Pregnancy

Frequently Asked Questions (FAQ) about pregnancy in times of COVID-19:

Are pregnant women at higher risk for COVID-19?

A recent study from Sweden shows that pregnant women, and women who recently gave birth, with COVID-19, may have a higher risk of requiring intensive care. Pregnant women can be badly affected by respiratory infections since their bodies and immune systems change during pregnancy. Pregnant women or women who recently gave birth should take extra caution to avoid a COVID-19 infection, especially those with additional risk factors, e.g. overweight or obesity, hypertension, and gestational diabetes. Pregnant women should report possible symptoms (including fever, cough or difficulty breathing) to their healthcare provider.

(Source: AOGS)

I am pregnant. How can I protect myself against COVID-19?

You should take the same precautions to avoid COVID-19 infections like anyone else. Please follow these instructions:

• Wash your hands frequently with an alcohol-based hand rub or soap and water
• Keep space between yourselves and others and avoid crowded spaces
• Avoid touching your eyes, nose and mouth
• Practice respiratory hygiene: cover your mouth and nose with your bent elbow or tissue when you cough or sneeze, then dispose of the used tissue immediately
Additionally, the following precautions are useful:
• Avoid contact with anyone displaying symptoms of coronavirus disease (COVID-19)
• Avoid public transport when possible
• Work from home, where possible
• Avoid large and small gatherings in public spaces, particularly in closed or confined spaces
• Avoid physical gatherings with friends and family
• Use telephone, texting or online services to contact your midwife, obstetrician and other essential services
• Clean and disinfect frequently touched surfaces at home
• Self-monitor for any signs or symptoms consistent with COVID-19 and seek early care from a healthcare provider

(Sources: WHO,UNICEF)

Please note, that in some countries masks are worn in accordance with local customs or in accordance with advice by national authorities in the context of COVID-19. Please make sure that you are aware of your national guidelines about wearing masks, how to remove and dispose of them and that you are informed about hand hygiene after removal. Medical masks should be reserved for healthcare workers and persons with symptoms, especially when there is a shortage of medical masks in your country.

(Source: WHO)

Should pregnant women be tested for COVID-19?

Please note, that testing protocols and eligibility vary from country to country.

The World Health Organization (WHO) recommends that pregnant women with symptoms of COVID-19 should be prioritised for testing. Because they may need specialised care, if they are tested positive for COVID-19.

It would also be recommendable for pregnant women who travelled in a country affected by COVID-19 within the previous 14 days or who has had close contact with a patient with confirmed COVID-19 infection – even if she does not show any symptoms.

(Source: The Lancet)

What care should be available during pregnancy and childbirth?

The World Health Organization (WHO) states that all pregnant women, have the right for high quality care before, during and after childbirth. This includes pregnant women with suspected or confirmed COVID-19 infections. According to the WHO a safe and positive childbirth experience includes:

• Being treated with respect and dignity
• Having a companion of choice present during delivery
• Clear communication by maternity staff
• Appropriate pain relief strategies
• Mobility in labour where possible, and birth position of choice

If COVID-19 is suspected or confirmed, health workers should take all appropriate precautions to reduce risks of infection to themselves and others, including hand hygiene, and appropriate use of protective clothing like gloves, gown and medical masks.

(Source: WHO)

What extra care should be available during the COVID-19 pandemic in general?

The World Health Organization (WHO) recommends that pregnant women with a suspected, probable or confirmed COVID-19 infection, including women who may need to spend time in isolation, should have access to woman-centred, respectful skilled care, including prenatal, obstetric, and neonatal care, as well as mental health and psychosocial support, with readiness to care for maternal and neonatal complications.

Moreover, the WHO suggests that all recently pregnant women with COVID-19 or who have recovered from COVID-19 should receive necessary information and counselling on safe baby feeding and appropriate Infection Prevention Control (IPC) measures to prevent the transmission of COVID-19.

(Source: WHO)

I am pregnant. What should I do if I develop symptoms like a cough, or a fever or if I have difficulty breathing?

If you develop symptoms like a cough, a fever, or if you have difficulty breathing, do not hesitate to seek for medical care. Make sure to call before you go to a healthcare facility and follow their instructions on how to proceed.

(Source: WHO)

What should I do if I feel unwell or I’m worried about my baby during self-isolation?

Please do not hesitate to contact your midwife/nurse/case manager/doctor, if you have concerns about the wellbeing of yourself or your unborn child. Your healthcare professional will give you further advice, and tell you whether you need to go to hospital.

If you have to go to the maternity unit or hospital, it is recommendable to go by private transport or arrange a hospital transport. Once you are onsite, make sure to alert the maternity unit, before you enter the hospital.

(Source: RCOG)

Should pregnant women/new mothers still go to all pre- /antenatal care examinations?

Yes, they should take pre-/antenatal care examinations seriously. The World Health Organization (WHO) recommends that pregnant women and women who have recently delivered – including those affected by COVID-19 – should attend their routine care appointments.

