A Post-Pandemic Insight on The Covid-19 and Pregnancy in Malaysia
Hana W. Jun Chen 1,*, Jegathambigai Rameshwar Naidu 1,*, Mohamed Najimudeen 1, Sakina Ruhi 1, Roy Rillera Marzo 2, Abdulah Y. Al-Mahdi 1, Haryati Anuar 1, Mohammed Faez Baobaid 1, Fatmawati Syamsu 3, Mohammed A. Abdalqader 4
Journal of Angiotherapy 8(2) 1-13 https://doi.org/10.25163/angiotherapy.829454
Submitted: 01 January 2024 Revised: 26 February 2024 Published: 28 February 2024
Abstract
A December 2023 COVID-19 outbreak in Southeast Asia prompted an update on Malaysia's existing understanding of COVID-19 and pregnancy. Research suggests that COVID-19 increases the risk of adverse maternal and perinatal outcomes. Pregnant women are more susceptible to COVID-19 due to physiological changes in the coagulation, immune, respiratory, and cardiovascular systems during pregnancy. Evidence indicates that pregnant COVID-19 patients are at an increased risk for severe illness and intensive care unit (ICU) admission. Stillbirth, neonatal death, and preterm labour are some of the most often reported adverse foetal outcomes. Data shows vertical transmission of COVID-19 is possible but rare. Currently, vaccination remains the most effective and safest strategy for protecting risk groups from severe illness, complications, and death. Although Malaysia has no plans to reinstate its movement control order, following a sharp rise in COVID-19 cases across the country, the Ministry of Health Malaysia (MOH) has prepared a five-point strategy as well as updated the COVID-19 Management Guidelines, including the therapeutic management of pregnant patients with COVID-19. The MOH encourages safe public practices and general measures including vaccinations, wearing masks, and maintaining hand hygiene. This review provides important insights into the COVID-19 pregnancy in Malaysia, susceptibility to COVID-19 in pregnancy, maternal and perinatal outcomes in pregnant women with COVID-19, transmission of COVID-19 to a newborn, COVID-19 treatment in pregnancy, COVID-19 vaccination in pregnancy and breastfeeding, and management of unvaccinated pregnant and lactating mothers in Malaysia.
Keywords: COVID-19; pregnancy; maternal outcome; fetal outcome; treatment; vaccination
References
Abdalqader M. A., Baobaid, M. F., Ghazi, H. F., Hasan, T. N., Mohammed, M. F., Abdalrazak, H. A., … Wei Jun, H.C. (2020). The Malaysian Movement Control Order (MCO) Impact and Its Relationship with Practices Towards Coronavirus Disease 2019 (COVID-19) among a Private University Students in Selangor. Malaysian Journal of Public Health Medicine, 20(2), 49–55. https://doi.org/10.37268/mjphm/vol.20/no.2/art.523
Abdalqader, M., Shebl, H., Ghazi, H., Baobaid, M. F., Wei Jun, H. C., Hasan, T. N., Mohammed, M. F., Abdalrazak, H. A., & Ads, H. O. (2020). The Facts about Corona Virus Disease (COVID-19): The Current Scenario and Important Lessons. Global Journal of Public Health Medicine, 2(SP1), 168–178. https://doi.org/10.37557/gjphm.v2iSP1.48
Allotey, J., Stallings, E., Bonet, M., Yap, M., Chatterjee, S., Kew, T., Debenham, L., Llavall, A. C., Dixit, A., Zhou, D., Balaji, R., Lee, S. I., Qiu, X., Yuan, M., Coomar, D., Sheikh, J., Lawson, H., Ansari, K., van Wely, M., van Leeuwen, E., … for PregCOV-19 Living Systematic Review Consortium (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ (Clinical research ed.), 370, m3320. https://doi.org/10.1136/bmj.m3320
Bala Krishnan A , Vinoth Kumar K K, Tharani Kumar L, (2024b). Concerning Fungal Coinfections in COVID-19: Risks, Types, and Prevention – A Review, Journal of Angiotherpay, 8(2), 1-5, 9457.
Bala Krishnan A, Vigneshwaran V, Tharani Kumar L, (2024b). Understanding and Combatting COVID-19: Insights from Clinical Characteristics and Management Strategies, Journal of Angiotherapy, 8(2), 1-9, 9455.
