The rapidly changing health advisories surrounding COVID-19, the novel coronavirus causing a pandemic, can be confusing. While the elderly and those with severe respiratory illness have been highlighted as high risk populations, the question remains as to whether pregnant people are also at risk.
Frederick Friedman, Jr., MD, Associate Professor of Obstetrics, Gynecology and Reproductive Science, at the Icahn School of Medicine at Mount Sinai, explains what we know about COVID-19 and pregnancy and how pregnant people can protect themselves.
I am pregnant. Am I high risk for COVID-19?
We don’t have a lot of data about coronavirus and pregnancy. There were two studies released about 18 pregnant individuals from China. Sixteen delivered by caesarean section, all delivered at term, and none of the children was affected. As a result of that very small study, it appears that as long as mom is healthy, the baby is likely to be healthy.
As far as we know the coronavirus does not cause problems for the fetus in cases of pregnant women who are exposed in the first trimester. However, it’s important to remember that we do not have much data that will confirm this. That being said, the general philosophy is that once the baby is formed, any virus that might cause birth defects would not have that effect. Whether or not COVID-19 causes developmental problems similarly is not yet known. But, as is the case with prior coronavirus infections, it does not seem to have any damaging effect on the baby.
Unfortunately, there are not enough data to say with certainty what effect the virus has on pregnancy and similarly what effect pregnancy has on progression of the disease. Due to the immune system changes in pregnancy and based on historic data from other viral infections, pregnancy might make women more susceptible to infection. In addition, they might have a more serious response to the virus. However, I emphasize that this is conjecture at present.
Should I put off trying to conceive?
At present, there are no recommendations to delay conception efforts. However, it is important to understand that our knowledge base will continue to expand. Also, it is critical that if one’s partner is ill, safe distances be maintained to prevent spread of the virus; that might delay conception efforts.
What if I have a pre-existing condition? Should I be particularly worried?
Anything that poses a severe risk to the mother—that is if the mom has a severe response to the virus that—could have harmful effects on the entire pregnancy, not just the baby. Such illness would place the mother at risk for preterm labor.
COVID-19 seems to affect most severely those individuals who are over 60, especially those over 80, which would not involve most of our pregnant patients. However, anyone with underlying respiratory ailments or chronic cardiovascular disease, as well as those who are immunocompromised have been affected more severely.
Are there particular precautions I should take after delivery? What about when I return home?
As much as birth is a social event, it’s also one that involves a baby who has a very poorly developed immune system and is highly susceptible to any types of infections. Any individual that handles the newborn should be free of any evidence of upper respiratory tract infection. No coughing, no runny nose, no sneezing, no fever.
Presently, most hospitals have visitation limits to the labor and postpartum floors. Due to the changing nature of the virus, each hospital’s visitation policy is in flux. Be sure to confirm the policy at your birthing location beforehand.
Additionally, while breastfeeding is generally encouraged, mothers who are suspected of having COVID-19 should keep distance from the baby when not feeding. Allow other caregivers to care for the baby and wear a mask while breastfeeding. The good news is that there have been no severe cases of coronavirus in individuals under nine years of age. But, discretion is the better part of valor.
Ultimately, we don’t know with certainty that pregnant or postpartum women are at greater risk for contracting the virus or having a more severe infection. Should they contract it, as is the case with influenza, these women tend to have a much higher risk of serious disorders. I would recommend the same universal precautions: avoidance of individuals with evidence of respiratory ailments like coughing, sneezing, and a runny nose; careful hand washing with soap and water or hand sanitizer; and avoidance of large crowds. Social distancing is difficult for some individuals, but prudent given our current situation.