Transmission of COVID-19 from mother to baby probable during pregnancy: ICMR

It is important to note that these are new findings; it was previously believed that the virus cannot cross the placenta and infect the baby.

Myupchar April 14, 2020 17:27:42 IST
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Transmission of COVID-19 from mother to baby probable during pregnancy: ICMR

According to an updated version of ‘Guidance for Management of Pregnant Women in COVID-19 Pandemic’ by the Indian Council of Medical Research (ICMR), vertical transmission of COVID-19 from mother to baby is ‘probable’. This means that a COVID-19 positive mother may be able to transfer the infection to the baby in utero (when the baby is still in the womb). The document adds that it is unclear what proportion of pregnancies are affected, and what the prognosis is for the newborns.

Transmission of COVID19 from mother to baby probable during pregnancy ICMR

Representational image. Image source: Getty Images.

The document also clarifies that no evidence of the virus has been found in breastmilk, so COVID-19 positive mothers can still breastfeed. However, ICMR recommends separating the mother from the baby, using a pump and thoroughly sterilizing all the equipment involved to reduce the risk of transmission.

For now, there is no evidence suggesting that one mode of birth is superior to another; caesarian sections can be carried out as long as the medical staff has donned PPE. Further, even given the new evidence, medical termination of pregnancy is not advised as per the ICMR guidelines.

What evidence is the document based on?

It is important to note that these are new findings; it was previously believed that the virus cannot cross the placenta and infect the baby. An oft-cited Lancet study of nine infants who were born to COVID-19 positive mothers showed no evidence of the virus transmitting. Earlier this month, an AIIMS couple that had tested positive delivered a healthy COVID-19 negative baby to much celebration.

However, a trio of studies have thickened the plot and shed scepticism on these beliefs. In two of the studies, researchers found Immunoglobulin M (IgM, a type of antibody produced in response to COVID-19) in some of the newborns. IgM is too large to cross the lining of the placenta, and its presence also indicates that the virus has been in the system for a longer period of time. These findings suggested to the researchers that the virus was in the babies before the delivery. Serological testing was used to confirm this; placental samples were not taken, which some cite as a limitation of the study.

In the third study, published in JAMA, 3 out of 33 infants born to COVID-19 positive mothers later tested positive for the virus. They all developed respiratory symptoms, but the silver lining is that they all recovered within a week. However, in this study, the babies were tested two days after delivery, so they could have contracted the disease after birth. But since due diligence was followed to clamp down on transmission, the suspicion of in-vitro transmission cannot be completely ruled out. 

The UK NHS also issued similar guidelines. Although only one case of in-vitro transmission (a case that is also disputed) has been reported, the NHS says vertical transmission is probable. 

In light of what we know

Encouragingly, there is no evidence to suggest that the virus is present in amniotic fluid or breastmilk. Cases in newborns also seem to be mild. Having said that, this is a developing situation so an abundance of caution is the best way forward currently. The ICMR recommends expectant mothers be even more thorough in maintaining physical distance and ramping up personal hygiene measures.

For more information, read our article on Pregnancy and COVID.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

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