Pregnant patients often doomed
No reported cases of survival among infected newborns
PORT LOKO, Sierra Leone
When Fatmata Kabia walked into the Ebola isolation centre, her chances of survival were almost zero.
Not because her symptoms were particularly bad — though they were. Not because the disease had already killed most of her family — though it had. Kabia, 21, appeared doomed for another reason: She was pregnant.
Few diseases are less understood than the Ebola virus, which has claimed more than 7,900 lives across West Africa. But one thing is clear: Pregnant Ebola patients rarely survive. And their babies never do.
Even as doctors watched a succession of Ebola-stricken pregnant women die or lose their babies in recent months, they weren’t entirely sure why it was happening. Perhaps the mothers’ immune systems were weakened, making them more susceptible to the incapacitating fever that accompanies the disease, or maybe the virus pooled in fetal fluid. Some of the babies died early in pregnancy, others closer to term.
“There have been no neonatal survivors” is how Denise Jamieson, an obstetrician with the Division of Reproductive Health at the U.S. Centers for Disease Control and Prevention (CDC), put it flatly.
Kabia didn’t know that. She knew only that some time after the disease crossed the border from Guinea to Sierra Leone, it had arrived in her town, called Lunsar. Then it snaked into her home, where her mother, father and brother tested positive. And then she tested positive.
A few weeks later, when she walked out of the Port Loko Ebola isolation centre — her test results negative, her baby growing in her belly — the epidemiologists had already started talking about her.
But Kabia faced six more months of pregnancy, six more months of potential battle with the disease. This time, though, it would be her baby’s fight, waged inside her.
“I’m just not sure what will happen,” she said.
Kabia is a small woman with big eyes and a wide smile. She rests her hands on her stomach when she sits and taps her sandal-clad feet on the ground. Sometimes, talking about the baby makes her nervous, like she’s waiting for the results of her Ebola test all over again.
She had become pregnant in August just as the disease started spreading rapidly across Sierra Leone. Kabia had already miscarried once, years before Ebola. She was so worried when she became pregnant this time that she didn’t tell her husband. One day, he pointed to her belly and asked: was she? Kabia told him, and they celebrated. He died from Ebola a few weeks later.
When she came down with the disease, already one month and three weeks pregnant, everything was working against her. Maternity wards had started closing amid fears that pregnant women with the virus would infect anyone who attempted to assist their deliveries. Ebola is transmitted through bodily fluids, which gush during childbirth.
An ambulance took her to a
“Based on what Il earned about the disease, I was expecting her to die. MATILDA N’GLANDA NURSE
hospital overflowing with suspected patients and filled with dirty mattresses. It wasn’t even an Ebola treatment facility — just a place to keep suspected patients while centres were built. Often, dead bodies lay on the floor for days. By the time she was admitted, her parents, brother and sister had died.
“Based on what I learned about the disease, I was expecting her to die,” said Matilda N’glanda, the head nurse.
Then, remarkably, Kabia’s health started to improve. “It was the drugs and God,” Kabia said.
She was released in mid-October, with a certificate declaring her a survivor. It was supposed to mean the end of her battle with Ebola. But Kabia had a bad feeling about the baby.
Two weeks later, she touched herself between her legs and saw that her fingers were red. She tried to stay composed, to drag herself to a clinic, even though she knew she might be refused treatment.
“I worried I was going to lose it,” she said.
Although the research is in the early stages, many obstetricians have suggested that Ebola might pool in a woman’s placenta even after it has disappeared from the rest of her body. The same is true of other diseases, such as malaria. In other words, Kabia could test negative for Ebola but her baby could still have it.
Some doctors and nurses have begun testing the fetuses of the miscarried infants of Ebola victims. The research isn’t formal, and it’s still in an early stage, but the results have been startling. Grazia Caleo, an epidemiologist for Doctors Without Borders, remembers the first fetus she tested last year.
“It was the highest viral load we’ve ever seen. Just off the charts,” she said.
Everyone who knew Kabia saw the bleeding as a sign of how tenuous her situation was. Still, weeks have passed since then, her pregnancy is now entering its fifth month, and the fetus appears healthy.
At the beginning of the HIV outbreak, nearly half of all pregnant HIV patients passed the virus on to their babies. It took years, but scientists learned that by using anti-retroviral drugs, they could cut the mother-to-child transmission rate to less than five per cent.
For now, in every recorded case, mothers with Ebola pass the disease to their children.
But Kabia remains optimistic. “I think my baby will be safe,” she said.