Balachandren, N., Davies, M. C., Hall, J. A., Stephenson, J. M., David, A. L., Barrett, G., O'Neill, H. C., Ploubidis, G. B., Yasmin, E., & Mavrelos, D. (2022). SARS-CoV-2 infection in the first trimester and the risk of early miscarriage: a UK population-based prospective cohort study of 3041 pregnancies conceived during the pandemic. Human reproduction (Oxford, England), 37(6), 1126–1133. https://doi.org/10.1093/humrep/deac062
Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., Hohmann, E., Chu, H. Y., Luetkemeyer, A., Kline, S., Lopez de Castilla, D., Finberg, R. W., Dierberg, K., Tapson, V., Hsieh, L., Patterson, T. F., Paredes, R., Sweeney, D. A., Short, W. R., Touloumi, G., … ACTT-1 Study Group Members (2020). Remdesivir for the Treatment of Covid-19 - Final Report. The New England journal of medicine, 383(19), 1813–1826. https://doi.org/10.1056/NEJMoa2007764
Capobianco, G., Saderi, L., Aliberti, S., Mondoni, M., Piana, A., Dessole, F., Dessole, M., Cherchi, P. L., Dessole, S., & Sotgiu, G. (2020). COVID-19 in pregnant women: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology, 252, 543–558. https://doi.org/10.1016/j.ejogrb.2020.07.006
Cascini, F., Pantovic, A., Al-Ajlouni, Y. A., Failla, G., Puleo, V., Melnyk, A., Lontano, A., & Ricciardi, W. (2022). Social media and attitudes towards a COVID-19 vaccination: A systematic review of the literature. EClinicalMedicine, 48. https://doi.org/10.1016/j.eclinm.2022.101454
Centers for Disease Control and Prevention. (2022). ACIP: Guidance for Vaccine Recommendations in Pregnant and Breastfeeding Women. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html
Centers for Disease Control and Prevention. (2024). Special Clinical Considerations: Pregnancy and Recent Pregnancy. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/clinical-considerations-special-groups.html
Chen, H. W. J., Marzo, R. R., Sapa, N. H., Ahmad, A., Anuar, H., Baobaid, M. F., Jamaludin, N. A., Hamzah, H., Sarrafan, S., Ads, H. O., Kumar, K. A., Hadi, J., Sazali, H., & Abdalqader, M. A. (2023). Trends in Health Communication: Social Media Needs and Quality of Life among Older Adults in Malaysia. Healthcare (Basel, Switzerland), 11(10), 1455. https://doi.org/10.3390/healthcare11101455
Dumitriu, D., Emeruwa, U. N., Hanft, E., Liao, G. V., Ludwig, E., Walzer, L., Arditi, B., Saslaw, M., Andrikopoulou, M., Scripps, T., Baptiste, C., Khan, A., Breslin, N., Rubenstein, D., Simpson, L. L., Kyle, M. H., Friedman, A. M., Hirsch, D. S., Miller, R. S., Fernández, C. R., … Gyamfi-Bannerman, C. (2021). Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA pediatrics, 175(2), 157–167. https://doi.org/10.1001/jamapediatrics.2020.4298
Ferrazzi, E., Frigerio, L., Savasi, V., Vergani, P., Prefumo, F., Barresi, S., Bianchi, S., Ciriello, E., Facchinetti, F., Gervasi, M. T., Iurlaro, E., Kustermann, A., Mangili, G., Mosca, F., Patanè, L., Spazzini, D., Spinillo, A., Trojano, G., Vignali, M., Villa, A., … Cetin, I. (2020). Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG : an international journal of obstetrics and gynaecology, 127(9), 1116–1121. https://doi.org/10.1111/1471-0528.16278
Gilmore, B., Ndejjo, R., Tchetchia, A., de Claro, V., Mago, E., Diallo, A. A., Lopes, C., & Bhattacharyya, S. (2020). Community engagement for COVID-19 prevention and control: a rapid evidence synthesis. BMJ global health, 5(10), e003188. https://doi.org/10.1136/bmjgh-2020-003188
