If you’re pregnant, the coronavirus pandemic has likely put you on edge.
That’s because the Centers for Disease Control and Prevention (CDC) lists pregnant women among the group of people who are at higher risk for severe illness from COVID-19.
Why is that and what does it mean for you and your growing baby? These are the questions that Dr. Kristina Adams Waldorf, a professor of obstetrics and gynecology at University of Washington School of Medicine and expert in pregnancy infections, is trying to answer.
In the middle of January, when infections started spreading beyond the Wuhan region, Adams Waldorf began to rapidly build a program to study coronavirus infections in pregnancy.
Although there are still many unknowns about how the coronavirus can affect a pregnancy, experts have issued guidance for pregnant women based on what they know so far. Adams Waldorf and Dr. Edith Cheng, a professor of obstetrics and gynecology and chief of service for obstetrics at University of Washington School of Medicine, explain how you can keep yourself safe and your baby, too.
Are pregnant women more likely to get infected from the coronavirus?
Just because you’re pregnant doesn’t mean you’re any more or less likely to get infected with the coronavirus, Adams Waldorf says. Keep in mind, however, that this virus is more infectious than influenza (flu) and you should take precautions to avoid becoming ill.
So far, the data on pregnancy outcomes after infection with COVID-19 is very limited. On top of that, many studies looking at pregnancy and COVID-19 have mainly been on women who are in the later stages of pregnancy, not in their first trimester.
What does that all mean?
More research needs to be done, Adams Waldorf says, to know if being pregnant at any stage makes you more vulnerable to the disease and what the risks might be.
Are pregnant women at higher risk for severe illness from COVID-19?
In general, pregnancy is associated with changes in the immune system, which can put you at higher risk for health issues and complications from illnesses like the flu. That can also apply to COVID-19, but experts need to conduct more research to know for sure.
“Based on the numbers for the coronavirus, we don’t know if there’s higher risk for preterm birth or stillbirth or what happens to children that are exposed to the virus in utero and what happens when they grow up,” Adams Waldorf explains.
What experts do know is that certain viral illnesses can cause preterm birth or miscarriage.
“Our experience from the 2008-2009 influenza epidemic identified a link to increased preterm deliveries among women who were extremely ill,” Cheng says. “However, it’s the complications and severity of the viral illness rather than the virus itself that is most concerning.”
While researchers like Adams Waldorf hope to find out more about how the new coronavirus specifically affects pregnant women and their babies, in the meantime, she urges you to take extra precautions to stay safe.
Can you pass the coronavirus on to your baby?
Any kind of infection — be it from the coronavirus or not — is potentially dangerous for pregnant women. But what does it mean for your growing baby?
A study of nine pregnant women found no evidence of the virus in amniotic fluid, cord blood or breastmilk, but a more recent study of 33 babies born to mothers who had COVID-19 noted that three of the babies were infected, although timing of the infection is unclear.
The newness of this virus means it’s simply too early to tell, Adams Waldorf notes, but she hopes her work will offer more definitive findings in the future.
“My lab will be analyzing the early and late immune responses in pregnant women who have become infected with the virus that causes COVID-19,” she says. “We want to understand what is different about the infection in pregnant women, how this infection can impact growth of the fetus, placental biology and whether it can cause an increased risk for problems in pregnancy like preterm birth or stillbirth.”
Should you change your birth plan due to the coronavirus?
With orders to stay at home and avoid others, you might be wondering what that means for your labor and delivery.
Switching to a home birth might seem appealing, but giving birth outside of the hospital can bring other risks. In the United States, for example, newborn mortality rates are higher after a home birth than after a hospital birth.
To make hospitals safer for delivering mothers during the pandemic, many healthcare organizations have implemented new visitor policies. UW Medicine has adopted visitor safety measures to protect its patients and staff but still allows you to have a support person during your labor and delivery.
With these additional protections in place, you can still consider hospitals a safe place to deliver your baby during the coronavirus crisis.
How does social distancing apply to pregnant women and newborns?
