Today we're talking about something that has been on the mind of many mothers and mothers-to-be: the impact of COVID-19 on pregnancy and breastfeeding.

 

COVID-19 and pregnancy

• The national obstetrical and gynecologic societies of Canada, the USA, and UK have all issued guidance on COVID-19 and pregnancy1-3
• There is no strong evidence that pregnant women are at increased risk of contracting COVID-19 compared to the general population4
• Symptoms in pregnant patients are typically similar to the general population: malaise, cough, dyspnea, fever5,6
• Pregnant patients are not at increased risk of severe disease; however critically ill mothers have a high risk of intrauterine fetal demise and neonatal mortality4
  • The most frequently documented adverse outcome in pregnant patients with COVID-19 is spontaneous or iatrogenic preterm labour7,8
• There is no strong evidence for vertical transmission of COVID-191
  • One study reported no presence of SARS-CoV-2 in samples of amniotic fluid, placenta, neonatal throat swab, anal swab and breastmilk9
  • Most neonates test negative on RT- PCR, however, IgM and IgG antibodies and elevated IL-6 were found in the sera of 6 neonates born to mothers with COVID-19, despite the neonates themselves having negative RT-PCR tests7
• C-sections, preferably with epidural anesthesia, have been considered safe for both the health care workers and the patients, with appropriate airborne precautions and safety measures10
• FIGO guideline highlights11
  • Antepartum care
    • Suggest treatment in tertiary care hospitals with effective isolation facilities and PPE 
    • CT chest may be considered in addition to the diagnostic algorithm 
    • Close fetal monitoring
  • Delivery
    • COVID-19 itself not an indication for delivery unless there is need for improving maternal oxygenation
    • Negative pressure room for suspected/confirmed cases
    • Vaginal delivery or C-section, but short procedure time
  • Postpartum care
    • Separation if mother is critically ill
    • Co-rooming if mild disease or asymptomatic: washing hands, respiratory hygiene

 

COVID-19 and breastfeeding

• The WHO provides balanced, practical guidelines on breastfeeding for patients with COVID-19, which weigh the enormous benefits of close physical contact between newborn babies and their mothers with the potential risks of COVID transmission12
  • Mothers with confirmed COVID-19 are encouraged to breastfeed, if they wish to do so. Mothers should use excellent respiratory hygiene, wear a mask if one is available, and routinely clean and disinfect high-touch surfaces
  • Mothers with confirmed COVID-19 are encouraged to have close contact with their newborns, including skin-to-skin and room sharing. Mothers should use excellent respiratory hygiene, wash hands frequently, and regularly clean surfaces.
• For working mothers pumping while working on the front lines: there is no good evidence around this
  • It is our personal feeling that this can certainly be done safely – weighing the benefits of breast milk with the theoretical risks of transmission
  • Use excellent hand-hygiene and regular thorough cleaning practices

 

 

 

Sources

1. Elwood C, Boucoiran I, VanSchalkwyk J et al. Updated SOGC Committee Opinion – COVID-19 in Pregnancy. Updated Mar 13 2020. https://www.sogc.org/en/content/featured-news/Updated-SOGC-Committee-Opinion__COVID-19-in-Pregnancy.aspx
2. Novel Coronavirus 2019 (COVID-19): Practice Advisory. American College of Obstetricians and Gynecologists (Immunization, Infectious Disease, Public Health Preparedness Expert Work Group). Updated Apr 23 2020. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
3. Coronavirus (COVID-19) Infection in Pregnancy: Information for healthcare professionals. Royal College of Obstetrics and Gynaecologists (UK). May 13 2020. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/
4. Qiao J. What are the risks of COVID-19 infection in Pregnant Women? Lancet, Mar 2020. doi:10.1016/S0140-6736(20)30365-2
5. Beslin 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,Apr 2020. doi:10.1016/j.ajogmf.2020.100118
6. Chen L, Li Q, Zheng D et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. New Eng J Med, Apr 2020. doi:10.1056/NEJMc2009226
7. Parazzini F, Bortolus R, Mauri PA et al. Delivery in pregnant women infected with SARS-CoV-2: A fast review. Int J Obstet Gynecol, Apr 2020. doi:10.1002/ijgo.13166
8. Gajbhiye R, Modi D, Mahale S. Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV- 2 in women with COVID-19: A systematic review. MedRxiv, pre-print, Apr 2020. doi:10.1101/2020.04.11.20062356v1
9. Yin M, Zhang L, Deng G et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Pregnancy In China: A Retrospective Cohort Study. MedRxiv pre-print, Apr 2020. doi:10.1101/2020.04.07.20053744
10. Chen R, Zhang Y, Huang L et al. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth, Mar 2020. doi:10.1007/s12630-020-01630-7
11. Poon LC, Yang H, Kapur A et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynaecol Obstet, Apr 2020. doi:10.1002/ijgo.13156
12. World Health Organization. Q&A on COVID-19 , pregnancy, childbirth, and breastfeeding. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid-19-and-breastfeeding. Updated May 7 2020.