Gottlieb, R. L., Vaca, C. E., Paredes, R., Mera, J., Webb, B. J., Perez, G., Oguchi, G., Ryan, P., Nielsen, B. U., Brown, M., Hidalgo, A., Sachdeva, Y., Mittal, S., Osiyemi, O., Skarbinski, J., Juneja, K., Hyland, R. H., Osinusi, A., Chen, S., Camus, G., … GS-US-540-9012 (PINETREE) Investigators (2022). Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. The New England journal of medicine, 386(4), 305–315. https://doi.org/10.1056/NEJMoa2116846
Hammond, J., Leister-Tebbe, H., Gardner, A., Abreu, P., Bao, W., Wisemandle, W., Baniecki, M., Hendrick, V. M., Damle, B., Simón-Campos, A., Pypstra, R., Rusnak, J. M., & EPIC-HR Investigators (2022). Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. The New England journal of medicine, 386(15), 1397–1408. https://doi.org/10.1056/NEJMoa2118542
Jamieson, D. J., & Rasmussen, S. A. (2022). An update on COVID-19 and pregnancy. American journal of obstetrics and gynecology, 226(2), 177–186. https://doi.org/10.1016/j.ajog.2021.08.054
Jun Chen, H. W., Marzo, R. R., Tang, H. C., Mawazi, S. M., & Essar, M. Y. (2021). One Mutation Away, the Potential Zoonotic Threat – Neocov, Planetary Health Impacts and the Call for Sustainability. Journal of Public Health Research, 10(1 Suppl). https://doi.org/10.4081/jphr.2021.2941
Luca, D. D., Vauloup-Fellous, C., Benachi, A., & Vivanti, A. (2023). Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Seminars in Fetal & Neonatal Medicine, 28(1), 101429. https://doi.org/10.1016/j.siny.2023.101429
Marconi, V. C., Ramanan, A. V., de Bono, S., Kartman, C. E., Krishnan, V., Liao, R., Piruzeli, M. L. B., Goldman, J. D., Alatorre-Alexander, J., de Cassia Pellegrini, R., Estrada, V., Som, M., Cardoso, A., Chakladar, S., Crowe, B., Reis, P., Zhang, X., Adams, D. H., Ely, E. W., & COV-BARRIER Study Group (2021). Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. The Lancet. Respiratory medicine, 9(12), 1407–1418. https://doi.org/10.1016/S2213-2600(21)00331-3
Marzo, R. R., Chen, H. W. J., Abid, K., Chauhan, S., Kaggwa, M. M., Essar, M. Y., Jayaram, J., Changmai, M. C., Wahab, M. K. B. A., Ariffin, I. A. B., Alwi, M. N. B. M., Head, M. G., & Lin, Y. (2022). Adapted digital health literacy and health information seeking behavior among lower income groups in Malaysia during the COVID-19 pandemic. Frontiers in public health, 10, 998272. https://doi.org/10.3389/fpubh.2022.998272
Marzo, R. R., Jun Chen, H. W., Ahmad, A., Thew, H. Z., Choy, J. S., Ng, C. H., Chew, C. L. A., Heidler, P., King, I., Shrestha, R., Rahman, F., Rana, J. A., Khoshtaria, T., Matin, A., Todua, N., Bicer, B. K., Faller, E., Tudy, R. A., Baldonado, A., Penamante, C. A., Bahari, R., Younus, D. A., Ismail, Z. M., Lotfizadeh, M., … Elsayed, M. E. G. (2024). The evolving role of social media in enhancing quality of life: a global perspective across 10 countries. Arch Public Health, 82(28). https://doi.org/10.1186/s13690-023-01222-z
Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G. J., Grobman, W. A., Saade, G. R., Manuck, T. A., Longo, M., Sowles, A., Clark, K., Simhan, H. N., Rouse, D. J., Mendez-Figueroa, H., Gyamfi-Bannerman, C., Bailit, J. L., Costantine, M. M., Sehdev, H. M., Tita, A. T. N., Macones, G. A., & National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network (2022). Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA, 327(8), 748–759. https://doi.org/10.1001/jama.2022.1190
Ministry of Health Malaysia. (2008). Clinical Practice Guidelines: Management of HIV Infection in Pregnant Women. https://www.moh.gov.my/moh/attachments/3886.pdf
