Pregnancy

COVID-19 & Pregnancy

Being pregnant can already be stressful, but it’s even more overwhelming given the spread of the novel coronavirus and COVID-19, the disease it causes.

It’s only natural to have questions about the coronavirus and what it means for your pregnancy. Here’s what you need to know.

What is the coronavirus and COVID-19?

There are actually seven different types of coronavirus known to infect humans, according to the Centers for Disease Control and Prevention (CDC). Many are mild and cause colds, but some forms of the virus, specifically MERS-CoV and SARS-CoV, can cause severe illness. The form of coronavirus that’s circulating right now is 2019-nCoV.

On January 30, the World Health Organization (WHO) declared the coronavirus a global health emergency. Officially known as a “Public Health Emergency of International Concern,” this term is used to describe “an extraordinary event” that constitutes a public health risk to multiple countries, potentially requiring a coordinated international response, according to WHO. On March 11, WHO said COVID-19 is officially a global pandemic.

There’s a lot scientists are still trying to learn about COVID-19, according to infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security.

How is the coronavirus spread, and what are the symptoms of COVID-19?

Coronaviruses typically spread from an infected person to other people via respiratory drops that get into the air by coughing or sneezing, the CDC saysThe CDC also says that there is some evidence that COVID-19 may also be spread by exposure to the virus in small droplets and particles that can linger in the air for minutes to hours. Those viruses may be able to infect people who are further than six feet away from the person who is infected or after that person has left the space.

Touching or shaking hands, or touching a surface that has been contaminated with the virus and then touching your mouth, nose or eyes before you wash your hands may also spread the virus, but the CDC says this is not thought to be the main way the virus spreads.

People who have had confirmed cases of COVID-19 have experienced the following symptoms, per the CDC:

  • Fever
  • Cough
  • Shortness of breath
  • Chills
  • Shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • A new loss of taste or smell
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Symptoms can appear anywhere from two to 14 days after a person has been exposed, and they’ve ranged from causing mild illness to severe cases.

It’s important to note that some people with COVID-19 do not show symptoms, but they can still spread the virus. 

What does COVID-19 mean for your pregnancy?

Scientists are still trying to learn more about how this virus impacts pregnancy. Here’s what we know right now:

  • Pregnant women are immunocompromised and therefore more susceptible to complications of respiratory infections like COVID-19, so experts recommend doing your best to follow certain precautions, like practicing good hand hygiene — an important step at any time.
  • An analysis published by the CDC in June found that moms-to-be with COVID-19 are more likely to be hospitalized in an intensive care unit and put on a ventilator, suggesting pregnant women are more likely to have severe COVID-19 complications. However, the research did not account for labor and delivery hospitalizations.
  • A small study of nine pregnant women in Wuhan, China, with confirmed COVID-19 found no evidence of the virus in their breast milk, cord blood or amniotic fluid. 
  • In May, a small study of 46 pregnant women with symptomatic COVID-19 published in the American Journal of Obstetrics & Gynecology found that most had mild cases, but some developed breathing problems.
  • A small retrospective study published in The Lancet reviewed obstetric and neonatal outcomes of seven pregnant women at a hospital in Wuhan who had contracted COVID-19 in their third trimesters. The outcomes for all seven moms were good; none were admitted into intensive care and all were later discharged from the hospital.
  • A small study of 43 pregnant women in New York with confirmed COVID-19 published in the American Journal of Obstetrics & Gynecology in April found that unlike SARS and H1N1, pregnant women do not seem to experience more severe illness from the coronavirus compared to the general population.
  • A study published as a letter in The New England Journal of Medicine looked at testing data from pregnant women who delivered between March 22 and April 4 at New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center in New York City. Although the study was small, focusing on just 215 moms-to-be, 88 percent of the women who tested positive for COVID-19 did not show any symptoms.
  • A research letter published in JAMA in late May analyzed testing data from 782 pregnant women admitted for birth at three Yale New Haven hospitals in Connecticut. Of those women, 12 (1.5 percent) had previously tested positive for SARS-CoV-2, the virus that causes COVID-19. In the rest of the women, 30 (3.9 percent) tested positive for SARS-CoV-2 and 22 (73.3 percent) of those didn’t have symptoms. Eight of 14 women with symptoms (47 percent) tested positive. Overall, 22 (2.9 percent) of patients without symptoms tested positive. Based on the findings, the researchers concluded that COVID-19 rates among pregnant women are fairly low.
  • A research letter published in Infection Control & Hospital Epidemiology analyzed electronic health data of women giving birth at four affiliated hospitals with Mass General Brigham Health from mid-April to early May for COVID-19 test results. It found that 7.9 percent of pregnant women with COVID-like symptoms and a 1.5 percent of pregnant women with no symptoms tested positive for COVID-19 at four Boston hospitals.

The CDC says the following about pregnancy and COVID-19: “Based on what we know at this time, pregnant people might be at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, pregnant people with COVID-19 may be at increased risk for other adverse outcomes, such as preterm birth.”

Bottom line? Because there are still so many unknowns about how the coronavirus impacts pregnant women, it’s essential to follow social distancing guidelines and wear a mask in public, says Rajeev Fernando, M.D., an infectious disease expert in Southampton, New York and member of the What to Expect Medical Review Board.

What impact could COVID-19 have on a newborn?

