Pregnancy & Coronavirus: Get The Facts

The recent coronavirus (COVID-19) outbreak has been prevalent in the headlines for weeks now, and while information on risk factors and the spread/containment has been at times confusing, we want to address some of the most common questions we are hearing regarding how this illness affects pregnancy and infant health.

It is important to note that the body of scientific reporting on this most recent outbreak is still new, with a limited amount of completed studies pointing to concrete recommendations. This means that you and your doctor are your best source for advocacy and information directly related to your specific health concerns surrounding coronavirus risks and treatment.

Q: Are pregnant women more susceptible to infection, or at increased risk for severe illness, morbidity, or mortality with COVID-19, compared with the general public?

A: We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy.

Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick.

Q: Are pregnant women with COVID-19 at increased risk for adverse pregnancy outcomes?

A: We do not have information on adverse pregnancy outcomes in pregnant women with COVID-19. Pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related coronaviruses [SARS-CoV and MERS-CoV] during pregnancy. High fevers during the first trimester of pregnancy can increase the risk of certain birth defects.

Q: Are pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19?

A: Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.

Transmission during pregnancy or during delivery

Q: Can pregnant women with COVID-19 pass the virus to their fetus or newborn (i.e. vertical transmission)?

A: The virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through respiratory droplets. Whether a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus or neonate by other routes of vertical transmission (before, during, or after delivery) is still unknown. However, in limited recent case series of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for the virus that causes COVID-19. Additionally, virus was not detected in samples of amniotic fluid or breastmilk.

Limited information is available about vertical transmission for other coronaviruses (MERS-CoV and SARS-CoV) but vertical transmission has not been reported for these infections.

Infants

Q: Are infants born to mothers with COVID-19 during pregnancy at increased risk for adverse outcomes?

A: Based on limited case reports, adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection, and at this time the risk of adverse infant outcomes is not known. Given the limited data available related to COVID-19 during pregnancy, knowledge of adverse outcomes from other respiratory viral infections may provide some information. For example, other respiratory viral infections during pregnancy, such as influenza, have been associated with adverse neonatal outcomes, including low birth weight and preterm birth. Additionally, having a cold or influenza with high fever early in pregnancy may increase the risk of certain birth defects. Infants have been born preterm and/or small for gestational age to mothers with other coronavirus infections, SARS-CoV and MERS-CoV, during pregnancy.

Q: Is there a risk that COVID-19 in a pregnant woman or neonate could have long-term effects on infant health and development that may require clinical support beyond infancy?

A: At this time, there is no information on long-term health effects on infants either with COVID-19, or those exposed to the virus that causes COVID-19 in utero. In general, prematurity and low birth weight are associated with adverse long-term health effects.

Transmission through breast milk

Q: Is maternal illness with COVID-19 during lactation associated with potential risk to a breastfeeding infant?

A: Human-to-human transmission by close contact with a person with confirmed COVID-19 has been reported and is thought to occur mainly via respiratory droplets produced when a person with infection coughs or sneezes.

In limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19. No information is available on the transmission of the virus that causes COVID-19 through breast milk (i.e., whether infectious virus is present in the breast milk of an infected woman).

In limited reports of lactating women infected with SARS-CoV, virus has not been detected in breast milk; however, antibodies against SARS-CoV were detected in at least one sample.

Stay Connected

In this time of developing information and news, it is important not to panic and to stay connected to up-to-date COVID-19 information from expert medical sources such as the Center for Disease Control & Prevention, or the American College of Obstetrics & Gynecology. Axia will continue monitoring expert sources and address developing conditions to ensure you receive exceptional quality care and information.

Telemedicine with AxiaConnect

If you are experiencing flu-like symptoms (i.e., cough, fever, shortness of breath, sore throat), we ask that you DO NOT come to the office for any pre-scheduled appointments, and that you call your care center location and ask to speak to a triage staff member who can guide you with more information and treatment suggestions.

We are also now offering virtual appointments through AxiaConnect, our new telemedicine service. AxiaConnect is secure, HIPAA-compliant, and simple to use. The program only requires downloading the ZOOM app prior to your appointment. No complicated login process involved, no password to remember. At the time of your appointment, simply click to enter your waiting room with your provider, and be connected with real-time care and medical guidance.

AxiaConnect telemedicine appointments can be made to replace a variety of visit types, including:

• Routine OB/pregnancy care visits
• Problem GYN visits
• Surgical consults
• Vaginitis/STI testing
• Routine post-partum visits
• Routine post-op visits
• Follow-ups related to: IUD, birth control, lab results, medication adjustments
• …and a lot more!

Ready to get started with AxiaConnect? Find a care center near you, and call us to schedule your virtual visit.

We are here for you, and together, we’ll make sure you are prepared.