Here are some common questions we are being asked routinely about coronavirus (COVID-19, SARS-CoV-2 ) and pregnancy:
Am I at a higher risk for coronavirus while I'm pregnant?
Because COVID-19 is a relatively new virus, there are not enough reports to conclusively say if pregnant women are more susceptible than the general public. With that said, we must remember that due to normal physiologic changes of pregnancy, women have 1) an altered immune system during the pregnancy (more on this from the CDC), and 2) their lung volume and function is changed from the growing uterus and the pressure it puts on the diaphragm. Because of these factors pregnant women may very well be more susceptible, and at higher-risk for more severe symptoms when infected. Even though the CDC and American College of Obstetricians and Gynecologists don't have any specific guidance for pregnant women, we recommend being very vigilant and following some of the general precautions we outline (see our post on minimizing Coronavirus risk). Given that the likelihood of catching the virus is higher with personal contact (within 6 feet) of infected individuals, contact precautions, frequent hand washing are highly advised.
What happens if I get the coronavirus when I'm pregnant?
We still don't have too much information on this. However, based on the published data on SARS, MERS, and more recent reports on COVID-19 in pregnancy, we anticipate most healthy pregnant women to have mild symptoms similar to the general public, and approximately ten-percent to manifest severe symptoms. We do caution that this is based on limited evidence, and firm conclusions can't be drawn from such small studies. As with non-pregnant adults, the severity of the infection is also dependent on the woman having other chronic conditions that can affect the body's ability to fight the virus, such as diabetes, lupus, and being severely obese.
Can I pass the coronavirus to my baby?
To date, based on published COVID-19 reports, or publications on SARS and MERS, there is no evidence that the coronavirus can cross the placenta and infect the baby inside the womb. This has been examined by checking for the virus in the amniotic fluid, umbilical cord blood, and the mother's breast milk. The question of passing the virus through the birthing process is one that is puzzling many healthcare providers. There is no concrete evidence that the baby can get the infection by passing through the vagina (and exposure to secretions), but because many infected women in the reports were delivered by cesarean, it is hard to draw a meaningful conclusion about this therefore we recommend treating this on a case-by-case basis and speaking with your pregnancy provider about the mode of delivery.
Should I cancel my babymoon? Should I not travel?
We recommend referring to the CDC travel advisory page for COVID-19 for the most up-to-date recommendations as travel to most (if not all countries) is not markedly restricted. Current recommendations include limiting non-essential domestic travel with the United States, but even with that said, you should ask yourself several questions regarding your planned travel with the United States:
- How risk averse am I?
- Can I cancel travel if the destination suddenly becomes a hotspot?
- Can I handle a possible quarantine away from home?
- What if they issue a travel ban to the country I'll be returning from?
- Can I handle a quarantine at home?
With that said, and considering how fluid the situation, I'd personally avoid any non-essential travel which in turn limits exposure to other people and surfaces (i.e. rental cars, hotels), and decrease my risks of exposure as much as possible.
What should I do if I think I'm infected?
If you think you're infected, which generally manifests itself with fever, cough, and sore-throat, call your pregnancy provider. If you're not under the care of a provider (obstetrician, midwife, family practitioner), call the hospital where you plan to deliver, or your local health department. Many states and cities have set up hotlines, which you can find on-line. If you plan on going to a hospital, do let them know your symptoms ahead of time, or before you enter the facility so that the staff can take appropriate contact precautions to protect against being infected. With many mild cases, you may be triaged via telemedicine and not have to go into a facility.
Can I breastfeed my baby if I'm infected?
Our national organizations do not have any firm guidance on breastfeeding, and asks that you review this with your pregnancy provider. Even though reports to date have not shown no evidence of the virus in breast milk, the studies have involved very small number of women, and no meaningful conclusions can be drawn. The major risk with breast feeding is exposure of the neonate to the virus through non-milk exposure including skin contact. As it stands, breastfeeding is not contraindicated and reasonable options to consider include:
- For an infected mother to "pump and dump" while sick, or pump and allow a non-infected (healthy) adult to feed the baby
- For an infected mother to practice good hand-hygiene, wear a mask, and avoid direct contact with the baby (6 feet) as much as possible when not feeding
Should I wear a mask? Why is hand-washing so important?
No, you do not need a mask unless you're sick. In fact, some experts warn that you can introduce a virus to your face while trying to put on a mask. Washing hands on the other hand is a must. The virus is spread by droplets from coughing and sneezing landing on hands, and other surfaces (they can last up to 9-days there). A good 20-second hand-washing or use of hand-sanitizer (at least 60% alcohol) is invaluable in protecting you against an infection.
What prenatal visits or exams can I skip to minimize my exposure?
The decision to reduce the number of your prenatal visits should be made after careful discussion with your pregnancy provider as it will depend on 1) your comorbidities (if any), and 2) gestational age. Many providers are implementing telemedicine during these difficult times to provide virtual prenatal care. If your provider is not offering this, feel free to connect them with us via support@TelePerinatal.com as we can help them with several cost-effective telemedicine solutions. Given the extensive nature of this topic, we'll have a separate dedicated post, which you can access here.
Is it safe to deliver at a hospital caring for patients with COVID-19?
Yes. Hospitals in the United States have been working hard to implement measures aimed at 1) taking care of COVID-19 patients while protecting their staff and other patients, 2) taking care of non-infected patients safely, and 3) contingency plans for surge capacity (when the system may get overwhelmed). With that said, many new rules are being actively implemented including updated visitors policies, and reduction of elective procedures, therefore keeping up to date with this information is invaluable. Lastly, be sure to ask your provider of their contingency plan in the event he/she gets infected with COVID-19 and requires quarantine.
Do I need to take any special precautions if I'm a health care worker and pregnant?
In our other post, we outlined some simple risk reducing measures for home, general work place, and schools (even though many of the latter are now closed). With respect to health care workers, the employers should take precautions to limit exposure of pregnant health care workers to any COVID-19 infected individuals. With that said, given that many COVID-19 infected individuals are asymptomatic or have mild-disease, general precautions (as recommended by CDC) are warranted, along with a discussion with your facility leadership regarding shifting your responsibilities to non-patient facing ones. In a separate post found here we provide you with our thoughts regarding limiting exposure for staff in obstetrical offices.
