Covid during pregnancy: In rare cases, infants face complications
Several recovered Covid-19 pregnant women in the city have given birth to children with in-built antibodies against the virus, while in some rare cases, doctors have observed that such newborn babies are developing complications including multisystem inflammatory syndrome in children (MIS-C). However, paediatricians associated with paediatric Covid-task force believe that the presence of seroprevalence is not the reason, rather it is believed that antibodies protect against the virus.
Amrita Sundareswaran contracted Covid-19 during her first six weeks of pregnancy along with four of her family members. The 36-year-old recovered completely from the infection without any post-Covid complications. She delivered her first child at Nanavati Max Superspeciality Hospital on April 26. But soon, the child developed a breathing problem that worsened within 24 hours and the newborn was put under a ventilator for artificial breathing support. Her treating doctors however had no answer for the sudden development of pulmonary hypertension in the infant.
Dr Tejal Shetty, consultant paediatrician and neonatalogist at the hospital who was one of her treating doctors said that Amrita underwent an emergency caesarean section at night on April 26. Within half an hour of delivery, the newborn started developing breathing problems. Considering, 50-60% of newborns after a caesarean section has such complications, he was put under oxygen. But the next day, his breathing declined further and he was immediately put on Continuous positive airway pressure therapy (CPAP) support.
On the same day, out of curiosity, the doctors performed an antibody test on the infant and to their surprise, they found seroprevalence in his blood.
“We did a 2D ECHO test that showed the infant had developed pulmonary hypertension and the pulmonary pressure was high (66mm Hg). He was immediately kept under a ventilator as he wasn’t maintaining his oxygen on his own. After six days, we again did a 2D ECHO which showed that the pulmonary pressure had come down to 35mm Hg. The child was on a ventilator for 21 days,” she said. “It wasn’t proportionate medically and we didn’t have the answer why it was happening. Considering the medical history of the mother with Covid-19 infection, we did the antibody test,” she added. The infant was finally discharged after 33 days on May 30. He is still on medication for the pulmonary pressure but is stable.
“The child might have got exposed to the virus in the first trimester of the pregnancy when organogenesis (mass of cells turn into complete organs in the developing embryo) takes place. So, there is a possibility that during the formation, the premature lungs got exposed. This virus is just 17 months old so, maybe two years down the lane, we would have a better answer,” Dr Suruchi Desai, senior consultant, obstetrics and gynaecology who treated Amrita.
“But we have observed that when mothers who are exposed to the virus at any point of the pregnancy, babies develop some complications including minor ones,” she added.
‘MIS-C cases among new born babies’
This is not the only case where such ‘unexplained’ complications have been observed among babies with inbuilt antibodies after birth. Dr Samir Sheikh, consultant neonatologist from Wockhardt Hospital, Mira Road was involved in the birth of two babies who developed complications after delivery which pointed towards a multisystem inflammatory syndrome in children (MIS-C).
Conventionally, children after 4-6 weeks of recovering from Covid-19 develop this condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. As per doctors, though it can be deadly, most children get better with timely medical care.
“It is proven that the antibodies produced in the Covid-19 recovered mothers can be transmitted to the newborn babies. But in some cases, we have seen that it doesn’t work as a protective shield. Rather, it is detrimental for the newborn babies which leads to the development of health complications,” he said.
Dr Biraj Thakkar, a neonatologist at Akanksha Hospital and Research Institute (AHRI) in Anand who had witnessed similar cases, stating same said while Covid-19 antibodies protect adults from the virus, they can impair the immune system in newborns.
However, Dr Bakul Parekh, past president of the Indian Academy of Paediatrics (IAP) and part of the paediatric Covid task force has refuted the claims stating that such presence of antibodies in newborn babies has no role on their health.
“Newborns with inbuilt antibodies developing complications after birth happens in the rarest of rare cases. Also, it can’t be attributed to the antibodies present in their bodies. Antibodies help to fight against the pathogens, so, it is assumed that it helps in building the immunity,” he said.
