We know that everyone has been following the news about the worldwide spread of COVID-19 and that there are many questions and concerns about what this outbreak will mean during pregnancy. The brief comments below reflect both the limited knowledge and expert opinions as of 3/11/2020. Most advice for pregnant women is similar to the advice for the general population in the United States.
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Question: Are pregnant women more susceptible to infection or at increased risk for severe illness, morbidity, or mortality with COVID-19?
Answer: Pregnant women are more susceptible to severe illness in outbreaks of other related coronavirus infections (SARS-CoV, MERS-CoV) as well as influenza. Limited data from China, however, do not show a greater risk for acquisition or severity of COVID-19 in pregnant women compared to other adults. Data from nine, third trimester, women with COVID-19, suggest that severe infection near the end of pregnancy may impact timing and route of delivery.
Question: Can pregnant women pass COVID-19 to their fetus during pregnancy?
Answer: To date there is no evidence for intrauterine infection among women diagnosed with COVID-19. Limited information is available about intrauterine transmission for other coronaviruses (MERS-CoV and SARS-CoV) however, maternal to fetal transmission has not been reported for these infections either.
Neonates can acquire COVID-19 through respiratory droplet transmission. Adults with possible or confirmed infection who are caring for newborn infants should follow CDC guidance, including with regard to breast feeding. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html
Question: I am pregnant and a healthcare worker, should I avoid caring for patients that are potentially infected with COVID-19?
Answer: Pregnant healthcare personnel should follow best hand hygiene practice, standard precautions, and be aware of all updated infection control guidelines for their health care facilities to keep themselves and others safe in the healthcare environment. There is no recommendation to specifically prohibit pregnant employees from caring for patients with suspected or confirmed COVID-19.
Question: I am pregnant and planning to travel this spring/summer. Should I cancel my trips?
Answer: The impact of COVID-19 in the U.S. and around the globe is evolving quickly. All patients should avoid travel to areas designated with a Level 3 or Level 2 CDC Travel warning. Pregnant women should consider avoiding all non-essential travel, domestically or internationally. Patients should be aware that they may be subject to travel restrictions, disruptions, and limitations in movement affecting return to home should exposure to COVID-19 occur. Pregnant women at particularly high risk such as those with pulmonary co-morbidities or immunosuppression should avoid all travel. Patients should review the latest information and advisories before embarking on any trip. https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
Question: I was on a crowded T train this morning, near a patient that was coughing. Should I be tested for Coronavirus?
Answer: No testing is indicated in this situation. The COVID-19 tests are currently only recommended for patients with respiratory symptoms and exposure risk factors such as travel to a Level 3 areas or exposure to a confirmed patient with COVID-19. Testing guidance is likely to evolve rapidly and indications for testing are likely to expand in the next two weeks.
Question: I am pregnant and concerned about going to crowded places (i.e., the T, a restaurant, a conference, a concert, work meetings). Should I avoid such social settings?
Answer: The CDC now recommends that people with risk factors for increased disease severity (older adults and those with chronic medical conditions) spend most of their time at home, avoiding activities that involve large crowds. While CDC does not consider pregnancy alone to be a risk factor for increased disease severity, this is appropriate advice for high risk pregnant women with comorbidities.
While recommendations regarding social distancing for all members of our society are still in development in Massachusetts, as of the time of this document, pregnant patients may take extra precautions to keep away from large concentrations of people, practice good hand hygiene, and avoid touching the face. https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html
Question: I am pregnant and have fever, cough, myalgias, sore throat, and headache. Could this be COVID-19?
Answer: While the data on new cases in Massachusetts is evolving quickly, at the time of this document, influenza and other respiratory viruses that occur commonly in winter are much more common than community-acquired COVID-19. During pregnancy, appropriate diagnosis of and treatment for influenza remains of utmost importance. Please call your OB office to report your symptoms. If there is a reason to think you may have been exposed to the new coronavirus, your OB provider work with the hospital’s Infection Control and Infectious Diseases consultants to determine if you need to be tested for COVID-19. They will provide instructions to you on where testing can be arranged, if needed.
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