COVID-19 in pregnancy

Background

Reported data and outcomes for pregnant patients similar to non-pregnant patients
- Physiologic and immunologic changes in pregnancy may make them more susceptible to contracting viral respiratory illness but symptoms and outcomes demonstrate no significant differences from non-pregnant COVID19

34 pregnant women reported with COVID; 0 deaths reported.
Median age: 30 years (mostly 2nd and 3rd trimester -- median gestation 36 weeks)
Symptom onset within 13 days prior to, and 3 days after, delivery
Infants of affected mothers all tested negative
No maternal/pregnant deaths reported from COVID

Applies to broader infection prevention
Isolation of pregnant patients with COVID19 and PUIs
Pre-hospital (for confirmed COVID19 or PUI):
- Notify OB unit prior to arrival
- EMS: driver should contact receiving unit to follow local protocols
- Hospitalization: usual hospital protocols for isolation
Infants born to mothers with COVID should be considered PUI
- Prevention of mother-to-child transmission (PMTCT): may temporarily separate mother from baby until mother’s transmission based isolation precautions are discontinued (due to respiratory secretions)
  - No data on vertical transmission
    - Thought to spread mostly by close contact with respiratory droplet
  - Very limited data on routes of transmission other than contact with respiratory droplet - however small cohorts tested didn’t demonstrate transmission via these others routes (note amniotic fluid and other sources were not tested)
  - Discontinuation of isolation made on local ID guidance and case-by-case
  - Discontinuation criteria same as for other COVID19
    - Resolution of fever without anti-pyretic, resolution of symptoms, and negative COVID19 testing
  - Face mask, hand hygiene before each feeding
    - Dedicated breast pump if nursing
    - Entire pump should be entirely disinfected per manufacturer recommendations between each feed

Are pregnant women at increased risk of adverse pregnancy outcomes?
- No data exists on this (regarding pregnancy loss, misscarriage, etc)
- High fevers in early pregnancy previously demonstrated (in SARS and MERS) to increase risk of birth defects. May be possible here. But no data.
Lactation
- No evidence of virus found in breastmilk. (but no good data on this). Most transmission noted to be due to close respiratory droplet contact during feeding
Should pregnant patients not be out and about in the community?
- Prenatal care still encouraged
- Usual precautions encouraged (as with general population)

Authors: