2019的新型冠狀病毒 (武漢肺炎病毒) 已經發生超過8 個月了，最近出生小嬰兒的孕期也已幾乎全部發生於此新型冠狀病毒流行的時代裡。 在這個新的時代，我們偏好在家吃外送，看網路電視 而比較少出門。身為婦產科醫師的我，也一直在了解它對於產婦的影響。有兩點想與大家分享。
首先，懷孕中感染並不會增加武漢肺炎的死亡率。但感染新型冠狀病毒的媽媽可能會經由胎盤垂直感染給小孩。所以孕婦戴口罩，勤洗手與社交距離的重要性再跟大家提醒。很幸運的，目前在台灣我們並沒有這樣的個案出現。
第二點是我覺得比較少人討論到的：維他命D缺乏。在台灣30歲的婦女普遍有三分之一都有維他命D的缺乏。維他命D由食物吸收，但必須靠肝，腎與(陽光照射)皮膚活化(註)。所以在這個大家因為疫情都比較少出門曬太陽的大環境裡，我覺得維他命D缺乏的比例會更高。
維他命D幫助鈣質的吸收，對於骨骼與肌肉的健康有很大的幫助。對於孕婦它甚至可能減少孕期糖尿病或子癲癇症 的風險。但至於有些報告指出維他命D缺乏可能是武漢肺炎死亡率的危險因子，英國國家衛生機構NICE 已經釋疑，認為維他命D缺乏與武漢肺炎死亡率並無因果關聯。
(註) 維他命D3是目前比較被廣泛使用的口服維他命，因其不需要經由身體活化。
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謝謝熱心讀者的詢問，這是本篇文章所採用的醫學文獻。
懷孕與武漢肺炎的死亡率關聯
Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775.
2019的新型冠狀病毒由胎盤垂直感染的證據
Vivanti, A.J., Vauloup-Fellous, C., Prevot, S. et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun 11, 3572 (2020). https://doi.org/10.1038/s41467-020-17436-6
維他命D 降低子癲癇症與孕期糖尿病風險的證據
Palacios C, Kostiuk LK, Peña-Rosas JP. Vitamin D supplementation for women during
pregnancy. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD008873.
DOI: 10.1002/14651858.CD008873.pub4
台灣北部人口維他命D缺乏的證據
Lee MJ, Hsu HJ, Wu IW, Sun CY, Ting MK, Lee CC. Vitamin D deficiency in northern Taiwan: a community-based cohort study. BMC Public Health. 2019;19(1):337. Published 2019 Mar 22. doi:10.1186/s12889-019-6657-9
英國國家衛生機構 (國家臨床卓越協會, National Institute of Clincal Excellence, NICE) 對於維他命D與武漢肺炎關聯的看法
https://www.nice.org.uk/advice/es28/chapter/Key-messages Accessed August 23rd, 2020
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It has been more than 8 months since the start of the global pandemic of COVID-19. We are now seeing the ripple reflected in the way we live, even in Taiwan. People prefer to stay home now: they order delivery food instead of going to restaurants, and watch video streaming at home instead of going out. As an obstetrician and gynaecologist, I wondered about its effect on women.
First of all, pregnancy does not increase mortality of SARS-CoV2 virus infection. But it can transmit from mother to child via their placental connection. The virus has recently been found in the placenta of a mother and newborn with COVID-19: proving vertical transmission other than routes such as breastfeeding and/or air droplet transmission. So it is worth reiterating the importance of masking at public spaces and hand hygiene for pregnant women. Luckily, in Taiwan thus far, there has not yet been any cases of vertical transmission.
The second point is less well discussed but may well affect more women. And that is Vitamin D deficiency, which is already common in Taiwan pre-COVID-19 era. Its prevalence is about one third in 30 year-olds. In the COVID-19 era, I suspect the prevalence will increase even further because people prefer staying home. Vitamin D deficiency has also been found to be more common in patients who succumb to COVID-19, although it merely reflects the association between vitamin D deficiency and multiple-comorbidities rather than a causal relationship. However, we already know that vitamin D deficiency in pregnancy can be related to a number of birth-related complications such as gestational diabetes and pre-eclampsia. So it is worthwhile testing for vitamin D levels at the beginning of pregnancy. Vitamin D3 is widely used as a supplement in patients with deficiency, because it does not require activation by sunlight.
