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Feto © Genetic Literacy Project
di
Stefania Elena Carnemolla
L’infezione respiratoria (COVID-19) causata dal coronavirus SARS-CoV-2, già 2019-nCoV, può avere effetti sulla gravidanza? Le donne in gravidanza possono trasmettere il virus al feto e, dopo il parto, al neonato o alla neonata durante l’allattamento?
Con la comparsa del nuovo coronavirus la scienza continua ad interrogarsi. La prudenza in questi casi è, tuttavia, d’obbligo anche perché le prime risposte ai primi dubbi possono variare nel tempo a seconda dell’evoluzione del comportamento del virus. Nelle ultime ore i ricercatori dell’ Istituto Superiore di Sanità hanno ad esempio, realizzato, sulla base delle informazioni disponibili, una panoramica sull’infezione da COVID-19 contratta in gravidanza o durante l’allattamento, includendovi le indicazioni per gli operatori sanitari che entrano in contatto con madre e bambino.
LE DONNE IN GRAVIDANZA SONO A RISCHIO?
Sulla base della letteratura scientifica disponibile le donne in stato di gravidanza sono considerate a rischio per le conseguenze sulla madre e sul feto nel caso di influenza stagionale o di infezioni respiratorie virali, come la COVID-19. Se nel primo caso è raccomandato un vaccino all’inizio della stagione influenzale, il discorso cambia nel secondo, questo perché non esiste ancora alcun vaccino contro il SARS-CoV-2. Ci preme, infatti, ricordare come settimane fa sia circolato un falso mito che ha acceso non poche speranze su un vaccino già disponibile contro il nuovo coronavirus. Un falso mito, ad esempio, registrato da ISSalute, portale dell’Istituto Superiore di Sanità: “Al momento non è disponibile un vaccino contro il nuovo coronavirus (SARS-CoV-2). Quando si sviluppa una nuova malattia, un vaccino diventa disponibile solo dopo un processo di sviluppo che può richiedere diversi anni”. In assenza di un vaccino, spiegano i ricercatori ISS, le donne in gravidanza vengono, pertanto, invitate a seguire le “comuni azioni di prevenzione primaria” del Ministero della Salute come il lavaggio o la disinfezione delle mani e il divieto di contatto ravvicinato con persone sospette o malate, come quelle che soffrono di infezioni respiratorie acute.
Nel primo caso le mani andranno lavate con acqua e sapone per almeno 20 secondi, in alternativa è possibile utilizzare un disinfettante a base di alcool al 60%. L’igiene delle mani è fondamentale perché la diffusione del virus è facilitata dal contatto delle mani contaminate, cioè, non igienizzate, con bocca, naso e occhi. Quanto al secondo caso la distanza con i soggetti sospetti o malati dev’essere almeno di due metri, in particolare “quando tossiscono o starnutiscono o se hanno la febbre, perché il virus è contenuto nelle goccioline di saliva e può essere trasmesso col respiro a distanza ravvicinata”.
Alla domanda se le donne in gravidanza siano più suscettibili alle infezioni o se non corrano un rischio maggiore di sviluppare una forma severa di COVID-19, i ricercatori ISS spiegano che “al momento non si hanno informazioni circa la suscettibilità delle donne in gravidanza alla patologia da nuovo coronavirus”. Le ipotesi per ora rimangono, pertanto, sul tappeto.
VIRUS E FETO
La madre può trasmettere il virus al feto secondo quella chiamata trasmissione verticale? “Dai primi 19 casi SARS-CoV-2 di donne in gravidanza e neonati nati da madri con sintomatologia clinica da COVID-19 descritti in letteratura” spiegano i ricercatori ISS “sappiamo che il virus non è stato rilevato nel liquido amniotico o nel sangue neonatale prelevato da cordone ombelicale. Attualmente non esistono pertanto evidenze a supporto di una trasmissione verticale del virus SARS-COV-2. Allo stato attuale delle conoscenze e qualora non sussistano specifiche indicazioni cliniche materne o fetali, per le donne con sospetta infezione da SARS-CoV-2 o affette da COVID-19 non sembra opportuno ricorrere elettivamente al taglio cesareo, rimanendo valide le indicazioni correnti all’espletamento del parto per via vaginale o chirurgica”.
GESTIONE OSPEDALIERA
Davanti a casi sospetti o certi la gestione ospedialiera, spiegano i ricercatori ISS, dovrà rifarsi a quanto raccomandato per la gestione delle condizioni infettive, procedendo, in caso di necessità, all’isolamento della madre e/o del neonato o della neonata. Durante il ricovero l’eventuale separazione tra madre e neonato o neonata dovrà essere “attentamente ponderata dal team ospedaliero insieme alla madre, valutando i rischi e i benefici di questa scelta, incluso il potenziale protettivo del colostro, del latte materno e dell’allattamento”.
VIRUS E LATTE MATERNO
Il latte materno può contenere il virus? Ad oggi, ricordano i ricercatori ISS, il virus responsabile della COVID-19 non è stato riscontrato nel latte materno raccolto dopo la prima poppata, colostro, al contrario, in almeno in un caso sono stati rilevati nel neonato anticorpi contro il SARS-CoV-2.
Che modalità di allattamento deve seguire una donna con sospetta infezione o affetta da SARS-CoV-2? Considerato il potenziale protettivo del latte materno, spiegano i ricercatori ISS, in condizioni cliniche accettabili e rispettando il desiderio delle madri, l’allattamento può avvenire al seno o con latte materno spremuto. I ricercatori dell’Istituto Superiore di Sanità spiegano anche come ridurre il rischio di trasmissione al neonato o alla neonata. Ad esempio, durante la poppata, oltre all’igiene della mani, è raccomandato l’uso della mascherina. Nel caso in cui madre e neonato o neonata vengano separati, la madre dovrà essere aiutata a mantenere la produzione di latte grazie alla spremitura manuale o meccanica e seguendo le necessarie norme igieniche.
OPERATORI SANITARI
Infine, operatori o professionisti che entrano in contatto con donne in gravidanza o neonati sono tenuti a seguire le raccomandazioni preventive e ad osservare nella gestione dei piccolissimi tra 0 e 2 anni e davanti a casi di SARS-CoV-2 una guida operativa sull’alimentazione dei lattanti e dei bambini piccoli nelle emergenze.
Abbiamo parlato di:
Istituto Superiore di Sanità Website | Twitter | YouTube
ISSalute Website | Twitter | Facebook | Instagram | YouTube
Ministero della Salute Website | Twitter | Facebook | Instagram | YouTube
