COVID-19 (coronavirus disease 2019) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Information about COVID-19 and interim care guidelines are evolving rapidly. Based on several studies, the epidemiology, virology, transmission, and symptoms and signs of COVID-19 in pregnant women are similar to those in nonpregnant patients. Early results showed no increased risk compared with nonpregnant patients (1, 2). However, data from the Centers for Disease Control and Prevention (CDC) and other publications indicate an increased risk of intensive care unit admission, mechanical ventilation, and death in pregnant patients with symptomatic COVID-19, particularly in those with underlying health conditions such as diabetes and cardiovascular disease (3).
Risk of obstetric complications (eg, preterm labor, preterm birth, preeclampsia, cesarean delivery) may be increased, at least in patients with moderate and severe infection (usually including pneumonia), but whether this risk is increased is not yet confirmed. Also, whether any such risk differs from the risk conferred by other respiratory virus infections is unknown.
1. Liu D, Li L, Wu X, et al: Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: A preliminary analysis. Am J Roentgenol Mar 18, 1–6: 2020. doi.org/10.2214/AJR.20.23072 Epub ahead of print.
2. Breslin N, Baptiste C, Gyamfi-Bannerman C, et al: COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020. https://doi.org/10.1016/j.ajogmf.2020.100111 Epub ahead of print.
4. Schwartz DA: An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: Maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med Mar 17 2020. doi: 10.5858/arpa.2020-0901-SA Epub ahead of print.
5. Wang W, Xu Y, Gao R, et al: Detection of SARS-CoV-2 in different types of clinical specimens. JAMA Mar 11, 2020. doi: 10.1001/jama.2020.3786 Epub ahead of print.
Diagnosis of COVID-19 is similar in pregnant and nonpregnant patients.
Chest x-ray and/or CT, if otherwise indicated, should be done because the fetal radiation doses are low.
The Society for Fetal-Maternal Medicine (SMFM) and the American College of Gynecology (ACOG]) have a suggested algorithm for triage and evaluation of pregnant women with possible COVID-19 (1). Recommendations in this algorithm are similar to those for evaluation of nonpregnant patients.
General medical treatment for COVID-19 is mainly supportive and is similar in pregnant and nonpregnant patients. Acetaminophen is recommended for treatment of fever and mild to moderate pain.
Oxygen saturation should probably be kept > 95% or a PaO2 of > 70 mm Hg.
All pregnant women should be advised to follow the CDC guidelines for preventing COVID-19 and to take precautions to minimize their exposure, including staying at home as much as possible, regular handwashing, and social distancing. These precautions are similar to those in nonpregnant patients.
All health care workers should wear appropriate personal protective equipment (PPE).
To decrease exposure to pregnant women, health care practitioners should contact their pregnant patients about consolidating prenatal visits and ultrasound appointments, although consensus about how to schedule such appointments has not yet been determined. Blood pressure, blood glucose, and fetal monitoring tracings can sometimes be transmitted electronically, and some appointments may be done through telephone or video conferencing.
Separating mother and infant after delivery should be considered on a case-by-case basis. Ending separation may need to wait until risk of transmission to the infant has been thoroughly evaluated. Evaluation should usually include laboratory testing.
Risk of transmitting the virus in breast milk is low or absent. If the woman chooses to breastfeed continually despite being separated from her infant, she should express milk to be transported and fed to the infant by a caregiver who is not infected unless COVID-19 has been ruled out in her. When expressing breast milk, a woman should be advised to practice good hand hygiene (eg, washing her hands before touching the breast pump and bottle parts and before expressing breast milk). A dedicated breast pump should be used if possible; it and all pump parts that contact the breast or breast milk should be thoroughly cleaned and disinfected after use. The pumping area (eg, dials, power switch, counter top) should be cleaned with disinfectant wipes. If the woman chooses to breastfeed directly, she should wear a face mask and wash her hands before each feeding.
The safety and efficacy of the vaccines for pregnant women, the fetus, and the neonate remain unknown because these groups have been excluded from clinical trials. However, current consensus statements and practice bulletins from the CDC, ACOG, SMFM, and Royal College of Obstetricians and Gynaecologists state that the any of the currently authorized COVID-19 vaccines should be offered to pregnant women after discussing the lack of safety data with them; the vaccines should be given preferentially to pregnant women at highest risk of severe infection until safety and efficacy of these novel vaccines are validated.
Manifestations, diagnosis, and treatment of COVID-19 are similar in pregnant and nonpregnant patients.
Risk of obstetric complications may be increased, but whether risk is increased is not yet known.
Vertical transmission and transmission in breast milk are unlikely.
Consider separating possibly infected mothers from infants until transmission risks can be thoroughly evaluated.
Consolidate prenatal visits and testing to minimize maternal exposure.
Offer pregnant women a COVID-19 vaccine after a discussion of the current lack of data, risks, and benefits.