COVID-19, the disease caused by a new coronavirus, spread rapidly around the globe and is a pandemic, according to the World Health Organization. Many of my pregnant patients have expressed concerns, both for themselves and their babies, about the impact of COVID-19 on their health. To answer often-asked questions about pregnancy and COVID-19, I’ve teamed up with my husband, an infectious disease specialist and internist. Together, we reviewed the limited data available to provide evidence-based responses below.
Please remember, recommendations and guidelines will continue to change as we learn more about this illness.
How does the coronavirus spread?
- The virus is carried in respiratory droplets transmitted by sneezing and coughing. If people are nearby, droplets might land in their mouths or noses or possibly be inhaled.
- Viral particles called aerosols may float or drift in the air when an infected person talks, sings, or breathes. People nearby may inhale aerosols.
- Research shows the virus can live on surfaces and may be spread when a person touches those surfaces, then touches their face.
- The virus may be shed in saliva, semen, and feces; whether it is shed in vaginal fluids isn’t known. Kissing can transmit the virus (you obviously would be in very close contact with the infected person). Transmission of the virus through feces, or during vaginal or anal intercourse or oral sex appears to be extremely unlikely at this time.
Current evidence suggests that the incubation period of the virus is anywhere from two to 14 days. It’s possible that someone could be infected but not have any symptoms (presymptomatic or asymptomatic) and be able to spread the virus.
Handwashing, social distancing, and other ways to help prevent the spread of coronavirus
What can I do to protect myself from catching the coronavirus?
Practice excellent hand hygiene by frequently washing hands with soap and water for 20 seconds. Avoid touching your face, especially your eyes, mouth, and nose. Public health officials urge people to tightly limit gatherings and to stay home as much as possible. Social distancing is important to limit the spread of the virus. It’s safe to go out for walks — just try to remain six feet away from anyone who doesn’t live with you. Many states require people to wear a cloth mask in public, especially in places where it’s hard to carefully observe social distancing. Even a cloth mask, when used to cover the mouth and nose completely, helps protect you and others.
If you have a mild cough or cold, stay at home and limit exposures to other people. Sneeze and cough into a tissue that you discard immediately, or into your elbow, to avoid making others sick. Wash your hands immediately afterwards. Drinking fluids and getting sufficient rest also are important in maintaining the health of your immune system.
Can I travel for my baby-moon?
We recommend avoiding all travel at this time, given the concerns that the virus could be widespread, as well as the changing travel restrictions (see CDC travel advisories).
Should I reschedule my baby shower because of the coronavirus?
While a baby shower is a joyous and important occasion, public health agencies such as the Centers for Disease Control and Prevention (CDC) recommend social distancing to limit the spread of the virus. Gathering with people from other households could expose you and others to the virus if one person is ill—with or without symptoms. Particularly in large gatherings and indoor gatherings, the risk of possible exposure and infection is quite high. We recommend limiting social gatherings at this time.
Concerns about becoming sick
What should I do if I have a fever or cough? What if I’ve traveled from a place where the virus is widespread or have been in contact with a person confirmed to have COVID-19?
The first step is to call your doctor’s office to inform them of your symptoms, travel, or contact with someone who has a confirmed case of COVID-19. Do not simply go to your doctor’s office. It is very important to limit the spread of the virus. Particularly if you have symptoms, it is best to call your doctor first to determine whether you need testing and/or to come in for evaluation. The American College of Obstetrician and Gynecologists has provided all obstetricians with guidelines for pregnant patients who may have symptoms of COVID-19 or exposure to COVID-19, and your obstetrician may be able to help you triage your symptoms over the phone.
What is my risk of becoming very ill if I do have COVID-19?
We are beginning to learn more about the possible impact of this novel coronavirus on pregnant women. At this time:
- No evidence shows that being pregnant increases a woman’s risk for getting COVID-19.
- A recent study looked at nearly 409,462 women, ages 15 to 44, who had symptomatic COVID-19. Of these women, 23,434 were pregnant. Even after taking age, race, ethnicity and underlying health conditions into consideration, pregnant women were more likely to need intensive care, to require a ventilator (breathing machine), and to require a heart-lung bypass machine, compared to women who were not pregnant. Deaths were more likely among pregnant women, also. However, it’s important to know that the overall risk of these complications was low. For example, 1.5 symptomatic pregnant women out of 1000 died, compared to 1.2 symptomatic women out of 1000 who were not pregnant. And the study didn’t include pregnant women who tested positive for the virus, but had no symptoms.
