Covid-19 during pregnancy: all your questions answered

Baby Yum Yum - Covid-19 during pregnancy all your questions answered
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With every passing day, we are bombarded with information about the coronavirus (COVID-19) – and we aren’t always certain what is fact and what is disinformation or even rumour-mongering. We turned to expert gynaecologist, Dr Joanne Pottow, to put minds at ease when it comes to questions around pregnancy, breastfeeding and COVID-19.

She explains that while the information evolves daily, SASOG (South African Society of Obstetricians and Gynaecologists) and the Royal College of Obstetrics and Gynaecology have put out guidelines to help answer any questions you might have.

Q. Are there any specific Covid-19 risks – or increased risks – for pregnant women?

Pregnant women themselves do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population. Data is limited but special consideration should be given to pregnant women with concomitant (naturally occurring or accompanying) medical illnesses who could be infected with COVID-19 until the evidence base provides clearer information.

Q. What basic precautions and extra precautions should pregnant women take during Coronavirus pandemic?

Social distancing measures are steps you can take to reduce the social interaction between people. This will help reduce the transmission of coronavirus. We strongly advise you to follow these six measures as much as you can and to significantly limit your face-to-face interaction with friends and family if possible.

Avoid contact with someone who is displaying symptoms of COVID-19. These symptoms include high temperature and/or new and continuous cough, nasal congestion and a scratchy throat.

  1. Avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible.
  2. Work from home, where possible.
  3. Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs.
  4. Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media.
  5. Use telephone or online services to contact your GP or other essential services.

Handwashing and respiratory hygiene: There are general principles you can follow to help prevent the spread of respiratory viruses, including:

  • washing your hands more often with soap and water for at least 20 seconds or use a hand sanitiser (with a minimum of 70% alcohol) when you get home or into work, when you blow your nose, sneeze or cough, eat or handle food;
  • avoid touching your eyes, nose, and mouth with unwashed hands;
  • avoid close contact with people who have symptoms;
  • cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands;
  • clean and disinfect frequently touched objects and surfaces in the home.

Q. Can COVID-19 increase the risk of miscarriage?

There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Case reports from early pregnancy studies with SARS and MERS do not demonstrate a convincing relationship between infection and increased risk of miscarriage or second-trimester loss.

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Q. Can Covid-19 be passed on to a newborn by its mother?

A few cases of possible vertical transmission (transmission from mother to baby antenatally or intrapartum) have been reported. In these cases, it remains unclear whether transmission was prior to or soon after birth. Expert opinion is that the foetus is unlikely to be exposed during pregnancy.

A case series published by Chen et al. tested amniotic fluid, cord blood, neonatal throat swabs and breast milk samples from COVID-19 infected mothers and all samples tested negative for the virus. In another study, three placentas of infected mothers were swabbed and tested negative for the virus; in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests.

There is currently no evidence concerning transmission through genital fluids and transmission is, therefore, most likely to be as a neonate.

There are limited data to guide the postnatal management of babies of mothers who tested positive for COVID-19 in the third trimester of pregnancy, but there is no evidence at present of (antenatal) vertical transmission as of 17 March 2020.

Q. Can Covid be spread to a baby through breast milk? Can you still breastfeed if you have Covid-19?

In six Chinese cases tested, breast milk was negative for COVID-19; however, given the small number of cases, this evidence should be interpreted with caution. The main risk for infants of breastfeeding is the close contact with the mother, who is likely to share infective airborne droplets.

Wondering if you can continue to breastfeed if you have coronavirus? In light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breast milk.

The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with her. This guidance may change as knowledge evolves.

Q. What should a pregnant woman do if she suspects she has the virus?

Please telephone your healthcare provider and ask for guidance as they know your medical history and can best advise you regarding testing, self-isolation and management of the potential infection.

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