Covid 19 and pregnancy
HOWARD S ARMISTEAD
Pregnancy is a special time for a woman. It also can be an especially difficult and dangerous time. The miracle of childbirth is no walk in the park.
Although a woman’s body is obviously different from a man’s, it is less obvious a woman’s immune system is also different. When a woman is pregnant, and a new life is forming, her body’s selenium resources are redirected away from maintaining immune vigilance against invading microbes and towards facilitating the rapid development and growth of new foetal cells. Like all human cells, every new foetal cell requires selenium.
The immune system evidently sacrifices to provide part of the extra selenium the unborn child needs to grow. Thus, a pregnant woman has a slightly higher need for selenium in her diet when she is pregnant. She an even higher requirement when she is breastfeeding. When nursing, she is giving away part of her immune system to her infant in the white blood lymphocyte cells in breast milk. That means her immune defences may be slightly lowered.
Another amazing aspect of maternal immunity is that a pregnant woman’s immune system is so delicately sensitive that if the foetus is not developing correctly, is malformed or has a genetic defect, it responds and triggers a spontaneous abortion – a miscarriage. A miscarriage is usually a blessing in disguise. Otherwise, a defective baby would be born. The hypersensitive maternal immune response may also hold one key to understanding autoimmune disease and why women suffer autoimmunity twice as often as men.
When Covid-19 suddenly burst on the world scene, I immediately recognized it would be a hazardous time for women to become pregnant and wrote an advisory about that. It would be best to delay pregnancy, if possible, until the pandemic subsides.
When viruses infect cells, they commandeer the cell’s nucleus, its protein production factory. Virus often damage cells’ DNA, our hereditary genetic code. Damaged DNA often leads to birth defects, childhood cancers, or babies born with developmental problems or lifelong diseases. The earlier in pregnancy viral infection strikes, the greater the chance for birth defects or congenital disease in the child. In the third trimester the danger lessens, but still exists.
Most women know if they are infected with measles virus during their first or second trimester, the child will likely be born deaf. An even more striking example of birth defects are those associated with Zika virus. Like SARS-CoV-2 (SARS-2) and Ebola, Zika originated in flying mammals – bats.
Not all viruses can cross the maternal placenta. Zika can. Once inside, Zika attacks the cells of the developing foetal nervous system. That stunts development of the brain. If infected early enough, the baby will be born essentially without a brain. This often prompts a physician to perform a late-stage abortion to prevent an encephalitic baby being born with no capacity to function as a human.
Viruses attack various cells based on the molecular key the virus possesses to a particular cellular receptor, the entryway into cells. Covid-19 is especially destructive because it carries the key to a very common receptor, the ACE-2 receptor, found on many cell types. That is a major reason SARS-2 is so destructive, affecting so many systems in the body. Covid-19 presents a panoply of challenges in pregnancy.
Early in the Covid pandemic it had not been well-established if vaccination was 100 percent safe for women who were pregnant. Due to a surfeit of caution, pregnant women are usually not allowed to participate in clinical trials of new vaccines or medications. So, there was some uncertainty. As a result, only about a third of pregnant women in the US were fully vaccinated. This was well below the national average.
Now it has been conclusively established that vaccines are absolutely safe for both the expectant mother and the foetus. They provide three-for-one protection – for the mother, the foetus, and the new-born infant. Of course, vaccination is not a guarantee against infection.
Critically, vaccines are highly protective in preventing severe illness and death. With the Omicron variant, vaccines are much less protective against initial infection but still provide great protection against more serious outcomes.
Vaccines usually greatly reduce the chance of infection with most variants, but not so much with highly contagious Omicron. When breakthrough infections of any variant do occur, they tend to be milder and shorter in duration if one is vaccinated.
Covid-19 is especially dangerous late in pregnancy, and the post-partum period after birth. Statistics vary by country depending on base rates, but in South Africa deaths among pregnant women increased 35 percent to 40 percent in the initial waves of SARS-2. As with others, the risk of severe Covid outcomes is higher among those with comorbidities such as diabetes, high blood pressure, and obesity.
In the United States Covid-related maternal mortality is approximately 70 percent higher in pregnant women than in non-pregnant women. The Covid risks to pregnancy include more miscarriages, still births, and preterm births. According to the July 2021 medical journal Lancet Regional Health – Americas, overall, there is a 10 percent increase in early births, a 40 percent increase in preterm births and a 60 percent increase in very preterm births.
The immune reaction to SARS-2 also increases chances of childhood developmental disorders, including delays to foetal development of the heart and lungs. In a small percentage of cases Covid damages the placenta, reducing the oxygen supply to the foetus. That may trigger foetal death or a stillborn birth. The risk of stillborn birth increased 50 percent early in the pandemic. Then it rose to four times normal with Delta.
Pregnant women are three times as likely to become severely ill and require intensive care in the ICU compared to non-pregnant women. One study reported that 5 percent of pregnant women are hospitalized, 2 percent land in the ICU, with at least 1 percent requiring ventilation. Delta variant increased the rate of death from just one-half-of-one percent to 2.5 percent of pregnant women in America with Covid, a 500 percent increase. These statistics vary greatly by country.
What appears constant is that approximately 75 percent of pregnancy-related deaths from Covid occur in the weeks following childbirth – after pregnancy. As has been demonstrated with other deadly viral infections, a high daily dose of selenium should greatly reduce that mortality rate.
Selenium is a natural antiviral element. It inhibits a human protein called NF-kB that plays a primary role in increasing both inflammation and viral replication. That makes this mineral a broad-spectrum antiviral that helps reduce the impact of most viruses that make us sick, including HIV, Ebola, SARS-2, influenza-A, Hantavirus, and numerous others. As the key element required for the immune system to function properly, selenium also benefits several ways in pregnancy.
Selenium supplements improve both male and female fertility. Early in pregnancy, added selenium reduces the incidence or severity of morning sickness. Because selenium helps reduce the occurrence and impact of viral infection during pregnancy, it reduces the frequency of birth defects caused by damage to cellular DNA during infection. This also reduces miscarriages.
In the third trimester, higher levels of selenium reduce premature births and preeclampsia – high blood pressure during pregnancy. The increased number of premature births in Covid is likely due to the selenium deficiency the virus causes. 100 percent of those with severe Covid or that die are deficient in selenium. Supplementing selenium back into a person may be the key to reducing mortalities caused by rapid selenium depletion due to intensive replication.
With Covid-19, and now Covid-21-Omicron, it is too soon to know what the future holds for children born during these pandemic times. Will different variants provoke different long-term effects? No one knows. It may be years before long-term damage to childhood development can be finally determined, or if lifelong diseases result from pregnancies during this pandemic.
Every mother wants a perfect child. No mother wants to suffer the ultimate price in childbirth or shortly thereafter. Boosting maternal reserves of protective selenium will not prevent all possible problems in pregnancy, or all deaths. It should significantly reduce them – Covid or no Covid.
