Coronavirus and pregnancy (Updated)

First reported in Wuhan, China, on December 31, 2019, coronavirus (also known as COVID-19) has spread across the globe, with upwards of approximately 930,000 people infected and 46,000 deaths in more than a dozen countries (as of April 1 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 in-depth studies to tell us how pregnant women are specifically impacted by COVID-19, but what we’ve seen so far is that pregnant women seem to fare far better than we would think when it comes to this infection.

This is at odds with what we normally see when it comes to viruses in pregnancy. It is well-known that with weaker immune systems, pregnant women are usually more susceptible and often become sicker and have worse outcomes when compared to the non-pregnant population. This is especially true for other similar viruses such as influenza.

A new registry called the PRIORITY registry has launched to better understand the effects of COVID-19 on pregnancy, and researchers are doing their best to collect data. If you are pregnant or know someone who is and has been affected by the coronavirus, you can go here to help doctors and researchers learn more.

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. Studies that have been released so far have been very small in number, and none of these infants were COVID-19 positive when swabbed, though they did have antibodies in their blood. 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.

However, in the immediate postpartum period, the recommendations do differ. 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.

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 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.