Last updated: 03/30/20
Tara Sander Lee, Ph.D., a scientist with 20 years’ experience in academic and clinical medicine with an emphasis on the cause of pediatric disease, shares eight reasons why pregnant women can remain hopeful during the coronavirus crisis. [Read Tara’s bio]
There is a lot we do not yet know about the coronavirus and pregnancy. Unfortunately no long-term studies have been done and information is changing rapidly. But some recent reports of early cases are helping to shed light and inform pregnant women and their physicians. A review of the data shows that there is good news for pregnant moms and their children.
At this time, pregnant women do not appear to be at a higher risk of infection compared to the average healthy adult. There is not enough information to currently know whether pregnant women have a greater chance of getting sick from COVID-19 than the general public. According to the CDC, “older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.”
In utero transmission of the coronavirus during pregnancy is not yet proven. It is not fully understood how COVID-19 is spread and according to the CDC, “We still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery.” Initial published studies out of China from independent groups reported in the journals Lancet, Translational Pediatrics, and Frontiers in Pediatrics that there was no evidence of vertical transmission in mothers diagnosed during late pregnancy with COVID-19 pneumonia. The coronavirus was not detected in the amniotic fluid, cord blood, or breast milk. Neonates also tested negative for the virus after birth. But since then, two research teams in China (Dong et al. and Zeng et al.) presented additional details in the journal JAMA of 3 neonates who may have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in utero from mothers with coronavirus disease 2019 (COVID-19). In a corresponding JAMA editorial, Drs. David Kimberlin and Sergio Stagno of the University of Alabama at Birmingham cautioned that “at this time, these data are not conclusive and do not prove in utero transmission” and “more definitive evidence is needed before the provocative findings they report can be used to counsel pregnant women that their fetuses are at risk from congenital infection with SARS-CoV-2”. The CDC has issued interim guidance on breastfeeding for mothers with confirmed COVID-19 or under investigation for COVID-19.
Pregnant women may or may not experience COVID-19 related complications. There were no early cases of maternal deaths in a detailed analysis of published reports of 38 pregnant women with COVID-19, of whom 37 had confirmed SARS-CoV-2 infection. The majority of women underwent cesarean sections and there were co-morbid conditions present in some of the women, but they did not apparently result in life-threatening maternal COVID-19 related disease. The Society for Maternal Fetal Medicine (SMFM) reports that out of 18 women studied, only one required intubation. A New York hospital also reported that some women are not showing any symptoms or complications of COVID-19 until after giving birth. A maternal death associated with COVID-19 has been described in a recent report out of Spain. To help provide guidance, SMFM and the Society for Obstetric Anesthesia and Perinatology (SOAP) recently issued a new statement regarding Labor and Delivery COVID-19 Considerations.
Women infected with coronavirus during pregnancy deliver live babies. Recent studies from China in the journals Lancet and Translational Pediatrics, as well as a detailed analysis of published reports of 38 pregnant women with COVID-19, report that pregnant women who develop COVID-19 pneumonia in their 3rd trimester went on to have live births. One case was reported of a stillborn infant born to a mother with COVID-19 in Spain who died during the emergency C-section.
Infant death caused by COVID-19 is rare. According to the CDC, “We do not know at this time what if any risk is posed to infants of a pregnant woman who has COVID-19. There have been a small number of reported problems with pregnancy or delivery (e.g., preterm birth) in babies born to mothers who tested positive for COVID-19 during their pregnancy. However, it is not clear that these outcomes were related to maternal infection.” A couple cases have been reported of infant deaths including a 10-month-old child in China and a 9-month-old in the U.S. who reportedly had other health issues.
There are things you can do now to reduce your risk of infection during pregnancy. The virus is spread through respiratory droplets (when an infected person coughs or sneezes). You should avoid large crowds, avoid people who are sick, wash your hands often, and work from home if possible.
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 Delgado G, C.S., Davenport M, et al., A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med, 2018. 33: p. 3-14.