20 Mar 2020 More COVID-19 Pregnancy Information for Intended Parents, Surrogates
Here is more information for intended parents and surrogates about the coronavirus disease COVID-19 and what experts are saying about its potential impact on pregnancy. Thanks to our colleague Dr. John Norian of HRC Fertility for sharing this informative Q&A, much of which is drawn from recent articles and from the American Society for Reproductive Medicine (ASRM) and the American College of ObGyns (ACOG).
Information for Pregnant Patients regarding COVID-19
Q: If I’m pregnant, will my fetus (aka soon-to-be baby) get the virus?
A: Likely not. The vertical or in-utero transmission, i.e., from future Mom to fetus or from Gestational Surrogate to fetus for prior corona viruses (SARS and MERS) has not been reported. Because it is such a new virus, it is unclear if COVID-19 can cross the placenta and infect the fetus. As of now, there have not been any cases of vertical cases published in peer-reviewed medical journals.
Q: If I’m pregnant AND I get COVID-19, is that bad?
A: It is not ideal. There is not much information regarding patients with this corona virus (COVID-19). But pregnant patients with other corona viruses (ie., SARS-CoV and MERS-CoV) are at a higher risk of severe illness such as preterm delivery, miscarriage, and growth restriction. Critical maternal complications are also higher with these two other corona viruses. Thus, women with confirmed COVID-19 should be self-monitored at home for at least 14 days and be monitored regularly by the Obstetricians for fetal growth and Doppler assessments. Pregnant women with COVID-19 pneumonia should be managed by a multi-disciplinary team at a high-level medical center. After delivery a pregnant patient with COVID-19 will likely be isolated away from her newborn for typicall at least 14 days. Now please remember that any patient with a bad respiratory ailment (e.g., Asthma, Pneumonia, etc.) can also have a more complicated pregnancy similar to one with COVID-19. So... let’s do our absolute best to stay healthy! See below for tips on how to do so.
Q: What should I do if I’m a gestational carrier/surrogate or if my fetus will be born via a surrogate during the outbreak?
A: Because of strict travel restrictions now present throughout the world, it is highly recommended that families and patients develop contingency plans in the event that these babies need to be cared for following their birth. If the gestational carrier tests positive for COVID-19, then the baby should be cared for separately and isolated for 14 days with close surveillance.
Q: Should I breast feed my baby if I have COVID-19 or am a PUI (person under investigation of COVID-19)?
A: This is more complicated, and working with your health care provider would be recommended. Briefly, in limited studies COVID-19 and SARS the viruses have not been detected in breast milk. But COVID-19 is transmitted via respiratory droplets produced when an infected person coughs or sneezes. Thus, it is most likely that a newly delivered woman with COVID-19 or who is a PUI will be recommended to pump breast milk and to remain in isolation away from her infant. The mother or gestational surrogate must use good hand-washing and sterile techniques before touching any breast pumps or bottle parts.
Q: What is the risk to pregnant women of getting COVID-19? Is it easier for pregnant women to become ill? Will they be more sick than other people?
A: The short answer is that we really do not currently know if pregnant women are (1) more likely to get COVID-19 and (2) if it’s going to be a more serious illness compared with the general public. The nice thing is that pregnant women are typically younger and are non-smokers so hopefully their mortality rates will be significantly better. Now with this being said, pregnant women experience changes in their bodies that may increase their risk of some infections. It is always important for pregnant women to protect themselves because they are at higher risk of developing severe illness with viral respiratory infections.
Q: Who are the highest risk groups?
A: Thank goodness, but it appears NOT to be pregnant patients or young children as of now. People most at risk are older adults and those with respiratory disease, heart disease, and/or diabetes. Adults in their 80s, 70s, and 60s and those who are active or former smokers are at high risk. But please do not get complacent with preventative measures because young people with COVID-19 can still get very sick.
Q: What is the mortality rate for COVID-19 and how does this compare to other viruses?
A: The latest global mortality rate is: 3.4%, higher than originally reported. In comparison, the mortality rate of the seasonal flu is 0.1% of those infected. The death rate for COVID-19 is highest for older patients. By age group the mortality rates are as follows: 14.8% for 80+ yr olds (yo), 8% for 70 – 79 yo, 3.6% for 60 – 69 yo, 1.3% for 50 -59yo, 0.4% for 40 – 49yo, and 0.2% for those 10 – 39 yo. Please remember that mortality rates can be difficult to calculate, often because people with mild disease may be overlooked and under-reported in the calculation.
Q: What can I do to avoid COVID-19?
A: (1) Avoid close contact with people who are sick. (2) Take everyday preventive actions such as listed below:
- Clean your hands often
- Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughin g, or sneezing, or having been in a public place.
- If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
- To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
- Wash your hands after touching surfaces in public places.
- Avoid touching your face, nose, eyes, etc.
- Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
- Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
- Avoid all non-essential travel including plane trips, and especially avoid embarking on cruise ships.