Many pregnant women are concerned regarding the possible impact of COVID-19 infection during the pregnancy and in the post-partum period, especially when breastfeeding their newborn baby. There is limited data available regarding the effect of COVID-19 in pregnancy and breastfeeding. The data available to date suggest that pregnant women who become infected by SARS-CoV-2 (the virus that causes COVID-19) do not appear to be more severely unwell than non-pregnant women. Most pregnant women with COVID-19 will experience only mild or moderate cold-and-flu-like symptoms.
There is no evidence that COVID-19 increases the risk of miscarriage or early pregnancy loss. In general, the immune system is suppressed during pregnancy, and this may impact on the severity of symptoms caused by respiratory viruses. During the first trimester of pregnancy, high fevers can potentially increase the risk of certain birth defects. Prompt medical attention is important if you develop high fevers during early pregnancy.
Several case series of pregnant women with COVID-19 have been published, and there is so far no report of vertical transmission of SARS-CoV-2 (i.e. the virus passing to your developing baby during the pregnancy). No studies reported any abnormalities in babies whose mothers were infected with COVID-19 during the pregnancy.
There is a lack of published scientific data to determine whether pregnant women are more susceptible to COVID-19. In general, pregnancy causes physiological changes to the woman’s immune system, which may make them more susceptible to viral respiratory infections including the novel coronavirus.
The WHO has released a report on 24 Feb 2020 relating to 147 pregnant women in China with suspected or confirmed COVID-19, and reported that 8% of these pregnant women had severe COVID-19 disease and 1% were in a critical condition. This compares with statistics regarding severity of COVID-19 in the general population, where 14% are severe and 6% are in a critical condition.
There is one case report of a pregnant woman in China infected with COVID-19 who required mechanical ventilation at 30 weeks’ gestation, and she underwent an emergency Caesarean and made a good recovery.
Currently there is no evidence that the virus is carried in breastmilk, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) support breastfeeding in women diagnosed with COVID-19. Women who are diagnosed with COVID-19 should wear a facemark while feeding their baby, and wash their hands thoroughly before each feed.
No vaccination is available for COVID-19. In Australia, the flu season will overlap with the peak of the COVID-19 pandemic, increasing the strain on the health system. Vaccination for Influenza is recommended in pregnancy, especially during this pandemic. Influenza is a potentially serious disease for pregnant women, due to changes in the immune system during pregnancy. Pregnant women can experience severe complications from Influenza.
To reduce the transmission of COVID-19, the following measures are very important:
If you are concerned you may have COVID-19, please call your GP or the National COVID-19 Hotline on 1800 020 080. If you develop symptoms (such as fever, cough, sore throat, diarrhoea, fatigue, difficulty) and you have had close contact with someone diagnosed with COVID-19, you should seek urgent medical review at a fever clinic for consideration of COVID-19 testing.
In light of the COVID-19 pandemic and the risks to pregnant women, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has suggested the following:
On 16 March 2020, the Australian government implemented new Medicare legislation to allow obstetricians to provide Telehealth consultation during pregnancy. This may facilitate the above strategies to reduce the risk of transmission of COVID-19 during the pregnancy.
If you have concerns or abnormal symptoms (e.g. feeling reduced baby movements, vaginal bleeding, pain), then you should contact your obstetrician, just as you would during normal times.
It will be useful to have a blood pressure measuring device at home, and please contact your obstetrician if your blood pressure is over 140/90mmHg during the pregnancy.
For additional information, the following resources can provide important updates and advice: