Pregnant women & Breastfeeding should take precautions
While it’s too early for researchers to know specifically how COVID-19 will affect pregnant women or the babies they are carrying, CDC experts are urging pregnant women to take precautions.
“Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19,” public health experts at CDC wrote.
Women who were pregnant during past similar outbreaks, including SARS and MERS, were more vulnerable and public health experts therefore are urging pregnant women to do all they can to avoid getting any infections by frequently washing their hands and avoiding other people who are sick.
It’s not clear if a COVID-19 infection could harm an unborn child, although high fevers during the first trimester can be detrimental. CDC health experts are also urging caution for health care providers who are pregnant.
While little is known yet about how COVID-19 will affect pregnant women, an expert on pregnancy, women’s care and obstetrics answers your questions.
Dr. Natalie Rochester is an OB-GYN and medical director of the UCHealth Greeley Hospital Birth Center. She has practiced medicine in Colorado for the past seven years, and is also a mother of two girls.
Pregnancy-related coronavirus information from the CDC is limited. But Rochester is advising her patients to treat COVID-19 similarly to other viruses, such as the seasonal flu, and take the same precautions to prevent it.
These precautions include:
Wash your hands frequently with soap and water. Wash for at least 20 seconds before you eat, after you sneeze and after using the bathroom.
Use alcohol-based hand sanitizers in addition to hand-washing.
Regularly clean surfaces like counters and your mobile phone.
Avoid community candy jars, and be careful at buffets, where many people touch surfaces or utensils.
Sneeze and cough into a sleeve rather than into your hand or the air.
Avoid contact with anyone with cold or flu symptoms.
Stay home from work or school if you are sick.
If you’re sick or immunocompromised, avoid places with large numbers of people.
Rochester said she got great advice from a physician when she had some preterm pregnancy complications. She now shares this advice regularly with patients, especially now as the new coronavirus has started to spread across the United States, and more recently, in Colorado.
“He encouraged me as a patient to practice no-regrets medicine,” she said. “If you don’t do something, will you regret it? We all must continue to live life and care for our families, however we must make smart decisions. Keeping ourselves and our family safe is important.”
Am I more susceptible to the coronavirus because I’m pregnant?
Coronavirus is a family of viruses that can cause respiratory symptoms similar to the common cold and seasonal flu. Symptoms range from mild to severe. COVID-19 is the name given to the disease caused by this year’s outbreak of a new strain of coronavirus.
“Most people who develop coronovirus have mild symptoms and do not need to be hospitalized,” Rochester said.
The new coronavirus spreads from person to person. According to the CDC, the virus appears to spread:
Between people who are in close contact with one another (within about 6 feet).
Via respiratory droplets produced when an infected person coughs or sneezes.
When droplets land in the mouths or noses of people nearby or are, possibly, inhaled into the lungs.
During pregnancy, women experience changes within their bodies that might make them more susceptible to viral respiratory infections, and this could include COVID-19, Rochester said.
“Pregnant women should continue to manage their pregnancy using the same preventive actions they always would to stay healthy, such as washing their hands and staying away from people who are sick,” she said.
For now, public health officials at the CDC are advising against travel to China, South Korea, Iran and parts of Italy and Japan.
However, women need to assess their risk for traveling any time they are pregnant.
“During pregnancy we recommend not flying after 36 weeks (gestation),” Rochester said.
(Learn more about traveling and the coronavirus.)
But at this time, she’s advising pregnant women not to travel if they are sick, and “to avoid sick passengers, but know that during air travel you cannot limit or determine the wellness of those near you.”
Car travel can lead to few exposures to sick people than air travel.
Are there risks from COVID-19 for unborn children?
Rochester said the evidence is not yet clear on whether the unborn child will be affected, so staying as healthy as possible is best.
“As always, practice good hygiene,” she said. “Covering your mouth and nose with a sneeze or cough, and washing your hands are important. And traveling to countries that are highlighted on the CDC high risk areas is not recommended during pregnancy.”
What should I do if I start feeling flu-like symptoms during my pregnancy? Could it be COVID-19?
The CDC estimates that influenza (seasonal flu) has resulted in between 9 and 45 million illnesses, between 140,000 and 810,000 hospitalizations, and between 12,000 and 61,000 deaths annually since 2010.
Reported COVID-19 illnesses have ranged from mild symptoms to severe illness and death. Symptoms include fever, cough and shortness of breath.
So, it’s entirely possible that someone with respiratory symptoms has the seasonal flu and not COVID-19. Either way, high fever during the first trimester can increase certain birth defects. And it is known that other respiratory viral infections during pregnancy, such as the flu, have been associated with outcomes such as low birth weight and preterm birth, according to the CDC.
“If you’re feeling sick, low-sugar hydration (such as water) is very important,” Rochester said. “You know you’re well hydrated when your urine is a light yellow color.”
She said that it is OK for pregnant women to take Tylenol (not aspirin or ibuprofen) if they have a fever of 100.4 degrees or higher.
“If you’re drinking lots of fluids and have taken Tylenol but you’re not able to keep your fever down, or you’re vomiting or have other symptoms such as difficulty breathing, then we’d want you to call your health care provider immediately,” she said.
During the call, your health care provider can help advise you as to where and when you should be evaluated by a health care provider.
What will happen if I show up at the hospital pregnant and with COVID-19 symptoms?
First, anyone with mild symptoms is asked to call their provider or clinic before they arrive, Rochester said.
“We will have questions about their symptoms and how far along they are in pregnancy to determine next best steps,” she said. “Sometimes we may have you stay home, and sometimes we may ask you to come into the hospital. But we will do a prescreen to reduce the risk of you coming in and being exposed to other things when it’s not necessary.”
The Colorado Department of Public Health and Environment is now running tests locally to determine if patients have COVID-19. Results are coming back within about 24 hours. If a person tests positive, the results are sent to the Centers for Disease Control and Prevention for confirmation.
Tests are not available for everyone at this time. For now, providers are testing people — pregnant or not — who have symptoms consistent with COVID-19 — including fever, cough and shortness of breath — who also have recently traveled to areas where there have been outbreaks. Health workers who have been exposed to people who have tested positive for COVID-19 are also being tested. In addition, patients who have been hospitalized with illnesses like pneumonia and other symptoms consistent with COVID-19 are being tested when there’s not another explanation for their illness, like a positive test for influenza.
How far along a woman is in her pregnancy, as well as severity in symptoms, will determine where she would be sent if she tests positive for COVID-19, Rochester said. When a mother is admitted, she may be placed in a special isolation room on the labor floor or within another unit.
“Providers and staff will wear protective garments when entering and will remove those garments and wash when exiting the room to help limit the spread of the virus,” she said. “And depending on gestational age of pregnancy, the patient may also undergo fetal monitoring.”
If I get coronavirus while pregnant, can it be passed to my unborn child? Could it hurt my unborn child?
“We have no affirmative information telling us that COVID-19 has a negative effect on babies delivered to mothers with the virus,” Rochester said, and refers to the information updated daily from the CDC.
According to the CDC, the virus that causes COVID-19 is thought to spread mostly through close contact with an infected person, via respiratory droplets. And public health officials still don’t know whether a pregnant woman with COVID-19 can transmit the virus to her child before, during or after delivery.
However, in limited recent case studies of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for the virus that causes COVID-19, according to the CDC. Additionally, virus was not detected in samples of amniotic fluid or breast milk.
And at this time, there is no information on long-term health effects on infants either with COVID-19, or those exposed in utero to the virus that causes COVID-19.
“The CDC is obtaining more data daily on this,” Rochester said. “There is some question as to isolating baby from mom after delivery. Currently, we are evaluating if this is absolutely needed. Moms are currently encouraged to continue breastfeeding. If the pediatrician feels separating baby and mother is appropriate, then the mother is allowed to either breastfeed, with gloves and a mask, or pump milk for the baby.”
Currently, cases reported in China show no transmission of the coronavirus to baby from mom, but those cases are limited, she added.
Is my newborn more susceptible to the coronavirus?
There is no data on newborns, Rochester said, so she leans on the side of caution.
“Newborns are fragile and have undeveloped immune systems, but they are also born with antibodies from mom,” she said. “I would not recommend taking a newborn out in the community until this (outbreak) has resolved.”
But if you must take your newborn out, Rochester said to consider using a car seat cover that completely covers the car seat, usually resting over the handle. This not only helps keep germs out, but it also keeps away passersby who want to gawk at (and possibly touch) your cute little one.
Consider grocery and food delivery services, as well as other options that can limit your exposure to public places and groups of people.
“As parents, we are the protectors of our children,” Rochester said. “It is totally acceptable to ask people to wash their hands or to limit guests the first month or two (after birth) to allow for bonding.”
She said you can always use your doctor as the “bad guy,” telling friends, family or neighbors that your physician recommended you limit guests and your baby’s exposure to outside people.
“Mandate people to wash their hands and don’t come in when they are sick,” she stressed.
If I get the coronavirus, should I be breastfeeding or giving my child my breast milk?
There is no concrete guidance yet about a woman with coronavirus delivering and then breastfeeding, Rochester said. But there is also no evidence that coronavirus is passed on through breast milk.
“Breastfeeding is recommended, as babies receive antibodies,” she said. “Whether a mom pumps milk or does breastfeeding would be based on discussion with the pediatrician and mother prior to birth.
“As more is learned about the virus, the recommendations are changing.”
What if I’m pregnant and work somewhere like a hospital. Should I be concerned?
Pregnant workers should be taking the same precautions all workers are to limit their exposure to illnesses.
“Use standard precautions: washing hands and avoiding people who are sick,” Rochester said. “If you work in a health care setting and you care for sick people, you need to be extra diligent.”
Pregnant health care workers, as with all health care workers, should follow risk assessment and infection control guidelines when exposed to patients with suspected or confirmed COVID-19, according to the CDC.
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