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Pregnant During the Pandemic? Here’s What You Need to Know

Pregnant During the Pandemic? Here’s What You Need to Know

An already fraught time can be made more stressful by the risk of infection. Learn why you can mostly rest assured.

On February 29, Carrie Symonds, the fianceé of British Prime Minister Boris Johnson, announced she was pregnant. Five weeks later, on April 4, she revealed she was recovering after falling ill with symptoms of COVID-19. Johnson himself was admitted to the hospital with symptoms the following day. He spent a week there, including three days in the intensive care unit.

Whether or not Symonds actually had COVID-19, she found herself among the millions of people on the largely unmapped journey of pregnancy during the pandemic.

If you’re pregnant right now, you’re not only preparing for one of the most intense and emotional experiences of your life, but you’re also coping with concerns about the coronavirus. You may even face the possibility of delivering in a hospital filled with COVID-19 patients.

Here’s a rundown of what to expect during pregnancy, labor, delivery and early parenthood in the COVID-19 era.

Am I at higher risk for getting the virus, or for getting severely ill?
Some good news: As far as we can tell based on current data, pregnant people face a similar level of COVID-19 risk—both for infection and for serious illness—as other adults.

“So far, most of the pregnant women [in studies] have done well,” says Jeanne S. Sheffield, MD, Director of the Division of Maternal-Fetal Medicine and professor of Gynecology and Obstetrics at Johns Hopkins Medicine in Baltimore, Maryland. “It’s very similar to the general population—most of them are asymptomatic or had very mild symptoms. A couple of them had critical disease.”

That said, there’s still much we don’t know about COVID-19. To be on the safe side, some experts consider pregnant people to be a high-risk group. This is in part because they’re likelier to get sicker from influenza and other respiratory viruses—including those caused by other coronaviruses—than non-pregnant people. Additionally, a pregnant person’s immune system differs in ways that could lead to vulnerability to infection.

So until we have more data to suggest otherwise, caution is warranted. That’s especially true if you have other diagnoses like diabetes or chronic lung disease—conditions we know can raise the risk for serious illness.

I don’t have the virus, as far as I know. During my pregnancy, what should I be doing?
You’ll want to keep observing social distancing, handwashing and disinfection guidelines. You should also continue to eat healthful meals, exercise regularly (if possible), get adequate sleep and avoid alcohol and illicit drugs.

If you have to work away from home during this time, wash your hands often and talk to your employer about what they’re doing to protect you and your coworkers.

As you physically distance from others, be especially careful around children, who often carry the infection asymptomatically. Don’t allow play dates with kids from other households while distancing is in effect.

If I get COVID-19 while I’m pregnant, could the virus lead to problems with my pregnancy?
Complications like preterm labor have been reported in pregnant people testing positive for the novel coronavirus that causes COVID-19 (also known as SARS-CoV-2), but it’s not clear whether that is because of the virus or an unrelated reason. Other coronavirus diseases, including severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS), have been linked to miscarriage and stillbirth. Fortunately, there are many published cases of pregnant people who tested positive but did well, as did their newborns.

If you’re ill with COVID-19 symptoms, follow guidelines from the Centers for Disease Control and Prevention (CDC), as well as the advice of your provider. People with COVID-19 who are not sick enough to need hospitalization should stay home and avoid taking public transportation. Know the signs of an emergency, and if your symptoms worsen, get help immediately. You should also avoid the people you live with as much as possible. Wear a face mask when you’re near them, and when you leave home to get medical care.

Can I pass the coronavirus to my unborn baby?
This mode of viral spread is called vertical transmission. Some viruses, like Zika, can devastate the developing fetus in this way. Fortunately, there hasn’t been clear evidence that this is happening with the novel coronavirus.

For example, a March 2020 study of 38 SARS-CoV-2-positive pregnant women published in Archives of Pathology and Laboratory Medicine found that none of their infants tested positive for the virus, nor were the researchers able to detect it in amniotic fluid.

There have been a few cases of newborns testing positive. But transmission could have occurred during or after birth.

“There’s still no true, strong evidence that there is vertical transmission,” Dr. Sheffield says. Based on published data, she added, “most of the babies have done just fine.”

Is prenatal care any different during the pandemic?
Some aspects may change. If you have a low-risk pregnancy, your provider may decide to space out routine visits to limit the number of trips you have to make to the clinic. If you do come in person, your clinic may restrict visitors for everyone’s safety.

Telehealth may also be an option for some visits. Sheffield says that although most prenatal checkups are done in person, they don’t all have to be. Patients who have a home blood pressure cuff and a Doppler monitor to listen to the baby’s heartbeat may be able to arrange a virtual prenatal visit. Just remember to always use such devices with the guidance of your OBGYN.

