Pregnancy can sometimes be an uncertain and stressful period in the best of circumstances. But during a pandemic, that anxiety can quickly multiply. Researchers are working quickly to learn more about what the new coronavirus — as well as its impact on our daily lives — means right now for people who are pregnant. And health care providers are game-planning with mothers about how to best manage care in light of growing limits on public contact.
Here's what we know so far.
Am I more at risk if I'm pregnant??
"The good news is that thus far there hasn't been any indication that pregnant women are more severely affected" by the novel virus, says Dr. Denise Jamieson, chair of the department of gynecology and obstetrics at Emory Healthcare and a senior author of a prepress review paper slated to publish in the American Journal of Obstetrics & Gynecology.
This comes as a welcome surprise, as the similar coronavirus that caused SARS had a much higher fatality rate for pregnant people (about 25%, according to the limited data available from the 2003 outbreak) than for the general population (about 10%).
The current, hopeful assessments of the new coronavirus are based in large part on a study published online last month in The Lancet of nine pregnant women in their third trimester in Wuhan, China, who had pneumonia caused by COVID-19. None of the women developed severe illness, and all of their babies were born healthy.
"According to the current evidence in China, the clinical performance of pregnant women with COVID-19 is consistent with that of ordinary adults," says Jie Qiao, director of the National Clinical Research Center of Obstetrics and Gynecology Disease in China, who was not involved in that study but authored a commentary about it in the same issue of The Lancet.
Jamieson notes, however, that "we don't have very much evidence from this coronavirus." And although the data from third-trimester pregnancies appeared reassuring, we don't yet know much about the first or second trimester during a COVID-19 illness. So Jamieson, Qiao and other experts are closely following the evolving data.
What extra precautions should I take while pregnant?
The immune system's efficacy dips during pregnancy, which places pregnant people at a higher risk for contracting many transmissible illnesses — whether foodborne or respiratory. "They should be considered an at-risk group," Jamieson says.
Official recommendations during pregnancy are currently about the same as for the general population, including avoiding crowds, staying away from sick people, washing hands frequently and not touching the face.
Qiao takes these suggestions a step further, adding that she recommends avoiding public areas if possible — and wearing a face mask when out. And talk to your doctor about telemedicine, to avoid unnecessary visits to the office. "Except important pregnancy checkups," she says, "consulting [your] doctors online is recommended." Many offices are already working to consolidate in-person appointments (for example, if someone is coming in for an ultrasound, a routine prenatal check might be added to the same visit).
In addition to personal steps, Jamieson notes that it is important to consider how such a widespread outbreak could strain the health system, leading to disruptions in normal care. To prepare for that, she says, she advises that pregnant people have their medical records on hand.
Neil Silverman, a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, adds that hospitals are already ramping up to increase the capacity to care for pregnant women.
What kind of contingency planning should I do for delivery?
One big change that is already occurring in many labor and delivery wards is that they are limiting the number of visitors who can accompany anyone admitted for delivery — including through the postpartum stay. "This has been, reasonably, upsetting," says Rachel Pilliod, an OB-GYN who teaches obstetrics and gynecology at Oregon Health & Science University. "We understand that giving birth is more than a physiological process," she says, and many families have expectations about sharing the occasion in person.
She advises women who might deliver during the pandemic to ask their provider and the place where they intend to deliver about current rules on visitors. Typically the limit has been to one other healthy adult for the duration of the hospital stay.
Ahead of delivery, Jamieson advocates that "every pregnant woman and her family should have a plan, which should include what would happen if she or an additional caregiver gets sick." For example, if a partner becomes ill with COVID-19 and is trying to self-isolate, is there another caregiver who can step in to help care for a newborn and mother? And because the illness is riskier for older adults, if the other caregiver might have once meant a new grandparent, a younger adult might be a better backup if possible.
If I do get sick, how do I protect my newborn?
If you do get sick near your delivery date with confirmed or even suspected COVID-19, there are special precautions to be aware of. Though new mothers might not be at higher risk themselves, it is important to avoid passing the virus to a newborn.
Early research has not shown any evidence that the virus can be transmitted in utero, during delivery or through breast milk. But transmission can occur after birth when infants are in close contact with someone who has the illness.
This issue raises challenging decisions for families and health care providers. The practice of keeping a newborn in the same hospital room as the mother after birth (known as "rooming-in") has become popular in many U.S. hospitals. But the U.S. Centers for Disease Control and Prevention currently recommends avoiding rooming-in for new mothers with diagnosed or suspected COVID-19 infections. The guidelines (as of publication) say these infants should be placed in isolation and themselves be treated as presumed coronavirus cases, being cared for by healthy caregivers and medical staff in protective garb. "The main purpose is to avoid close contact with mothers, isolating respiratory tract transmission and possible infection," Qiao says.
Pilliod notes that in her practice, the CDC guidelines will be discussed with families so that they understand the risks and trade-offs of their care decisions. Healthy family members may have the choice to spend time with the newborns in isolation.
If an infant is taken to isolation directly after birth, the CDC recommends that ill women who would like to provide breast milk for their infant use a breast pump, being sure to practice good pumping hygiene. Direct breastfeeding could also be possible if the infected mother wears a mask, but it is not currently the CDC's first choice. "It's a difficult decision, and I think the mother needs to be involved in the conversation about the risks," Jamieson says.
What else do I need to know if I get sick during pregnancy?
Research is underway, but there is not currently a definitive treatment or vaccine for COVID-19. Once these do emerge, it's a distinct possibility that they won't initially be approved for use during pregnancy and lactation. "This is one of the big concerns," Jamieson says.
For now, says Silverman, it is important to "be aware of the potential symptoms so [pregnant women] can call their health provider if they have any," which include fever, respiratory symptoms or possibly even diarrhea. Additionally, he notes, if they learn they have been in contact with someone who has tested positive for COVID-19, they should monitor their own temperature and be especially aware of any respiratory symptoms. Their health care provider can advise best steps for care and testing.
Qiao notes that individuals should also be careful when selecting over-the-counter medications for treating symptoms, as many standard remedies should be avoided during pregnancy (including many cough and cold — as well as pain and fever — medicines).
With the large uptick in the number of cases of the novel virus, researchers are gathering more data about the disease's impact on pregnant people, fetuses and newborns. Synthesizing all of that information will likely take additional time, but it will eventually help better guide public health and health care recommendations.
In the meantime, the best offense remains a good defense. And that means pregnant people — and those around them — should follow the best current personal and social hygiene recommendations. "We keep pregnant women and their newborns safer by keeping everyone around them healthy as well," Pilliod says. "It takes a village to keep us all safe."
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