Ministry of Health Malaysia. (2016). Clinical Practice Guidelines: Heart Disease in Pregnancy (2nd ed.). https://www.moh.gov.my/moh/resources/Penerbitan/CPG/CARDIOVASCULAR/7.pdf
Ministry of Health Malaysia. (2017a). Clinical Practice Guidelines: Management of Diabetes in Pregnancy. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/1a.pdf
Ministry of Health Malaysia. (2017b). Clinical Practice Guidelines: Management of Asthma in Adults. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG%20Management%20of%20Asthma%20in%20Adults.pdf
Ministry of Health Malaysia. (2018a). Clinical Practice Guidelines: Management of Hypertension (5th ed.). https://www.moh.gov.my/moh/resources/penerbitan/CPG/MSH%20Hypertension%20CPG%202018%20V3.8%20FA.pdf
Ministry of Health Malaysia. (2018b). Clinical Practice Guidelines: Management of Chronic Kidney Disease (2nd ed.). https://www.moh.gov.my/moh/resources/penerbitan/CPG/CPG%20Management%20of%20Chronic%20Kidney%20%20Disease%20(Second%20Edition).pdf
Ministry of Health Malaysia. (2020). COVID-19 Management Guidelines in Malaysia. https://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm
Ministry of Health Malaysia. (2021a). National COVID-19 Immunisation Program. The Special Committee for Ensuring Access to COVID-19 Vaccine Supply. https://intl.upm.edu.my/upload/dokumen/menul320210301113819Program_Imunisasi_COVID-19_Kebangsaan_Versi_Bahasa_Inggeris_(1).pdf
Ministry of Health Malaysia. (2021b). Clinical Practice Guidelines: Management of Tuberculosis (4th ed.). https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG-_Management_of_Tuberculosis_(4th_Edition).pdf
Ministry of Health Malaysia. (2021c). Guidelines on COVID-19 Vaccination in Pregnancy and Breastfeeding. https://jknperak.moh.gov.my/hsgsiput/images/covid19/covid_pregnancy.pdf
Ministry of Health Malaysia. (2022a). Annex 23a: Guidelines on the Management of COVID-19 in Obstetrics. https://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/ANNEX-23a-Guidelines-on-the-Management-of-COVID-19-in-Obstetrics-05042022.pdf
Ministry of Health Malaysia. (2022b). Clinical Practice Guidelines: Management of Chronic Hepatitis B in Adults. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/e-CPG_Management_of_Chronic_Hepatitis_B_in_Adults_-12_6_23.pdf
Ministry of Health Malaysia. (2022c). Malaysia COVID-19 Vaccination Policy. https://mysejahtera.moh.gov.my/en/covid-19/latest-malaysia-covid-19-vaccination-policy.
Ministry of Health Malaysia. (2023a). Pelan Pengurusan COVID-19: 5 strategi hadapi lonjakan kes. Keratan Akhbar. https://www.moh.gov.my/moh/resources/Keratan%20Akhbar/2023/Dis/Keratan_Akhbar_19.12_.2023_.pdf
Ministry of Health Malaysia. (2023b). Annex 23e: Clinical Management of Confirmed COVID-19 Case in Adult and Paediatric. https://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/ANNEX-2E-CLINICAL-MANAGEMENT-OF-CONFIRMED-COVID-19-28122023.pdf
Ministry of Health Malaysia. (2023c). Clinical Practice Guidelines: Management of Obesity (2nd ed.). https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/CPG_Management_of_Obesity_(Second_Edition)_2023.pdf
Molina, R. L., Tsai, T. C., Dai, D., Soto, M., Rosenthal, N., Orav, E. J., & Figueroa, J. F. (2022). Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic. JAMA network open, 5(8), e2226531. https://doi.org/10.1001/jamanetworkopen.2022.26531
Moniruddin Chowdhury, Syeda Humayra, Taha Sulayman, Keichiro Mihara et al., (2023). Use of Neutralizing Monoclonal Antibodies and Its Outcome Measures in COVID-19 Patients, Journal of Angiotherapy, 7(1), 1-7.
