As the COVID-19 pandemic spreads throughout the globe and through communities in the US, some estimates predict that 40-70% of people will be infected. This wide range shows that a lot depends on the steps we take to prevent the spread of infection.
For pregnant women, like myself, this is a sobering statistic. It brings home the point that we’ve all got to do our part to stop the spread of COVID-19. There are also a lot of things we can do to protect ourselves from becoming infected: strict social distancing, hand washing, disinfecting “high-touch” surfaces, practicing good cough and sneeze etiquette, and maintaining a healthy lifestyle.
Even with these measures, some of us may become infected. Because the data is so sparse, recommendations are still fluid, and much more information is needed to understand the best ways to care for pregnant women and their babies. Here’s what we know so far about COVID-19 infections during pregnancy.
What are the symptoms?
The typical symptoms seem to be the same as the symptoms for most other people, fever, cough, sore throat, muscle aches, fatigue and shortness of breath. If you think you might be infected, it is critical that you let your OB know right away. This is important not only for your own health and the health of your baby, but to protect healthcare staff and other women from becoming infected.
Does COVID-19 increase the risk of complications and miscarriage?
Because we have such limited data, a lot of what we think can happen comes from our understanding of complications from other respiratory infections. We know that high fevers during the first trimester can cause birth defects in babies. Flu infection has been linked with low birth weight and early birth. With SARS (a coronavirus in the same family as COVID-19, though much more deadly) there were risks of miscarriage, restricted growth of the baby and early birth. Pregnant women also faced higher admissions to the ICU. From the information we have access to right now, the risks don’t appear to be as severe for COVID-19 infections.
From the few studies that have been published about COVID-19 in pregnant women, we know that the women studied were in their third trimesters and had mild to moderate infections (infections that did not require oxygen support before delivery). It’s important to remember however, that we don’t know how pregnant women with conditions like gestational diabetes, high blood pressure, or preeclampsia will do if they are also infected with COVID-19. We also don’t know what an infection in the first or second trimester could mean for the health of mom or baby.
So far, the virus that causes COVID-19 has not been found in amniotic fluid (the fluid that surrounds the baby in the womb), in cord blood, the babies’ throats, or in breast milk, so the risk of infecting babies in the womb was thought to be very low. Two new scientific reports presenting data from 7 newborns challenge this assumption. These reports found that all 7 babies had antibodies to the virus (likely from mom), but 3 of the 7 had another type of antibody that is usually too big to come through the placenta from mom and may have developed in the babies after exposure to the virus in the womb. The data here is NOT conclusive, but gives scientists another thread to pursue.
What will happen during delivery?
According to the American College of Obstetricians and Gynecologists, pregnant women with COVID-19 don’t have to change the timing or type of delivery method they were planning. A lot depends their symptoms and other medical problems.
Some hospitals are limiting the number of people that can accompany a pregnant women during birth depending on the number of COVID-19 cases in the hospital, so this is also something to prepare for emotionally.
The recommendations about what do to after delivery are also different from country to country. According to Chinese medical guidelines, newborns should be isolated from infected moms for 2 weeks (or until mom is no longer considered infectious.) The CDC recommends that hospitals “consider temporarily separating” moms and newborns after a discussion about risks and benefits. The WHO, on the other hand recommends keeping mothers and babies together. Because the virus spreads mainly through respiratory droplets, they advise that moms should follow strict hygiene and infection control precautions like washing their hands and wear a face mask to minimize their baby’s exposure to the virus.
Can I still breastfeed my baby if I have COVID-19?
Again, at this time there is no evidence that the virus can be found in breast milk, so breast milk should be safe to feed to newborn babies. Right now, because the recommendation is to separate newborns from moms that have COVID-19, this could mean keeping the baby in a separate room, or at least 6 feet away from mom after delivery. Moms can consider pumping and having someone else feed the baby while you are sick.
It is critical to prevent newborns from getting infected. Even though early information from China was reassuring, we still don’t know enough about how the disease can affect them.
Again, all the data we have so far are from small studies, so we just don’t know enough yet about the risks to pregnant women and their babies. This is especially true when it comes to risks depending on which trimester a mom is infected.
The biggest things we can do to protect ourselves and our unborn babies is to prevent infection. If we do become infected (or suspect that we are infected), we must inform our medical team right away. This allows us to get the medical attention we need and also prevents us from spreading the infection to others.