In India, the scientific community quickly became aware of the importance of the data collected by Nair Hospital in Bombay to understand the effects of Covid-19 on infected mothers and their newborns. Authorities combined these observations with those from 18 medical schools in Maharashtra, expanding the study to 3,000 infected women. Under the aegis of the Indian Council for Medical Research (ICMR), a registry has been established: the “PregCovid Registry”, supervised by the National Institute for Reproductive Health Research (NIRRH), which is currently publishing its findings in medical journals.
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What did the researchers find? Their work first formulated recommendations for a good management of the crisis in obstetric services. Their studies focus on the need to systematically test pregnant women in order to slow down the chain of contagions: no less than 12% of them were infected in recent months, 88.5% of cases being asymptomatic.
Three cases of postpartum psychosis
Specific aspects have been identified. For example, patients who are pregnant with twins have a greater risk of developing preeclampsia. The data also highlights 15 ectopic pregnancies and 34 maternal deaths (1.1%), while another report estimates that 22% of recent maternal deaths are linked to Covid-19. In addition, Nair Hospital highlighted three cases of postpartum psychosis, usually rare disorders. “The majority of infected women suffer from anxiety and stress. But there is also an increased risk of postpartum psychosis and mental disorders ”, explains Dr Rahul Gajbhiye, clinical researcher at NIRRH. He recommends appropriate supervision in a hospital environment.
“There is an unusual number of co-infections with tuberculosis, malaria or dengue, which complicates clinical decisions”, he continues. Testing people for Covid-19 was indeed an opportunity to conduct additional examinations, which revealed other infections.
Better support for pregnant women
Some findings differ from those of the Nair hospital, which did not observe vertical transmission of the virus, that is to say from the blood of the mother to that of the embryo. However, a case has been documented in another hospital. “We have identified this first case in an asymptomatic mother, in the first trimester of her pregnancy, says Dr. Deepak Modi, placenta specialist at NIRRH. The virus has been found in the placenta and amniotic fluid. “ And efforts are directed towards the study of the placenta: “We are trying to understand whether the virus has effects on the health of the placenta and whether abnormalities in the placenta would cause the virus to be transmitted from mother to child”, says Dr Smita Mahale, head of the NIRRH.
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Now, all hospitals associated with the PregCovid registry are on alert on demonstrated risks. And if these observations apply to Indian women, the instructions are adaptable to other low and middle income countries of the South. With the key, the possibility, for these countries, to better support infected pregnant women and to develop health policies within the framework of the pandemic.