COVID-19 and pregnancy

 

What do we know about coronavirus 2019 and what it means for pregnant women and their unborn babies? What happens if a pregnant woman contracts the disease? Should she breastfeed while ill? Find out more.

We will update this information as we learn more about the risk of pre term birth and COVID-19 infection.

I’m pregnant. How can I reduce my risk of infection?

Dr Ryan Noach, Chief Executive Officer of Discovery Health, has advised pregnant women to be especially cautious in light of the recent outbreak of the 2019 coronavirus. “There is no information from published scientific reports about whether pregnant women are more susceptible to COVID-19 or not,” he says. “Pregnant women do; however, experience physiological changes that could make them more susceptible to viral respiratory infections.”

The World Health Organization (WHO) recommends that pregnant women should follow the same preventive measures as everyone else, such as washing your hands often (especially after being in any public places such as at work), avoiding contact with people who are sick, practising cough etiquette and more.

What effect does the 2019 coronavirus have on pregnant women?

According to Coronavirus (COVID-19) infection and pregnancy: Guidance for healthcare professionals, version 2 - 13 March 2020 published by the Royal College of Obstetricians and Gynaecologists:

  • Pregnant women do not appear to become more severely unwell if they have COVID-19 than the general population. As the 2019 coronavirus is a new virus, it is not yet clear how it can affect pregnant women. It is expected the large majority of pregnant women will experience only mild or moderate cold- or flu-like symptoms.
  • There are no reported deaths of pregnant women from COVID-19 at the moment.
  • If you are pregnant, you are more vulnerable to getting infections than someone who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you get COVID-19.
  • Pregnant healthcare workers are not more likely to get COVID-19 or have complications than their non-pregnant colleagues.

However, as having COVID-19 could put your unborn child at risk (possible risk of foetal growth restriction, or of premature birth if you become seriously unwell), you should discuss your pregnancy with your healthcare provider.

What should I do if I’m pregnant and think I’ve been exposed to COVID-19?

Pregnant women who experience fever and a cough and unusual shortness of breath should contact the doctor looking after them and explain that they have symptoms that are similar to those of COVID-19 (especially before any routine gynaecological appointments). Keep in mind that it’s important to either consult your doctor telephonically before going to their rooms, or set up a virtual consultation with your doctor to obtain their guidance. and make sure all healthcare professionals involved are aware of your medical and travel history before you go for a consultation. This keeps you and other pregnant women safe.

If you need to be tested for COVID-19, you will be tested in the same way as anyone else (swabs being taken from your mouth and nose, or you can also be asked to cough up sputum, a mixture of saliva and mucous). The swabs or sample are then sent for testing.

The WHO has also recommended special considerations and supportive therapies for pregnant patients with COVID-19.

What happens I test positive for COVID-19?

According to the Royal College of Obstetricians and Gynaecologists pregnant women should contact their midwife or antenatal team to make them aware of the diagnosis. If you have no symptoms, or mild symptoms, you will be advised to recover at home. You may be asked to self-isolate. If you have more severe symptoms, you might be treated in a hospital setting.

You can be told to self-isolate if:

  • You have symptoms of COVID-19, such as a high temperature or new, continuous cough.
  • You have tested positive for COVID-19 and your doctor recommends recovering at home.
What effect will the 2019 coronavirus have on my baby if I am diagnosed with the disease?

According to the Royal College of Obstetricians and Gynaecologists:

  • There is currently no evidence to suggest an increased risk of miscarriage.
  • Some babies born to women with symptoms of COVID-19 in China have been born prematurely. It is unclear whether COVID-19 caused this, or the doctors made the decision for the babies to be born early because the women were unwell.
  • There is also no evidence that the COVID-19 virus can pass to the foetus while you are pregnant. Therefore, it’s considered unlikely that your having COVID-19 will cause abnormalities in the baby. Keep in mind that, as this is a new virus, there is limited evidence about managing pregnant people with COVID-19 and who have just given birth. However, there are no reports of women diagnosed with COVID-19 during the third trimester of pregnancy having passed the virus to their babies while in the womb.
What should I do if I’m asked to self-isolate?

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for at least 14 days (depending on what your doctor recommends) and:

  • Not go to school, work, to hospitals or clinics or public areas
  • Not use public transport
  • Stay at home and not allow visitors
  • Ventilate the room you are recovering - by opening a window
  • Separate yourself from other members of the household as far as possible, and use your own towels, crockery and utensils
  • Ask friends and family, or use delivery services to run errands but tell them to leave items outside
  • Ask advice from your doctor or maternity team on attending routine antenatal appointments
What happens if I feel unwell or I’m worried about my unborn baby during self-isolation?

If you have concerns about your wellbeing or that of your unborn baby during your self-isolation, contact your doctor or maternity team. They will give you medical advice, including whether you need to be admitted to hospital or not.

