key: cord-0839055-pafq142y
authors: Jiao, Jian
title: Under the epidemic situation of COVID‐19, should special attention to pregnant women be given?
date: 2020-03-24
journal: J Med Virol
DOI: 10.1002/jmv.25771
sha: 4e26561117ec562175956e4dec8ef38ab21eab29
doc_id: 839055
cord_uid: pafq142y

The sudden outbreak and spread of COVID-19 in this spring led to a serious challenge to the global public health system. So far, the number of cases in the mainland of China has exceeded 80,000. In addition to China's neighboring countries like Japan, South Korea, Thailand and India, severe outbreaks have occurred in Italy and many other countries around the world. As dated on 12th Mar., WHO statistics showed that the confirmed cases reported outside China rise to more than 30,000. No epidemiological data on the prevalence and proportion of severe cases in pregnant women has been reported till now. This commentary gives some opinions on the issues that may be faced by three groups of pregnant population, i.e. late pregnancy, early and middle pregnancy and pregnant medical staff. Hoping to provide ideas for the development of relevant research and policy making. This article is protected by copyright. All rights reserved.

The sudden outbreak and spread of COVID-19 in this spring led to a serious challenge to the global public health system. So far, the number of cases in the mainland of China has exceeded 80 000, more than 3000 people died of this disease. The latest data showed that in addition to China's neighboring countries like Japan, South Korea, Thailand and India, severe outbreaks have also occurred in Italy and many other countries around the world. As dated on 12th March, the World Health Organization (WHO) declared that the confirmed cases reported outside China rise to more than 30 000. WHO had announced that "this is not a drill, it's a global pandemic."

The special expert group for control of the epidemic of novel coronavirus pneumonia of the Chinese Preventive Medicine Association has recently reported the epidemiological characteristics of these cases. 1 The results showed that the cases were concentrated in the age group of 30 to 79 years old, which accounted for more than 85% of the total number of confirmed cases, and the number of cases above 60 years old accounted for 30% to 45%. The crude death rate was 2.3% in all cases, 14.8% in the age group over 80 years old, 2.8% in men, and 1.7% in women, unfortunately, and sadly, more than 3000 

Although limited studies suggested that COVID-19 infection has no specific effect on late pregnancy, however, the first or second-trimester pregnancy deserves more attention. At different stages of pregnancy, the hormone level and immune status of pregnant women are totally different, which is bound to be closely related to the outcome of infection.

In the early pregnancy, the normal immune balance of the mother is challenged by foreign fetal antigens, 3 which may appear unstable state. This state will tend to be stable with the gradual adaptation of the mother. With the growth of the fetus, the mother's immune system is constantly adjusting this steadily, so that it can finally reach a good balance in the late pregnancy. Therefore, the maternal immune system in early pregnancy is actually very sensitive, and the fetus is also in an important stage of organ development. External stimulation, especially virus infections (such as rubella virus, cytomegalovirus, and herpes simplex virus), may cause serious immune system disorder and internal environment imbalance, which probably lead to disease, abortion for mother or abnormal growth and development for fetus. 4 

It is worth noting that women in late pregnancy with "a clumsy figure" are usually valued and well protected, while those in early pregnancy are often neglected because of their "normal figure and flexible movement."

Being medical staff (especially in China), pregnancy maybe never the reason for them to be free from work. In the current severe epidemic situation, many "expectant mothers" in my colleagues still stick to work in their positions, some of them even work in fever clinics and isolation wards, they deserve to be taken care of and supported by policies.

Routine COVID-19 testing, adequate rest, and better follow-up should be reflected in the policy.

As time goes by, no doubt we will have a better understanding of 2019-nCoV infections, while routine detection and monitoring of COVID-19 in pregnancy should be considered, standard design, clinical trials, and implementation of future COVID-19 vaccines for pregnant women also recommended. 8 We hope that human beings can exchange the most experience with the least cost.

Special Expert Group for Control of the Epidemic of Novel Coronavirus Pneumonia of the Chinese Preventive Medicine Association. An update on the epidemiological characteristics of novel coronavirus pneumonia (COVID-19)

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

H1N1 2009 influenza virus infection during pregnancy in the USA

Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome

The T helper type 17/regulatory T cell paradigm in pregnancy

The fetal origins of mental illness

National Health Commission of the People's Republic of China. Notice on strengthening maternal disease treatment and safe midwifery during the prevention and control of new coronavirus pneumonia

Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections

How to cite this article: Jiao J. Under the epidemic situation of COVID-19, should special attention to pregnant women be given?

The authors declare that there are no conflict of interests.

http://orcid.org/0000-0003-3751-2870