Are pregnant women at greater risk for COVID-19?

April 27, 2020

Pregnant women are understandably concerned about the novel coronavirus spreading across the United States and the world, worried that they or their babies might be at heightened risk.

The evidence shows that expectant mothers are no more likely to get sick than the general population, says Dr. Afshan Hameed, a UCI Health obstetrician and leading authority on high-risk maternal-fetal medicine. But if a pregnant woman does fall ill, she is not at higher risk of serious complications.

Nonetheless, since childbirth cannot be postponed, UCI Health has taken extensive precautions to prevent the spread of the virus to ensure the health and safety of all pregnant women, of new mothers and their infants, as well as the doctors, nurses and other staff members who care for them.

Most worrisome to expectant mothers is the fear that they might transmit the infection and harm their baby.

Virus transmission modes limited

Not enough is known yet, but overall the picture is encouraging, says Hameed, a professor of obstetrics and gynecology at the UCI School of Medicine. She cited three possible routes for transmission of infection to the baby:

  • One is whether the virus can be passed to the fetus through the placenta (in utero) during pregnancy.
  • The second is whether there is possible exposure to the virus during birth, whether in the vaginal canal or birth by Caesarean section.
  • Finally, there is person-to-person transmission through newborn care and breastfeeding.

The question of transmission in utero “is a gray area,” she says.

One small study found no signs of novel coronavirus RNA in babies born to women who had been infected. But after that study, subsequent reports from China indicated that antibodies to the virus had been found in some newborns within two hours of delivery. However, the type of antibodies indicated that they may have been infected during the pregnancy, and whether these antibodies were specific to COVID-19 remains unclear.

“We need more data in this area,” she says.

Fever always a concern

High fevers in pregnancy from any illness can affect a developing fetus, and fever is a common symptom of COVID-19. A recent report published in the New England Journal of Medicine indicates that 29 out of 33 COVID-19-positive pregnant women had no symptoms when in labor, then three of them developed a fever after delivery.

A woman’s obstetrician would work with her on ways to safely reduce risk, especially fever, before delivery. “You want the mother’s temperature to be normal to optimize intrauterine fetal environment,” Hameed explains. 

As for transmitting the infection during birth, there is no evidence the virus can be passed to the baby in the labor and delivery process.

“COVID-19 is spread by direct contamination from respiratory secretions primarily through respiratory droplets showered into air when a COVID-19 positive person sneezes or coughs,” she says, not from exposure to vaginal fluids or blood.

An infected woman in labor would be asked to wear a mask to protect everyone in the delivery room, including her baby, and special attention would be paid to everyone’s hand hygiene and personal protective equipment.

After the birth is the time of greatest concern when a mother has tested positive for the virus. Until she has cleared the virus from her system, she is able to transmit it to the baby and therefore should not handle her infant or be in close proximity, just as all COVID-19 patients should be in as much isolation as possible at home.

Breast milk not affected

Some good news: The virus is not found in breast milk, so a mother using good hygiene could still pump or express her breast milk for the baby’s nutrition until she is able to nurse.

Expectant mothers are also fearful about being exposed to COVID-19 during prenatal clinical visits and for the birth, itself, at the hospital.

UCI Health obstetricians are taking special care with all their patients long before delivery, Hameed says. One especially useful tool has been conducting prenatal visits by teleconferencing so that most pregnant patients can stay at home and avoid community exposure as much as possible.

“However, there are some high-risk patients who might need ultrasound or other checks not available at home, so they do need to come in more often.”

For those women as well as those who arrive to give birth, UCI Health has instituted special protocols to protect expectant mothers, newborns and healthcare providers from exposure to the virus. These include:

  • Taking patients’ temperatures upon arrival
  • Testing for the virus at each visit
  • Regular and rigorous disinfection of all surfaces
  • Wearing appropriate masking and other protective garments

Mandatory COVID-19 testing

In fact, UCI Health in early April initiated mandatory COVID-19 testing for all women as soon as they are admitted for labor and delivery, says Hameed. This extra level of care keeps patients, family and staff safe.

Because the novel coronavirus continues to spread within Orange County and across Southern California, UCI Health is still restricting who is able to accompany or visit a women during or after delivery to one support person.

Other visitors, she says, will have to wait to meet the newborn once it is safe at home.