What happens if I am in self-isolation and go into labour?

Please discuss this with your doctor or maternity team as soon as you know that you have contracted COVID-19. According to the Royal College of Obstetricians and Gynaecologists it is not recommended that you give birth at home or at a unit led by midwives only. This is because a pregnant woman with suspected or confirmed COVID-19 has to have her baby monitored to check how the baby is coping with labour (using continuous electronic foetal monitoring) and that their oxygen levels can be monitored hourly.

Here’s what to do:

  • If you go into labour, call your maternity unit for advice, and tell them again that you have suspected or confirmed COVID-19.
  • If you have mild symptoms, you could be told to stay at home (self-isolate) in early labour, the normal practice if you don’t have COVID-19.
  • When you and your maternity team decide you need to come in to hospital, follow the general recommendations for being admitted to hospital such as:
    • Using your own transport to get to hospital, if possible, instead of an ambulance
    • You will be met at the hospital entrance and be given a face mask. You need to wear the mask until you are isolated in a suitable room
    • COVID-19 testing will be arranged
    • Your birth partner will be able to stay with you throughout, but visitors will be kept to a minimum
Will my baby be tested for COVID-19?

Yes. If you have suspected or confirmed COVID-19 when your baby is born, your baby will be tested for the 2019 coronavirus.

Is skin-to-skin contact with my baby advised if I have COVID-19?

According to the Royal College of Obstetricians and Gynaecologists, you can have skin-to-skin contact with the newborn as long as your baby is well and doesn’t require care in the neonatal unit. There are some reports from China that suggest women with confirmed cases of COVID-19 have been told to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding. You and the doctors caring for your baby should discuss the best way to care for your baby. This guidance may change as scientists and doctors learn more about COVID-19.

What happens once I recover?

According to the Royal College of Obstetricians and Gynaecologists if you have a confirmed case of COVID-19, as a precaution, an ultrasound will be arranged 14 days after your recovery, to check that your baby is well. This 14-day period may become less as more information on how infected people are recovering becomes available. If you have recovered from COVID-19 and test negative for the virus before you go into labour, where and how you give birth shouldn’t be affected by your previous illness.

  • Please talk to your doctor about the approach they would like to follow.
Can I still breastfeed with COVID-19?

This information might change as scientists and doctors learn more about COVID-19.

You and your maternity care team should discuss the risks and benefits of breastfeeding. So says the Royal College of Obstetricians and Gynaecologists.

According to the Centers for Disease Control and Prevention in the United States of America, there’s no evidence to suggest that babies could get the 2019 coronavirus through amniotic fluid or breast milk. The main risk associated with breastfeeding the close contact between you and your baby as the virus is contracted through droplets spread through the air from ill people who cough or sneeze, through personal contact (and in rare cases, through faecal contamination).

Currently, the recognised benefits of breastfeeding outweigh any potential risks of transmitting the 2019 coronavirus through breastmilk. Mothers who have symptoms of or are diagnosed with COVID-19 can breastfeed, as long as they:

  • Try to avoid coughing or sneezing on your baby while feeding at the breast.
  • Wear a face mask.
  • Wash hands before and after breastfeeding.
  • Disinfect all surfaces that mother and baby may have touched.

If a mother is too unwell to breastfeed, she should express the milk into a bottle that’s been sterilised after each use and ask someone else to feed the baby. If she’s expressing breast milk in hospital, she should use a dedicated breast pump. Again, she should wash her hands thoroughly before touching the breast pump and any of the bottle parts.

For more information on pregnancy and COVID-19, read the sources below. Visit our dedicated coronavirus 2019 page for the latest updates, tools and insights.

What precautions must I take if I am formula-feeding baby?

When anyone who is ill feeds the baby formula:

  • Sterilise the bottle before each use.
  • Try to avoid coughing or sneezing the baby.
  • Wear a face mask.
  • Wash hands before and after feeding.
  • Disinfect all surfaces that the baby and the person feeding them may have touched.

Follow baby bottle sterilisation guidelines exactly.

Should I travel while pregnant?

Please follow the South African government’s guidelines. In South Africa the outbreak has been declared a national state of disaster and specific international and local travel restrictions apply. Avoid all non-essential travel.

If you cannot avoid travelling while pregnant, make sure you have health insurance before travelling and that your insurance covers your healthcare as well as the costs associated with the birth and care of a newborn if you go into labour abroad.

Royal College of Obstetricians and Gynaecologists

UNFPA statement on novel coronavirus (COVID-19) and pregnancy

https://www.unfpa.org/press/unfpa-statement-novel-coronavirus-covid-19-and-pregnancy

https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf

US Centers for Disease Control and Prevention. Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html

US Centers for Disease Control and Prevention. Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html

World Health Organization. Interim guidance. Link: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf

 

All medical information found on this website including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to protect and empower all South Africans by promoting a better understanding of COVID-19.

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