March 31, 2020
As the novel coronavirus continues to spread, pregnant women report concerns about how COVID-19 could affect them and their unborn babies. Current guidelines from the Centers for Disease Control and Prevention say women should avoid contact with anyone suspected to have COVID-19 during pregnancy. But there are no specific recommendations beyond the standard infection prevention strategies everybody is hearing: hand washing, social distancing, avoiding crowds, and working from home if possible.
Justin Brandt, assistant professor of obstetrics and gynecology in the division of maternal-fetal medicine at Rutgers University Robert Wood Medical School, discusses some common questions regarding pregnancy and coronavirus:
Are pregnant women more at risk if they contract COVID-19?
Although preliminary data about COVID-19 and pregnancy was reassuring, we have seen reports in the U.S. of some pregnant women having severe illnesses. Pregnant women experience physiologic changes in their chests that may make them more susceptible to viral respiratory infections. Based on our growing clinical experience with COVID-19 and our prior experience with SARS and MERS, which are also coronaviruses, women with COVID-19 might be at greater risk for pregnancy complications. The American College of Obstetricians and Gynecologists and the National Health Service from Great Britain are concerned that women might be more prone to miscarriage, preterm birth, and fetal growth restriction if they have COVID-19. What should a pregnant woman do if she thinks she is infected? Women should call their obstetricians and let them know their concerns. If symptoms are severe, they may need to be evaluated in the hospital. However, most women, even if pregnant, have mild symptoms and likely will not have to seek medical attention. My colleagues and I are triaging these calls over the phone to ensure that potentially ill patients are evaluated at the hospital while most are staying home. Patients at home with mild symptoms need to self-quarantine for a minimum of 14 days. They should not go to their routine prenatal visits until they have spoken to their doctor’s office and received instructions. We are encouraging our patients to be forthcoming with symptoms when they call, even mild symptoms, so we can ensure patients get optimal care.
What impact could COVID-19 have on unborn babies?
The clinical picture is changing rapidly. Most reports have suggested that the risk of vertical transmission is low. This means it is unlikely that the virus is transmitted from an infected mother to her fetus. However, it was recently reported that some newborns of mothers with COVID-19 have virus-specific antibodies. These antibodies, which are IGM subtype, are not usually transferred across the placenta from mother to fetus due to their large molecular size. This new data has some significant weaknesses, but this finding suggests that antibodies were produced by some babies who were exposed to the novel coronavirus in utero. We need more data to clarify and corroborate this risk, but there may be a reason to worry about vertical transmission and associated conditions, including birth defects, early neonatal disease, and other complications. At this time, though, the data is just too limited to comment definitively about this risk, and we may be reassured by data about the first-trimester infection with SARS, another coronavirus, which suggests the risk is low. We know that neonatal transmission occurs, and family members and friends with COVID-19 can transmit the infection to children. The majority of cases of COVID-19 involving children, including newborns and babies, have been asymptomatic or mild. We need to prevent these infections, though, because there have been reports of severe disease, even deaths, in children.
How is the medical community trying to reduce the risk of pregnant women and their babies?
At our Rutgers Health practice, we have modified our schedule for prenatal visits and obstetric ultrasounds. We are also using telemedicine as much as possible. We are doing everything we can to provide optimal prenatal care while minimizing the need for patients to leave their homes. During this time, expecting parents should check with their physicians and the hospitals in which they plan to give birth as visitor policies are changing frequently. Patients may be allowed to have one support person on labor and delivery or, in some cases, may not be allowed any visitor. In addition, many hospitals are screening visitors for fever or illness. Visitors or support persons may not be allowed to enter a hospital if symptomatic or high risk for COVID-19. Pregnant women who have COVID-19 should expect that they will be temporarily isolated from the baby following delivery. This is in accordance with guidance from the CDC and is intended to minimize the risk of neonatal transmission. The recent report of neonatal death in Illinois due to complications from COVID-19 underscores the importance of this policy. The baby can receive the mother’s breast milk and will be reunited with the mother as soon as transmission-based restrictions are lifted.
What should pregnant women keep in mind right now?
Pregnant women should adhere to the principals of social distancing, stay home, and avoid public gatherings. If parents must leave their homes, we want them to focus on adequate hand washing, trying not to touch their faces and keeping a safe distance of at least six feet from people who may be sick or people whose statuses are unknown. Expecting parents should prepare to be home for several months. They should have food, common medicines including Tylenol, thermometers, and other household items such as soap, toilet paper, and washing detergent. When possible, patients should take advantage of delivery services rather than going to markets and other stores where people may congregate. It is safe for pregnant women to be home if they develop mild illnesses. Most people who acquire COVID-19 will recover fully with minimal risk. This is true for pregnant women as well. However, symptoms may worsen rapidly. Shortness of breath, coughing up blood, inability to tolerate liquids due to persistent vomiting, and changes in mental status such as confusion are symptoms that require urgent medical attention. In addition, obstetrical complaints such as uterine contractions, vaginal bleeding, and perceptions of less fetal movement also require evaluation.