“We have a number of patients that are truly concerned about coming in to a clinic for their prenatal visit,” she says. “We have definitely made accommodations for them.”

Will my delivery plan have to change?
Not necessarily. “Labor itself is not going to be any different,” Sheffield says. “The environment may change a little bit.”

Some hospitals are testing pregnant patients for the coronavirus upon arrival. “We can notify the nursery if a mom is positive or negative, and it allows us to labor her or deliver her in the correct room,” Sheffield explains.

Your healthcare providers (HCPs) will be wearing masks and other personal protective equipment, and you may be asked to wear a mask, as well. For everyone’s safety, while a partner may be able to attend the birth, you may not be able to bring additional friends or family. If that happens, keep in mind that you will not lack for support—a labor nurse will always be available.

Policies differ among states and individual medical facilities, though. If you are due to have a baby soon, talk to your OBGYN and find out what your hospital or birthing center’s current procedures are for visitors, doulas, video conferencing and length of hospital stay.

Will the hospital be a safe place to deliver?
Hospitals nationwide are going to great lengths to protect patients and providers. The CDC calls for people with suspected coronavirus to be placed in a negative-pressure room—also called an airborne infection isolation room—if one is available. Strict visitor policies are intended to curb disease transmission.

Hospitals are making contingency plans in case they get overwhelmed with COVID-19 patients, too. When you’re 34 weeks into your pregnancy, check in with your provider about what to expect on this front.

While many people may fear going to the hospital at this time, both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) maintain that a licensed hospital or birth center is a safe place for delivery.

After you deliver, if you have the coronavirus or are suspected of having it, you and the baby may need to be temporarily separated—a sad scenario, but one you should prepare for if necessary.

If I test positive for the coronavirus, is it safe to breastfeed?
While some small studies suggest the novel coronavirus does not appear in breast milk, the science isn’t conclusive. This is a decision you should make in consultation with your family and HCPs.

Another concern about breastfeeding is that the mother could transmit the virus to the baby through respiratory droplets. So, if you have COVID-19 and decide to breastfeed, wear a face mask and wash your hands before each session.

Another option is to express your milk. Use a breast pump you don’t share with others, wear a mask while pumping, observe careful handwashing before and after you handle the pump and clean it according to recommendations. Consider having a person who doesn’t have COVID-19 give the baby the expressed milk.

I feel so frustrated by how little we know.
So are providers. But the news has been largely good so far, and chances are excellent that medical science will know more by your due date. To keep up with developments, check in with your OBGYN, as well as reputable information sources like the SMFM, ACOG and CDC.

“Guidelines keep changing. I know it’s frustrating to moms. I know it’s frustrating to practitioners,” Sheffield says. “We’re learning as we go on this one.”

Medically reviewed in April 2020.

Sources:

Mark Landler. “For Boris Johnson, Britain’s Baby Boom Starts at Downing Street.” The New York Times. February 29, 2020.
Carrie Symonds. “I’ve spent the past week in bed…” Twitter. April 4, 2020.
“Coronavirus: Prime Minister Boris Johnson tests positive.” BBC. March 27, 2020.
World Health Organization. “Not Every Pregnancy is Welcome.”
Centers for Disease Control and Prevention. “Coronavirus Disease 2019 (COVID-19): Pregnancy and Breastfeeding,” “Pregnant Women & Influenza (Flu),” “Coronavirus Disease (COVID-19) and Breastfeeding,” “Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020,” “Caring for Children,” “What We Know About Zika and Pregnancy.”
UpToDate.com. “Coronavirus disease 2019 (COVID-19): Pregnancy issues.”
University of Utah Health. “Coronavirus and Pregnancy.”
The American College of Obstetricians and Gynecologists. “Novel Coronavirus 2019 (COVID-19),” “Joint Statement: Recent Developments Regarding COVID-19 and Pregnant Women,” “Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients.”
Kate Marple. “Coronavirus (COVID-19) pregnancy FAQs: Medical experts answer your questions.” Babycenter. April 9, 2020.
DA Schwartz. “An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes.” Archives of Pathology and Laboratory Medicine. March 17, 2020.
BA Chaves, ABV Junior, et al. “Vertical Transmission of Zika Virus (Flaviviridae, Flavivirus) in Amazonian Aedes aegypti (Diptera: Culicidae) Delays Egg Hatching and Larval Development of Progeny.” Journal of Medical Entomology. 2019 Oct 28;56(6):1739-1744.
Society for Maternal-Fetal Medicine. “COVID-19: Changes in Pregnancy and Maternity Care Advice for Women and Their Families.” March 31, 2020.
OSHA.gov. “Guidance on Preparing Workplaces for COVID-19.”

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