- If pregnant women who are health care providers are concerned about their risk of exposure to COVID-19, we recommend that they discuss their concerns with their supervisor. At this time, no US guidelines restrict pregnant health care workers’ ability to care for patients, but the American College of Obstetricians and Gynecologists (ACOG) suggests avoiding high risk exposures to COVID-19 and wearing personal protective equipment at all times.
Does becoming ill with COVID-19 increase risk of miscarriage or other complications?
An increased risk of fetal malformations has not been documented in pregnant women who are infected with COVID-19, according to the CDC.
A recent report on nearly 600 hospitalized pregnant women with COVID-19 noted 12.6% of births were preterm (earlier than 37 weeks), higher than expected among pregnant women in the general population. In this report, the rate of miscarriage was about 2%. The rate of miscarriage in the general population is about 10%.
Our understanding may change as more information becomes available.
If I become sick, what is the risk of passing the virus on to my fetus or newborn?
Currently, only studies reporting on a limited number of cases are available to answer many questions, including this one. Many women in these case reports had COVID-19 during the third trimester of pregnancy.
- Two case report studies (here and here) with a total of 47 women with COVID-19 showed that none of the newborns tested positive for the virus that causes it, SARS-CoV-2.
- Another case report analyzing 33 pregnant women infected with SARS-CoV-2 found that three of their newborns were also infected with the virus and had clinical signs of infection, as well as confirmation of COVID-19 infection. It is unclear whether these newborns were infected while in the womb or if these infections were acquired after birth, as the newborns were tested when they were days old. The possibility of vertical transmission (passing the virus from mother to baby) has not been ruled out.
- Reassuringly, in a study from New York City of 101 babies born to mothers with COVID-19 at the time of birth, only two babies tested positive for SARS-CoV-2. These two babies did not become ill from the virus and had no concerning symptoms.
- The risk of passing the infection to a fetus appears to be very low. Currently there is no evidence of any fetal malformations due to maternal infection with COVID-19
If a woman has an infection with a high fever during pregnancy, it’s safest to use acetaminophen to lower temperature to avoid risk to the developing fetus.
Concerns about prenatal care, birth, and breastfeeding
Should I continue to have prenatal visits? I’m worried about being exposed to COVID-19.
Prenatal visits are important to ensure maternal and fetal health. However, given the current global pandemic we are facing, many obstetricians are either increasing the interval between visits or encouraging telehealth visits. Ask your obstetric health provider if you should buy a blood pressure cuff for use at home and monitor your baby’s movements. If you have any concerns about your health or your baby’s health, please call your obstetric team. We recommend that women talk to their obstetrician about their prenatal care and continue to attend appointments as long as their obstetrician feels it is appropriate.
I am worried that doctors, even obstetricians, will be diverted in an emergency setting and may not be available when I am delivering. Will that be the case?
Hospitals are responsible for making contingency plans for emergencies that might require diverting hospital staff. Ask your obstetric team about contingency plans at your hospital. They should be able to keep you updated on any change in plans. Obstetrics is an essential component of health, and it is likely that a physician trained in obstetrics will be present at the time of your baby’s birth. Ask your health care team about this.
I am worried about spending time in the hospital after delivery. Could this increase my risk of exposure to COVID-19?
Hospital staff and your obstetric team are trying to minimize the number of people who come to the hospital. There are rules to make sure that anyone who needs to evaluated for COVID-19 will be isolated from other patients. All medical staff are working hard to ensure that your risk of being exposed to COVID-19 is low.
In the hospital, many precautions are being taken to minimize exposure risks. If you choose to do so, it may be possible to go home sooner than you normally would after birth, as long as you feel well and your birth was uncomplicated. Talk to your obstetric team about this.
If I test positive for the virus that causes COVID-19, can I breastfeed my baby?
Currently, there is extremely limited evidence that the virus may be present in breast milk, and no evidence that it is transmitted through breastmilk. Given how the virus spreads, ACOG advises that mothers with COVID-19 can breastfeed their babies safely, although they should practice careful hand hygiene and wear a face mask. This will help minimize the infants’ exposure to the virus.
Another option is having a healthy caregiver feed the baby with pumped breast milk or formula. If a breast pump is used, be sure to clean all the parts carefully.
For more information about the coronavirus and COVID-19, please see Harvard Health Publishing’s Coronavirus Resource Center.