Najimudeen, M., Jun Chen, H. W., Jamaluddin, N. A., Myint, M. H., & Marzo, R. R. (2022). Monkeypox in Pregnancy: Susceptibility, Maternal and Fetal Outcomes, and One Health Concept. International Journal of Maternal and Child Health and AIDS, 11(2). https://doi.org/10.21106/ijma.594
National Institutes of Health. (2023). COVID-19 Treatment Guidelines - Special Considerations in Pregnancy. https://www.covid19treatmentguidelines.nih.gov/special-populations/pregnancy/
Phoswa, W. N., & Khaliq, O. P. (2020). Is pregnancy a risk factor of COVID-19?. European journal of obstetrics, gynecology, and reproductive biology, 252, 605–609. https://doi.org/10.1016/j.ejogrb.2020.06.058
RECOVERY Collaborative Group (2021). Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet (London, England), 397(10285), 1637–1645. https://doi.org/10.1016/S0140-6736(21)00676-0
Ruhi, S., Chen, H., Abdullatib, A., Khan, D. S., Syed, A., Naidu, J. R., Thangarajan, R., Al Gosha, H. A., Elsherbini, A. S. M., & Bhattacharjee, A. (2024). Childhood Vaccine Refusal Concern of Parents in Southern Malaysia and Its Effect on Health. Journal of Angiotherapy, 8(2), 1-6, 9475. https://doi.org/10.25163/angiotherapy.829475
Saad, A. F., Chappell, L., Saade, G. R., & Pacheco, L. D. (2020). Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19). Obstetrics and gynecology, 136(4), 823–826. https://doi.org/10.1097/AOG.0000000000004103
Taglauer, E., Benarroch, Y., Rop, K., Barnett, E., Sabharwal, V., Yarrington, C., & Wachman, E. M. (2020). Consistent localization of SARS-CoV-2 spike glycoprotein and ACE2 over TMPRSS2 predominance in placental villi of 15 COVID-19 positive maternal-fetal dyads. Placenta, 100, 69–74. https://doi.org/10.1016/j.placenta.2020.08.015
The American College of Obstetricians and Gynecologists. (2021). COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care. (n.d.). https://www.acog.org/en/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care
University of Liverpool. (2023). COVID-19 Drug Interactions. https://www.covid19-druginteractions.org/checker
Wastnedge, E. A. N., Reynolds, R. M., van Boeckel, S. R., Stock, S. J., Denison, F. C., Maybin, J. A., & Critchley, H. O. D. (2021). Pregnancy and COVID-19. Physiological reviews, 101(1), 303–318. https://doi.org/10.1152/physrev.00024.2020
Wei, S. Q., Bilodeau-Bertrand, M., Liu, S., & Auger, N. (2021). The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 193(16), E540–E548. https://doi.org/10.1503/cmaj.202604
WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, J. A. C., Murthy, S., Diaz, J. V., Slutsky, A. S., Villar, J., Angus, D. C., Annane, D., Azevedo, L. C. P., Berwanger, O., Cavalcanti, A. B., Dequin, P. F., Du, B., Emberson, J., Fisher, D., Giraudeau, B., Gordon, A. C., Granholm, A., Green, C., Haynes, R., … Marshall, J. C. (2020). Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA, 324(13), 1330–1341. https://doi.org/10.1001/jama.2020.17023
World Health Organization. (2020). COVID-19: WHO’s Action in Countries. Malaysia. https://www.who.int/docs/default-source/coronaviruse/country-case-studies/malaysia-c19-case-study-20-august.pdf?sfvrsn=a0f79358_2&download=true
World Health Organization. (2022). The Oxford/AstraZeneca (ChAdOx1-S [recombinant] vaccine) COVID-19 vaccine: what you need to know. https://who.int/news-room/feature-stories/detail/the-oxford-astrazeneca-covid-19-vaccine-what-you-need-to-know
World Health Organization. (2023). COVID-19 epidemiological update – 22 December 2023 (162nd ed.). https://www.who.int/publications/m/item/covid-19-epidemiological-update---22-december-2023
Yan, J., Guo, J., Fan, C., Juan, J., Yu, X., Li, J., Feng, L., Li, C., Chen, H., Qiao, Y., Lei, D., Wang, C., Xiong, G., Xiao, F., He, W., Pang, Q., Hu, X., Wang, S., Chen, D., Zhang, Y., … Yang, H. (2020). Coronavirus disease 2019 in pregnant women: a report based on 116 cases. American journal of obstetrics and gynecology, 223(1), 111.e1–111.e14. https://doi.org/10.1016/j.ajog.2020.04.014
Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T., Woodworth, K. R., Nahabedian, J. F., 3rd, Azziz-Baumgartner, E., Gilboa, S. M., Meaney-Delman, D., & CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team (2020). Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR. Morbidity and mortality weekly report, 69(44), 1641–1647. https://doi.org/10.15585/mmwr.mm6944e3
View Dimensions
View Altmetric
Save
Citation
View
Share