The potential benefits of Chinese integrative medicine for pregnancy women during the COVID-19 pandemic.

COVID-19 is a public health emergency of international concern now. The pregnant women have a higher risk of serious illness and death from viral infections. Based on a comprehensive review on the previous studies, we found that the virus transmitted by droplets and aerosols is more easily inhaled by pregnant women due to the altered anatomical structure of the respiratory system during pregnancy, and the prognosis is worse after infection when compared with non-pregnancy women. Another review of 18 studies comprising 114 pregnant women infected with COVID-19 published from 1 January 2020 to 26 March 2020 found that fever (87.5%) and cough (53.8%) were the most commonly reported symptoms, followed by fatigue (22.5%), diarrhea (8.8%), dyspnea (11.3%), sore throat (7.5%), and myalgia (16.3%). The majority of patients (91%) had cesarean delivery due to various indications. In terms of fetal and neonatal outcomes, stillbirth (1.2%), neonatal death (1.2%), preterm birth (21.3%), low birth weight (<2500 g, 5.3%), fetal distress (10.7%), and neonatal asphyxia (1.2%) were reported. Termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn when an indication for obstetric surgery or critical illness of COVID-19 in pregnant women occurs. It is important to administer all the available methods to protect these women.

Pregnant women may be more susceptible to COVID-19 due to immunological and anatomic factors. If infected, the virus may alter immune responses at the maternal-fetal interface, and affect the maternal and neonatal well-being. Chinese integrative medicine has potential ability of antivirus, anti-inflammation, immune regulation and organ protection in management of COVID-19. It also has a key role in preventing threatened abortion via regulating body immune functions, and thus can be applied as a preventive approach for pregnant women during the current pandemic. Although no specific medicine was recommended to prevent COVID-19 worldwide so far, in China, historically, traditional Chinese medicine (TCM) approaches including oral administration of preventive herbal formulae, wearing CM sachets, indoor herbal medicine fumigation, etc. were applicable for the prevention of infectious diseases. Chinese herbs including Atractylodis Macrocephalae Rhizoma, Scutellariae Radix, Lonicerae Japonicae Flos, Ophiopogonis Radix and Citri Reticulatae Pericarpium, were recommended by the health authorities of a number of Chinese provinces for pregnant women to prevent COVID-19.9, 10 Acupuncture and moxibustion have potential actions of improving immunity and regulating neuroimmune in preventing and treating COVID-19. Pregnant women during COVID-19 can also apply those TCM therapies such as acupuncture, moxibustion, massage, acupoint application and auricular therapy, at appropriate and safe acupoints, and under the instruction of physician.

Anxiety and depressive symptoms are common during the antenatal and postnatal period, while the COVID-19 pandemic exacerbates these psychological issues in pregnant women.13, 14 Providing mental health care to pregnant women is crucial during the current pandemic, Chinese integrative medicine deserves application to this population. Integrative medicine therapies such as acupuncture, massage therapy, healing touch and reflexology, were noted to be beneficial for high-risk pregnant women among who anxiety is more prevalent. Although evidence from quality scientific research is limited,16, 17 positive data had been showed, suggesting that acupuncture could provide as a supportive treatment for antenatal depression and anxiety.18, 19, 20, 21 Acupressure at SP6 was found to decrease the maternal anxiety level of women during labor in a randomized controlled trial. With a precise somatotopic presentation of the various brain structures involved in perinatal mood disorders, the auricular acupuncture microsystem was proposed to be an important complementary approach for managing perinatal depressive disorders. In addition, sleep problems are also prevalent during pregnancy and up to 78% of pregnant women report disturbed sleep. Several alternative interventions for poor sleep quality or insomnia have been suggested, including acupuncture, acupressure, herbal medication and exercise, however high quality researches to provide supportive evidence are needed.24, 25 Overall, for pregnant women during COVID-19, just as a recent Chinese guideline points out, various Chinese integrative medicine approaches are applicable in combination for physical and mental relaxation, anxiety relief and sleep assistance.

During the COVID-19 pandemic, pregnant women’s mobility is restricted due to home quarantine and reluctance to go to hospital for fear of risk of infection. Under the circumstances of social distancing and isolation, online counseling and training programs via the Internet using electronic media potentially promote the efficiency of health care during pregnancy. Given the simplicity and convenience of many Chinese integrative medicine therapies, self-interventions of these therapies at home under the online instruction from physician would be safe and feasible for pregnant women. For example, self-acupressure on PC6, the most commonly used acupoint for nausea and vomiting in early pregnancy, can give pregnant women many benefits. Self-administered moxibustion on BL67 could be offered to quarantined pregnant women with breech presentation. Thus Chinese integrative medicine could be applied in the design, development, and implementation of an Internet-based guided self-help therapy, proposed by Mirzadeh et al., for nutrition and healthy eating, physical activity, and psychological practices during pregnancy. As the use of mobile health technology such as smartphone could provide reliability of tongue coating diagnosis, the current trend of telemedicine and digital medicine helps to identify and adjust the TCM constitutions of women during perinatal care.

Overall, Chinese integrative medicine can bring potential benefits to pregnancy women during the COVID-19 pandemic, as shown in Fig. 1. However, evaluation on the safety aspects of Chinese integrative medicine in pregnancy should be emphasized. Reliable evidence supporting the safety of acupuncture during pregnancy is still lacking, and experts have conflicting views on the use of acupuncture during pregnancy. Noninvasive stimulation on acupoints may be more appropriate, which avoids uterine segment and can be self-administered.27, 28 Activities of health care need to be conducted under the instruction of safety classification and the principles of TCM contraindicated in pregnant women. With the increasing volume of internet activity during the COVID-19 crisis, the use of effective methods for health care regulators to monitor internet activity and to protect pregnant women from misleading statements is also crucial.

Fig. 1

The potential benefits of Chinese integrative medicine for pregnancy women during the COVID-19 pandemic.

Author contribution

Wei Wang: Conceptualization, Writing - original draft, Writing - review & editing. Qing Zhang: Writing - original draft. Fan Qu: Conceptualization, Writing - original draft, Writing - review & editing, Supervision.

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

None.

Ethical statement

This article did not have any research ethical consideration as authors did not perform research with human or animal subjects.

Data availability

Not applicable.