Pregnancy

Pandemic and Pregnancy: What You Should Know

An initial look at the limited research.

Posted Mar 15, 2020

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Pregnant woman with child.
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Among the limited research from China and current guidelines from the U.S. Centers for Disease Control and Prevention (CDC), there are some initial pieces of information laid out regarding COVID-19 and pregnancy. Based on the compilation of evidence by the Society of Maternal-Fetal Medicine, or SMFM, and their pregnancy experts, we’re beginning to see some early answers to important questions.  

First, it is worth noting that the precautionary guidelines provided by the CDC in terms of handwashing, avoiding touching one’s face, and social distancing apply across the board to everyone, and we can each do our part by following this guidance. Other answers to some basic questions are provided below:

What is known about COVID-19 and pregnancy?

As of yet, there is very limited information regarding the subject. Right now, the initial observations come from case series by medical specialists from China. What exactly are case series? They are descriptions of outcomes and exposure in patients by medical specialists.  

Based on the initial examination of two case series totaling 18 pregnant women from China, only one of these women received intensive care, which is reassuring. While previous coronaviruses, such as MERS-CoV and SARS-CoV, may have shown severe infection in pregnant women, the case series from China would suggest otherwise for COVID-19. Keep in mind the research on MERS-CoV and SARS-CoV and pregnancy is limited as well.

In the Chen et al. case series, all women had a known exposure to someone who was infected with COVID-19 or environmental exposure, such as being from Wuhan, the early epidemic center. Most of the women appeared to be in the late second or third trimester of pregnancy. Fever was present in seven out of nine women (78 percent) on admission and cough in four out of nine (44 percent). Preterm delivery was present in four out of nine women (44 percent); however, the gestational age at delivery was 36 weeks on average for those that were preterm, which is only one week away from full-term. Delivery APGAR scores reflecting the health of the newborns were reassuring (8-10), and there were no neonatal deaths. 

First trimester exposures and outcomes are very limited. More literature is needed about whether or not COVID-19 is linked to higher miscarriage risk or congenital anomalies. The data is reassuring from other respiratory infections, such as SARS-CoV and first-trimester exposure.

Is there evidence of transmitting the virus to the fetus?

Chen et al., in their Lancet article, found no evidence of COVID-19 within the amniotic fluid or blood of the umbilical cord in six infants of infected women at the time of delivery. The lack of transmission in the small number of cases is consistent with other common respiratory viral illnesses, such as influenza in pregnancy, which also has not shown to transmit to the fetus.     

Can I breastfeed if I am infected?

Chen et al., in the same Lancet article, found no evidence of COVID-19 in the breast milk of nine infected women. Breastfeeding is encouraged as the milk from the mother can provide immunity via antibodies transferred from mother to infant. Of note, it may be advised for a period of separation between the mother and infant to minimize transmission. In this period of time, a mother is encouraged to use good hand hygiene and use a breast pump to establish a milk supply, which can be fed to the infant by a healthy caregiver

What should I do if I am pregnant and at higher risk?

Pregnant women who have a severe chronic illness, such as heart, lung, or kidney disease, should follow the guidance by the CDC for higher-risk individuals. Some of the precautions include limiting close contact, frequent handwashing, and keeping away from others who are sick. Avoiding crowds and staying at home as much as possible is also recommended for these individuals. For further CDC precautions for high-risk individuals, see here.

Let us know if this information was helpful, and we’ll try and do our part to continue the conversation!  

References

The Society for Maternal-Fetal Medicine, Katz SD, Hughes BL.  Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. March 2020.