Published time: 02 June 2020
Authors: Elizabeth S McDonald
Keywords: Covid-19, Global Health, Public Health
Abstract
The Article by Nan Yu and colleagues1 provides timely information to inform policies concerning essential pregnant workers. In past epidemics (eg, H1N1 influenza, Middle East respiratory syndrome, and severe acute respiratory syndrome), pregnant women and their offspring have been at increased risk of morbidity and mortality.2 By contrast, the maternal, fetal, and neonatal outcomes reported by Yu and colleagues were surprisingly good. When considering this study, it is important to note that all of the women were full-term (≥37 weeks) and underwent caesarean section within 3 days of presentation. Prompt delivery allowed for experimental treatment in all women; all patients received antiviral treatment, including ganciclovir, oseltamivir, interferon, and Arbidol (ie, umifenovir) tablets. Traditional Chinese medicine, such as Jinye Baidu granules or Lianhuaqingwen capsules, or both, was also administered to four of seven women, and five of seven received the steroid methylprednisolone. Because the safety of these interventions during pregnancy is not established, infection in the first, second, or early third trimester, without immediate delivery, might not lead to similar favourable outcomes. For example, in a case series on nine pregnant women with a larger range of gestational ages and severe cardiopulmonary disease attributed to COVID-19, seven of nine died.3 Although the worse outcomes of this non-systematic series do not establish risk, they do highlight that low risk should not be assumed in the absence of multicentre databases to study pregnancy-related outcomes.
COVID-19 and essential pregnant worker policies
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