Pregnancy and COVID-19 – Greater Risks Call for Greater Care

Expectant women are particularly vulnerable to developing more severe cases of COVID-19. But it’s not all bad news.

The evidence is in the ICU wards of many hospitals, where the disproportionate number of pregnant women cries out a warning:  We don’t understand all of the effects of SARS-CoV-2 – we don’t have enough data yet –  but we do know that pregnancy carries special risks for severe COVID-19. We also know that the risks are even higher with increasing age, weight, blood pressure, and diabetes and that COVID-19 increases the chance of premature births and newborn admission to neonatal units.

Why Are Pregnant Women More at Risk?

Generally, changes in the immune system during pregnancy make women more vulnerable to respiratory viruses like the H1N1 flu and severe acute respiratory syndrome (SARS), which cause more admissions to the ICU and death in pregnant women than others. Viral infections are more severe during pregnancy because the immune system reduces the mother’s defenses to ensure that she doesn’t react against her fetus, which includes the father’s foreign genetic material.  

But it’s not a greater risk of contagion. Pregnant women have the same risk as any of us of contracting the SARS-CoV-2 virus. And they respond like non-pregnant women with either an asymptomatic or symptomatic disease course. The main difference is that even if they are asymptomatic, they still might require hospitalization and ICU care, because of how quickly the disease can progress. Pregnancy commonly increases the risk of blood clots, but combined with COVID-19, that risk is even higher. 

Few Risks for the Baby 

So far, COVID-19 during pregnancy seems to increase the risk of preterm deliveries, but not of miscarriages, fetal malformations or congenital anomalies. In fact, the risk of infection from mother to fetus seems low – there have been few infected babies born to mothers with COVID-19. A small percentage of infants have tested positive for the virus shortly after birth. Still, it’s not clear whether the newborns were infected before, during, or after birth. And most newborns who test positive for the virus have mild or no symptoms and recover. 

And breastfeeding is safe: It is unlikely that the virus spreads to the newborn through breast milk.  

However, the data is incomplete because there have been few cases of the coronavirus in pregnant women. And most data are from infections during the third trimester, which leaves critical unknowns like risks to the developing fetus during the first trimester. For example, a high fever from any cause during the first trimester will increase the risk of birth defects.

Tips for Pregnant Women

First and foremost, be vigilant and avoid getting COVID-19. As we all do, the same precautions will protect against getting COVID-19 – handwashing, social distancing, wearing a face mask, and limiting social interactions.  And however tedious, stay home as much as possible. 

Additional recommendations are to get routine vaccines against the flu and other respiratory pathogens, which are all proven safe, and keep up with doctor’s appointments and childbirth classes.

However, if you’ve had a known COVID-19 encounter, or symptoms yourself, it is essential to contact your doctor, self-isolate, and call the coronavirus hotline to get tested immediately.  If you have a high fever or trouble breathing, you should seek medical care immediately or go to the emergency room. 

As to vaccination, there is not a lot of data yet. So, best to follow the latest information from the World Health Organization, or the Centers for Disease Control.

Keeping Safe After Childbirth

If you’re COVID-19 positive, you must wear a face mask around your new baby, and always wash your hands before and after caring for and breastfeeding your newborn, and keep surfaces clean and disinfected. Unless you’re acutely sick, it’s okay to have your newborn’s crib in your room, but at least 1.5- 2 meters away. If you’re severely ill, it’s best to distance from your newborn. 

Two weeks after a positive COVID-19 test, you won’t be contagious, and while you will still need to wash your hands when caring for your newborn – which you would probably do anyway – it won’t be necessary to wear a face mask. However,  your newborn must be protected from COVID-19, which means that all friends and family should maintain distance, if possible, and always wear a mask and wash their hands. But never put a mask or face shield on your baby, as it could increase the risk of accidental suffocation, strangulation or sudden infant death syndrome (SIDS). 

It sounds like a lot: But habits are developed quickly. And every baby is magic.

Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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