As difficult as it may be for you and your family, you should follow social distancing guidelines whether you’re pregnant or not. The less exposure you have to other people, the better.
Friends and relatives who don’t already live with you shouldn’t visit you in person during your pregnancy. And while your loved ones may be excited to meet your newest addition after your baby is born, they should stick to virtual visits for the time being.
It can be difficult, especially if you’ve had to cancel your baby shower or post-birth visit, but remember that it’s for the health and safety of your growing family.
How can pregnant women protect themselves from the coronavirus?
Follow standard COVID-19 precautions: washing your hands, staying home, keeping 6 feet away from others and avoiding touching your face. If you start to become sick with a fever, cough or difficulty breathing, seek medical care immediately.
Adams Waldorf also recommends talking to your OB-GYN, midwife or nurse practitioner about the option of virtual visits for a portion of your maternity care appointments.
“I think patients should be asking their doctors how they can enroll in telemedicine programs,” Adams Waldorf says. “We need to be creative in providing prenatal care so that we can protect our patients from a COVID-19 exposure.”
UW Medicine’s TeleOB program is one example of this, where routine prenatal appointments are done virtually using a cell phone or computer so that you and your maternity care expert can see and talk to each other. If you’re enrolled in this program, you’re provided equipment and taught how to take your own blood pressure and find your baby’s heartbeat using a doppler.
Another important step to take is to make a back-up plan in case you or your partner gets sick. Consider things like who will care for your baby, how you’ll isolate the sick person in your home and how you’ll safely get help from others. If you think about this scenario ahead of time, it’ll make you feel more prepared and in control after you give birth.
What happens if you have COVID-19 when you give birth?
Hospitals around the country have instituted new safety policies during the pandemic, including screening moms-to-be who are admitted for COVID-19 symptoms.
“If you have tested positive or have COVID-19 symptoms, we have brought together experts in high-risk obstetrics, infectious disease, pediatrics and anesthesia to provide you with the safest delivery possible,” Cheng says.
After birth, the CDC and American Academy of Pediatrics (AAP) recommend separating newborns and moms who are exhibiting symptoms to prevent potential transmission. Although this is difficult and frightening, separating yourself from your newborn is one of the main ways to reduce your baby’s risk of becoming infected with the coronavirus.
Doctors are unsure how often newborns become infected and develop life-threatening illnesses from COVID-19, so it’s best to be cautious in the interest of your little one. To help you stay connected, your baby’s care team can share daily photos and progress reports about your newborn.
Once your symptoms are gone and you’re cleared by your doctor, you and your baby can be reunited again.
The World Health Organization (WHO), on the other hand, doesn’t yet recommend separating moms and babies. Instead, WHO suggests practicing infection prevention measures when caring for your newborn.
“This decision should be made after discussion with your obstetrical and pediatric team,” Cheng says.
Is it safe to breastfeed your baby if you have COVID-19?
The CDC, AAP and WHO all support giving breastmilk to newborns.
If you’re exhibiting symptoms of COVID-19 and decide to remain with your baby, Cheng encourages you to follow appropriate infection control and prevention measures. This includes washing your hands thoroughly before picking up your baby and wearing a mask and gloves.
If you do decide to separate, consider pumping and bottle-feeding expressed breastmilk, which can still benefit your baby. After you’re out of isolation and able to be reunited with your baby, you’ll be able to breastfeed directly.
The bottom line
With all the uncertainty that the coronavirus brings, it’s understandable to feel anxious or overwhelmed. Just remember that taking extra precautions can help you reduce your risk and arming yourself with the facts can help you feel more prepared for what’s to come.
If you need help addressing your anxiety about being pregnant during the pandemic, ask your OB-GYN or midwife about speaking with a social worker in your clinic.
If anything, you can rest easy knowing that researchers and frontline hospital workers are doing whatever they can to find answers and care for expecting moms around the world.
“I’m researching these things so we can better understand and protect pregnant women and their children,” Adams Waldorf says. “On top of that, our physicians are rapidly enrolling people in telehealth programs so that we can better serve our patients.”