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COVID-19 & Pregnancy
 
Jovian Wat, PhD and Kelsey McLaughlin, PhD

NOTE: THE COVID-19 PANDEMIC IS AN EVOLVING SITUATION AND THERE IS NEW DATA BEING PUBLISHED FREQUENTLY. WE WILL CONTINUE TO UPDATE THIS ARTICLE AS NECESSARY.

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On March 11th 2020, the World Health Organization declared the global COVID-19 outbreak a pandemic. Here is what you should know about the virus, and how it can impact pregnancy.

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What is COVID-19?

 

COVID-19 is the disease caused by the recently discovered coronavirus, officially named the SARS-CoV-2 virus.


COVID-19 has proven to be highly infectious, with over 18.3 million cases reported to the World Health Organization as of August 5th, 2020. Based on current data available, the global death rate from COVID-19 is approximately 3.8%.


A virus is a microorganism that can infect cells in the body and reproduce, creating thousands or millions of copies that can disrupt body functions. Once replicated, the virus can end up in bodily fluids (e.g. saliva) that can be transmitted to others through exposure.


COVID-19 is caused by a specific strain of the coronavirus, a large family of viruses that includes the strains that caused SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Coronaviruses can infect humans if they are transmitted between animals and humans – SARS was transmitted from civet cats, and MERS was transmitted from dromedary camels.


Scientists hypothesize the virus was likely transmitted from the horseshoe bat, however, the exact origin of the SARS-CoV-2 virus is not known. 

Pregnant Woman
Plant

Effects of COVID-19 on Pregnant Women & Developing Babies

 

Maternal health
 

Pregnant women with COVID-19 tend to experience similar symptoms compared to non-pregnant patients with COVID-19. The most common COVID-19 symptoms in pregnant women are fever, cough and shortness of breath.  


A recent article in the New England Journal of Medicine reviewed the symptoms of 118 pregnant women with COVID-19 in Wuhan, China. The majority of pregnant women had mild cases of COVID-19 (ie. no breathing difficulties), while 8% of women had severe disease. There were no deaths in this population of pregnant women.


Pre-existing medical conditions and a woman’s baseline health may impact the severity in which COVID-19 could impact a woman in her pregnancy. Of 64 pregnant women hospitalized with COVID-19 across 12 hospitals in the United States, 25% had a pre-existing lung condition and 17% had pre-existing heart disease. Maternal weight and ethnicity may also be associated to the severity of COVID-19 infection in pregnant women.


The COVID-19 pandemic has had a significant impact on the mental health of the general population, including pregnant women. Pregnant women surveyed in Canada reported an increase in symptoms of anxiety and depression, relative to pregnant women surveyed before the pandemic. The Canadian Mental Health Association has numerous resources and suggestions to help support your mental health at this time.

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Pregnancy health


Data show that pregnant women with COVID-19 are more likely to delivery prematurely, defined as delivery before 37 weeks of pregnancy (more articles: here, here, here).

 

Preterm delivery can occur for a number of reasons. Preterm delivery can be spontaneous, meaning that the body naturally goes into early labour, or it can be iatrogenic, meaning that doctors induce or deliver the baby early for medical reasons. Preterm delivery in any pregnancy can impact the baby’s health, as they are born at a lower birthweight and may require time in intensive care to promote growth and development.

 

The majority of preterm deliveries in pregnant women with COVID-19 are iatrogenic - doctors may be delivering women prematurely if they are concerned about the infected mother or baby’s health. 

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In the case of COVID-19, Caesarean deliveries in pregnant women with COVID-19 are higher, relative to women without COVID-19 (sources: here, here).

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Fetal health
 

An important question many women ask is whether pregnant women infected with COVID-19 can transmit the virus to their developing baby, a term called ‘vertical transmission’. A meta-analysis published in July 2020 studied 936 newborn babies from COVID-19 infected mothers; only 27 babies (2.9%) tested positive with the SARS-CoV-2 virus.

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This data suggests that while vertical transmission may be possible, it seems to be relatively rare.

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Newborn

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Breastfeeding & COVID-19

 

Current data suggest that breastfeeding is safe for COVID-19 positive women, if correct hygiene precautions are taken. 

 

A recent report followed 116 COVID-19 positive women who practiced skin-to-skin with their babies and breastfed with hygiene precautions (hand hygiene, breast cleansing, surgical mask). None of the babies were positive for COVID-19 at delivery, had COVID symptoms or were found to have COVID 14-days following breastfeeding. Additional studies support this conclusion.

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Recommendations for Pregnant Women

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The Society of Obstetricians and Gynaecologists of Canada, American College of Obstetricians and Gynecologists, and the Society of Maternal-Fetal Medicine recently updated their guidelines for clinical care of pregnant women with suspected or confirmed COVID-19 infection.

 

Key points from these guidelines include:

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  • Routine antepartum care appointments may be delayed for women with suspected COVID-19 infection

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  • Hospital birth is preferred for patients who have or are being tested for COVID-19 due to the potential for fetal distress; however, expectant management at home may be appropriate for other patients

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  • Droplet and contact precautions are necessary in the hospital, and the presence of family and household contacts may be limited in the delivery suite

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  • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed, while airborne infection isolation rooms may be needed for aerosol-generating procedures; babies born from patients with known or suspected COVID-19 should be tested and monitored accordingly

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  • Breastfeeding is still recommended, but cleansing of the breast, appropriate hand hygiene, and face coverings should be considered    

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COVID-19 Prevention 

 

All persons are recommended to review preventative measures with their healthcare providers or public health units.

 

The World Health Organization recommends:

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  • Frequent handwashing, either with soap and water or alcohol-based hand rub

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  • Avoid touching your eyes, nose, and mouth

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  • Maintain at least 1 metre (3 feet) of distance from anyone who is coughing or sneezing

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  • Limit travel to crowded and/or high-risk areas

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  • Isolate yourself if you are experiencing symptoms such as cough, fever, and headache

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  • Wear a mask if you need to go out

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Summary​

 

The global outbreak of COVID-19 infections remains an evolving situation. Preterm delivery is more common in pregnant women infected with COVID-19. However, the risk of a COVID-19 positive pregnant woman transmitting the virus to her baby seems to be low. Breastfeeding is recommended in COVID-19 positive women, with correct hygiene precautions. 


All persons are recommended to remain vigilant with the recommended protective measures and consult their healthcare provider or public health unit if they experience any onset of known symptoms. 

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Disclaimer

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Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.

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This article was written by Dr. Jovian Wat and Dr. Kelsey McLaughlin and edited by Dr. Kelsey McLaughlin and Dr. Melanie Audette​.

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