More information is still needed about what effect COVID-19 could have on your unborn baby or newborn. Here’s what we know right now:

  • The CDC says there have been a few case reports of preterm birth among babies whose mothers were confirmed to have COVID-19 — however, it’s unclear whether the coronavirus was to blame. In general, developing a high fever early in pregnancy could increase the risk of certain birth defects.
  • Research into whether or not COVID-19 can be passed to a baby in utero (which is known as vertical transmission) is ongoing, but the CDC says it’s probably unlikely.
  • The CDC says that babies under the age of 12 months may be at higher risk for severe illness from COVID-19 compared with older children. However, the organization says, research on how COVID-19 presents in babies and how severe the disease can be in this group neonates is based on case reports and small case series.
  • A study published in the medical journal Pediatrics looked at data from more than 2,100 children in China who contracted the coronavirus. About 4 percent of the children studied had no symptoms, 51 percent had mild illness and 39 percent had a moderate illness. Around 6 percent had severe or critical illness, compared to 18.5 percent of adults. Infants had higher rates of severe illness than older children. The researchers theorized that children might feel better than adults after contracting COVID-19 because children have fewer opportunities for exposure, higher levels of antibodies against viruses or different responses from their developing immune systems.
  • In May, the CDC issued an advisory about pediatric multisystem inflammatory syndrome (MIS-C), a rare condition affecting children, mostly in New York City, that seems to be linked to COVID-19. Research about MIS-C is ongoing, but current information suggests it has to do with a child’s immune response to COVID-19. Symptoms can include fever, rash, eye irritation, swollen hands or feet and belly pain. The syndrome appears to be very rare, but if your child has any of the symptoms, call your pediatrician right away.
  • The CDC says that current evidence suggests that the risk of a newborn getting COVID-19 from its mother is low, especially when she uses appropriate precautions before and during care of the newborn, like wearing a mask and practicing hand hygiene.

What do you need to know about COVID-19 if you’re planning on breastfeeding?

  • Although small studies have not identified any evidence of COVID-19 in breast milk, it’s still not entirely clear whether breastfeeding mothers can transmit the virus to their babies through nursing.
  • The CDC notes that breast milk can help protect babies against many illnesses. If you have COVID-19 and are nursing, take proper precautions like washing your hands before touching your baby and wearing a face mask, if possible, while nursing your baby. Or, if you can, express milk and have someone else feed it to your baby.
  • If expressing breast milk, mothers should make sure to clean their breast pumps properly each time and consider letting another caregiver bottle-feed the expressed milk to the baby.

How can pregnant women protect themselves from the coronavirus?

Even if there is not a confirmed COVID-19 outbreak in your area, Dr. Adalja says you should assume that the coronavirus is still circulating in your town. It can take days to get test results back and research has suggested that people can spread the virus before they even have symptoms.

Again, Dr. Fernando recommends that you do your best to stay home as much as possible.

If you go out in public, the CDC recommends that everyone wear a face mask to prevent the spread of infection. The World Health Organization (WHO) specifically recommends choosing a mask that has at least three layers.

How could the coronavirus impact your birth plan?

Many hospitals and birthing centers have enacted measures to keep mothers and babies safe during delivery. Every hospital is different, but here are a few changes moms might experience:

  • Restrictions on visitors and who is allowed in the delivery room.
  • Your doctors and nurses will be wearing protective gear.
  • You will be asked to wear a mask.
  • You may be able to be discharged early, if you want to be.
  • You may not be able to walk around the hallways during labor.

What happens if you test positive for COVID-19 just before giving birth?

The American Academy of Pediatrics (AAP) recommends that infants born to mothers with a confirmed case of COVID-19 be temporarily separated from their moms to lower the risk that the baby will be infected. Babies born to moms who are suspected of having COVID-19 should also stay in an area that’s separate from unaffected infants, the guidance says.

The AAP also offered up more, very specific advice:

  • If the place where you gave birth can’t put your baby in a separate area, or if you choose to keep your baby in your room despite the recommendations, your baby should be at least six feet away from you.
  • You can express breast milk after you wash your hands and clean your breasts. Ideally, your baby would then be fed by someone who is not infected. If you want to directly nurse your baby, the AAP says it’s important to use a mask and follow “meticulous” breast and hand hygiene.
  • Medical staff who attend your birth should use a gown and gloves, with either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection.
  • If your baby needs to go to the NICU, the AAP recommends that she is admitted to a single-patient room with the potential for negative room pressure or other air filtration system. If that’s not available, there should be at least six feet between your baby and other infants, and/or she should be placed in an air temperature-controlled isolette.
  • If testing is available, your baby should be tested for COVID-19 at 24 hours of age, and again when she’s 48 hours old. If your baby can’t be tested, she should be treated as if she’s positive for the virus for a 14-day observation period.

You should also wear a mask when you are around your baby and others, Dr. Fernando says. 

Should pregnant women be concerned about germs at the hospital?

Some pregnant women may worry about being exposed to COVID-19 at the hospital or doctor’s appointments.

Experts stress that it’s still very important that patients receive prenatal care during this time. However, many prenatal care providers have made changes to their services to protect patients. Some are spacing out appointments and condensing visits to try to limit the amount of time you’re in the office, says Sherry A. Ross, M.D., OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. Your doctor may even offer telehealth consulting for some visits, she says. Some providers will also let you wait in your car before your appointment.

When you do go to see your doctor, William Schaffner, M.D., an infectious disease specialist and professor at Vanderbilt University School of Medicine, says moms-to-be should practice good hand hygiene and try to avoid people who appear to be ill when at doctor’s appointments or at the hospital.

“The surfaces in hospitals and many doctor’s offices are disinfected on a regular basis,” he points out.

However, you still want to do your best to avoid touching things and then touching your face with unwashed hands.

It’s also important to wear a mask in public places at all times, whether you’re at your doctor’s office or hospital, Dr. Schaffner says. 

Talk to your doctor or midwife about any concerns you have about your labor and delivery, as well as a backup plan in case one of your caregivers should become sick.

Visit whattoexpect.com/news for the latest updates on COVID-19 as it relates to pregnancy and babies

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