Though some medical experts indicate a possibility of vertical transmission where the Sars-Cov-2, the virus that causes Covid-19, transfers from the infected mother to the foetus in the womb. However, due to a lack of scientific data, doctors aren’t certain if the newborn babies are getting infected and developing the antibodies by themselves.
“Several studies are going on but it would take time to get the answer. It took years to know that HIV can be transmitted from mother to the foetus in the womb and through breastfeeding,” said Dr Desai. Now, the hospital has started testing newborn babies with ‘unexplained’ health complications post-delivery if the mother had a history of infection. Also, placentas are being tested to find any abnormalities.
In some hospitals like the Wadia Hospital and the government-run JJ hospital, newborn babies after 7-8 days of delivery are being diagnosed with MIS-C. Dr Bela Verma, head of the paediatric department of the hospital and former president of Mumbai Association of Paediatrics said there are two possible ways that the newborn is contracting the infection— through horizontal transmission (post-delivery) or vertical transmission (pre-delivery). “Though there hasn’t been any official confirmation on vertical transmission, development of MIS-C indicates the possibility of infection in the uterus. We have got 2-3 such cases where babies have developed MIS-C within a week of delivery,” she said.
A study—‘Single-Cell RNA-seq Identifies Cell Subsets in Human Placenta That highly Expresses Factors Driving Pathogenesis of SARS-COV-2’, published jointly conducted by the Indian Council of Medical Research (ICMR)-National Institute of Research in Reproductive Health (NIRRH) at Parel and Bengaluru-based Indian Institute of Science (IISc), revealed that Sars-CoV-2 virus, which causes Covid-19, can infect the placenta in pregnant women. However, it was not established if a pregnant woman can pass on the infection to her child.
“We need more studies to establish and scientifically prove that the fetus can get infected from the virus through the placenta or any other way in the womb,” added Dr Verma.
To understand the epidemiological characteristic of the virus that is continuously mutating, researchers require data in bulk. The phenomenon of infants with Covid-19 antibodies was yet to be studied. HT found out that several civic-run hospitals that receive the most number of pregnant mothers with Covid-19 haven’t started conducting antibody tests among newborns.
Dr Sushma Malik, head of paediatric department, BYL Nair hospital where over 1,000 deliveries of Covid-19 infected mothers have been done said, “We haven’t done antibody tests on newborn babies yet.” Similarly, Dr Arun Nayak, head of department, gynaecology from Lokmanya Tilak General Hospital, known as Sion Hospital said, “We are contemplating to test babies with mothers who have been immunised to check if the antibodies are passing on the newborn. But, so far, we haven’t tested the newborn of infected mothers.”
Case study: ‘Vivaan—full of life’
Amrita Sundareswaran, 36, gave birth to her first child on April 26. But before she could even hold her baby, he was put under a ventilator. For 33 days, the infant fought for his life in the hospital before going home on May 30. For his parents, Vivaan – it means ‘full of life’ – is a warrior.
Last September, while the city was under the first wave of the pandemic, Amrita got the happiest news that she was pregnant. But her happiness didn’t last long. Only six weeks into her pregnancy, the Chembur resident along with her family members contracted Covid-19. She lost her father-in-law to the infection.
“Those were the scariest days. I was so worried about my child. What calmed me down was being told that the virus doesn’t pass on to the foetus and the infection rate among children was less in the first wave,” she said.
Amrita recovered without any complications and delivered Vivaan on April 26. But within 30 minutes, her nightmare came true when her baby was kept on oxygen support and later shifted to ICU.
Amrita was unaware that the antibodies developed in her body in reaction to Sars-Cov-2 could be transmitted to her son. “We were shocked when doctors told us that he has antibodies of the virus. We had already gone through a lot, and this broke us. We didn’t even know exactly why antibodies that saved us would harm my son,” she said.
For almost three weeks, she saw Vivaan through a glass door. “I couldn’t hold my baby. I would pump my breast milk thrice a day at home, and travel back to the hospital,” recalled Amrita. “Vivaan is completely healthy now. My son is a fighter.”