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First reported in Wuhan, China, on December 31, 2019, coronavirus (also known as COVID-19) has spread across the globe, with upwards of approximately 84,000 people infected and 2,800 deaths in more than a dozen countries (as of March 2020).

Pregnant women and nursing moms are a subset of women who require additional information when it comes to this outbreak. While we have some general recommendations, the important thing to remember is that there is not a lot of data on what might be best, given how new this virus is.

We have no studies to tell us how pregnant women are specifically impacted by COVID-19, but it is well-known that with weaker immune systems, they are likely to be more susceptible, just as they are to other similar viruses such as influenza. Pregnant women who do become infected with viruses like the flu certainly have increased risks, like needing to be intubated, as well as higher mortality rates than the general population. This is likely the case with COVID-19, but we don’t have enough case reports to say for sure.

Another concern is if infection with COVID-19 can cause issues like birth defects, miscarriage, or stillbirth. Again, we just don’t have enough information to know. When we look at similar outbreaks such as SARS, we did see an increase in these complications, including more generally when pregnant women have fevers in the first trimester.

It is still unclear if COVID-19 can be transmitted from mother to fetus if she becomes infected during pregnancy. Newborns who test positive for this virus may have caught it after they were born. So far we have not isolated the virus in amniotic fluid, but more work remains to be done.

There is no evidence yet that has shown COVID-19 in breastmilk. A case of transmission from nursing mother-to-baby has been reported, but this was likely from shared respiratory droplets and not the breastmilk itself.

In light of this lack of evidence of transmission, the Centers for Disease Control and Prevention encourages that women continue to breastfeed, including those who have tested positive for COVID-19. They recognize that breastmilk has many advantages, including the passing along of antibodies from mom to baby that can actually protect the baby from illness.

So what are some basic steps that pregnant women and nursing moms should take to avoid getting COVID-19 or passing it to their babies? They are actually pretty simple, and are similar to how we recommend avoid catching the flu and other respiratory viruses:

  • Wash your hands with soap and water often, for at least 20 seconds.
  • Avoid touching your eyes, nose, and mouth—especially with unwashed hands.
  • Cover your nose when you cough or sneeze with a tissue.
  • Stay home when sick!
  • If ill with COVID-19 and breastfeeding, wash hands before and wear a mask. Do the same when pumping and touching pump parts and bottles.
  • If it is an option, have a different person feed baby expressed milk if the mother is pumping.

For women who are positive for or suspected to have coronavirus when they are in the hospital at the time of birth, the CDC recommends separation of babies from moms to decrease the risk of exposure to the baby. The CDC acknowledges this recommendation is very cautious and not based on much data. They also acknowledge this may not be possible at every hospital based on space. Other recommendations include using a curtain to separate mom and baby if they must remain in the same room. They note that there are risks with separation, such as interfering with breastfeeding and bonding, and all of this must be taken into consideration for each mother-baby pair.

Takeaways

  • We aren’t entirely sure yet how COVID-19 affects pregnant women.
  • Preventing infection from coronavirus includes the same precautions we recommend for influenza.
  • The CDC says breastfeeding is safe in moms who have COVID-19.

References

  1. The Centers for Disease Control and Prevention. Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19. Accessed 28 Feb 2020.
  2. The Centers for Disease Control and Prevention. Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy. Accessed 28 Feb 2020.
  3. Worldometer. Coronavirus. Accessed 28 Feb 2020.
  4. The American College of Obstetricians and Gynecologists. Practice advisory: Novel Coronavirus 2019 (COVID-19). Accessed 28 Feb 2020.

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