In the coming weeks and months there might be some adjustments to the standard antenatal care schedule because healthcare professionals will try to minimise the direct patient contact in non-urgent cases in order to minimise the spread of COVID-19. So, in some cases pregnant women/new mothers will be phoning or video chatting with their healthcare professional. There might be other modifications as well, depending on the respective conditions of pregnant women/new mothers and whether they face a lower or higher-risk pregnancy.

After the child is born, it is also important to continue receiving professional support and guidance, including routine immunisations. New mothers should speak to their healthcare professional about the safest way to receive these appointments.

(Source: UNICEF)

Should I and my baby get the usual vaccinations (e.g. pertussis and influenza)?

Yes, you should. It is important that you and your child keep your vaccinations up to date. They protect you from serious diseases. Please contact your healthcare professional and make sure, that you and your baby get your vaccinations on time. If you cannot receive an appointment, make a note and try again as soon as the vaccination services resume work.

(Source: UNICEF)

I want to go to the doctor for my antenatal examinations, what precautions should I take?

Please talk to your doctor beforehand and follow his or her instructions. Try to avoid the use of public transport when possible. Being in public, please cover your mouth and nose with a cloth face cover to protect other people. Do not use a facemask which is meant for a healthcare worker. It is necessary to inform yourself on the rules and guidance regarding COVID-19 in your country. If you need support in doing this, please ask your healthcare team or the relevant parent organisation. Make sure you follow the recommendations of the World Health Organization (WHO) and of United Nations International Children’s Emergency Fund (UNICEF) how to protect yourself against COVID-19. You will find the recommendations here and here.

Can COVID-19 cause preterm birth?

The risk of medically indicated preterm birth and caesarean delivery in pregnant women with COVID-19 seems to be higher. However, it is unclear whether COVID-19 caused these preterm births, or whether delivery was recommended for the benefit of the women’s health and to enable her to recover. Most studies do not show an increased risk for serious illness in women and babies but a recent Swedish study found that women who recently gave birth, with COVID-19, may have a higher risk of requiring intensive care.

(Source: EClinicalMedicine; BMJ)

Can COVID-19 be passed from woman to her unborn or newborn baby?

Recent findings show that COVID-19 can be passed from a mother to her unborn child. It seems to occur in a minority of cases of maternal coronavirus disease infection in the third trimester. However, no significant consequence for newborns has been reported so far. Further research is needed to assess possible transmission of the virus in early pregnancy and potential risks for the unborn baby.
After birth, a newborn is susceptible to person-to-person spread and there are few cases in which babies were tested positive for the virus shortly after birth.

(Sources: AJOG)

If a pregnant woman is COVID-19 positive and shows symptoms like fever, cough and has breathing difficulty, does her state of health affect her unborn child in any way?

Currently there is no evidence of intrauterine infection of the baby, so direct effects of COVID-19 on the unborn infant are highly unlikely.

Consequences of infection with SARS-CoV-2 (the virus that causes COVID-19) in pregnancy are unclear; however, the possibility of adverse outcome should be considered and mainly depends on the severity of the maternal disease, potentially necessitating preterm delivery. In early pregnancy – if there is no other way and the health of the woman is at a severe risk, a termination of pregnancy might be considered.

The most recent report on 55 pregnant women with Covid-19 infection reports on pregnancy outcomes / complications as follows: preterm birth 43%, intrauterine growth restriction 9%, miscarriage/stillbirth 2%, and neonatal death 2%. Please be aware, that the numbers of infected women are too low to draw a final and proof conclusion if these complications are caused by the viral infection or other circumstances.

(Sources: The Lancet_1, The Lancet_2, AJOG)

If a woman is pregnant and COVID-19 positive, can her infection lead to malformations of her child?

While a baby is still in the womb, the placenta works to protect the baby against diseases. The placenta is an amazing organ that allows antibodies to pass from the mother to the baby, but most of the time the placenta blocks diseases from crossing to the baby.
Currently there is no report on intrauterine infection of the newborn baby, so direct effects of the infection on the unborn child are highly unlikely. This includes foetal malformations.

Intrauterine transmission of viruses from mother to baby is more likely to occur in later gestation. In early gestation the placenta barrier is more rigid and therefore serves as a strong shield against viruses.

So far, most of the reported COVID-19 infections included late gestation and no transmission of the virus. This makes it highly unlikely that transmission of the virus would occur in early gestation, the main window of possible foetal malformations.

But, as the reported number of infections in pregnancy is very low (and currently no reports on infections in early gestation are available), a final conclusion cannot be drawn yet.

Source: (EFCNI in collaboration with Dr Dietmar Schlembach)

More Frequently Asked Questions (FAQs) about newborn and maternal health:

Birth in times of COVID-19
Breastfeeding and donor milk in times of COVID-19
The Neonatal Intensive Care Unit (NICU) in times of COVID-19
Discharge and follow-up in times of COVID-19