COVID-19 and Pregnancy

2
0

Information regarding COVID-19 and pregnancy is limited. Given the newness of the disease, there isn’t yet much information on how COVID-19 affects fetal development and preterm birth. Other severe coronaviruses, MERS-CoV and SARS-CoV, are more problematic in those who are pregnant.

Here is what we do we know so far:

  • COVID-19-associated pneumonia does not seem to worsen during pregnancy beyond the risk of a non-pregnant cohort. However, the reported numbers are small and other coronaviruses (MERS-CoV, SARS-CoV) are more virulent in gravid women. Pregnancy is characterized by a reduction in T and B cells as well as a reduction in CD4+ cell activity. For this reason, many bacterial infectious diseases are more dangerous in those who are pregnant. We are awaiting more epidemiologic data about pregnancy and COVID-19-related pneumonia.
  • Vertical transmission does occur but not readily. A Chinese study of nine infants demonstrated no transmission of COVID-19 from the mother to the fetus in the 3rd trimester. However, all of the children were delivered by Cesarean. The same study found no virus in cord blood, amniotic fluid, breast milk or infants’ throats. A second study in China found about a 10% transmission rate from mother to infant (3 of 33 births).  All of the infants did well clinically ( JAMA Pediatr. March 26, 2020. doi:10.1001/jamapediatrics.2020.0878)
  • There is no good data on fetal demise or preterm labor in direct relation to COVID-19.  It is known, however, from other illnesses, that a high fever in the first trimester is associated with birth defects. There are case reports of preterm birth in patients with COVID-19 but at this point there are no prospective studies.
  • The CDC has issued specific guidelines regarding mother/infant contact in the post-partum period if the mother is COVID-19 positive or is a person under investigation (PUI). These are summarized below and can be found here and here.
    • Breastfeeding if the woman is COVID-19 positive or is a PUI: The CDC currently does not have any admonitions against breastfeeding if the mother is COVID-19 positive or is a PUI. So far, the COVID-19 virus has not been found in breast milk. The risk of transmission by usual routes remains and breast-feeding women should take all precautions including hand washing and wearing a mask when breastfeeding. A discussion of the pros and cons of breastfeeding while COVID-19 positive or a PUI is imperative.
    • “Rooming in” and Mother/Baby Contact when the mother is COVID-19 positive or a PUI.
      • It is unknown whether newborns with COVID-19 are at increased risk for severe complications.
      • Facilities should consider temporarily placing the mother and infant in separate rooms if the mother has confirmed COVID-19 or is a PUI. The risks and benefits of rooming in should be discussed with the mother.
      • Healthy family and staff who provide care for the newborn (e.g., diapering, bathing, and feeding) should use appropriate PPE. For healthy family members, appropriate PPE includes gown, gloves, face mask, and eye protection.”
      • Determination of when to reunite mother and baby is on a case-by-case basis, based on disease severity, etc.  This is a judgment call to be made by the provider, parent, public health officials and infection prevention and control personnel. Per the CDC, “Considerations to discontinue temporary separation are the same as those to discontinue transmission-based precautions for hospitalized patients with COVID-19.”  These criteria are:
        • Resolution of fever, without use of antipyretic medication
        • Improvement in illness signs and symptoms
        • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive sets of paired nasopharyngeal and throat swabs specimens collected ≥24 hours apart (total of four negative specimens—two nasopharyngeal and two throat).

Criteria for lifting quarantine/isolation in non-hospitalized patients are found here.

References:

Aghaeepour, E. A. Ganio, D. Mcilwain, et al. An immune clock of human pregnancy. Sci. Immunol 2017 2, eaan2946

CDC. Inpatient Obstetric Healthcare Guidance. https://www.cdc.gov/coronaviru... accessed 20 March 2020

CDC. Pregnant Women FAQ.  https://www.cdc.gov/coronavirus/2019-ncov/hcp/pregnant-women-faq.html

Chen H et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet 2020; 395: 809–15 Feb 12; [e-pub]. (https://doi.org/10.1016/S0140-6736(20)30360-3)

Schwartz, D.A.; Graham, A.L. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020, 12, 194.

 

 

 

 

No comments yet.