focus.de/gesundheit/news/unsicherheiten-abbauen-sterblichkeit-ausbreitung_id_11723764.html Zugriff: 3.3.2020

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