Many readers have submitted questions to the Globe regarding possible risks to pregnant women amid the coronavirus pandemic. Here’s some guidance from the Centers for Disease Control and Prevention.
According to an advisory posted to the CDC website, researchers currently don’t know whether pregnant women are at a greater risk of contracting the virus or related serious illness.
“Pregnant women experience changes in their bodies that may increase their risk of some infections,” the advisory says. “With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness.”
The advisory says researchers currently don’t know whether infected mothers can pass the virus to their unborn children, but the Guardian newspaper reported Monday that a newborn baby in the UK has tested positive. The mother tested positive at North Middlesex hospital in the UK, and results came through after the birth, the newspaper reported. The baby was tested for Covid-19 minutes after being born, according to the Guardian report.
“No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus,” the CDC notice says. “In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.”
The CDC says there have been a “small number” of reported problems with pregnancy and delivery, such as pre-term birth, for mothers who tested positive, but “it is not clear that these outcomes were related to maternal infection.”
In fact, it’s not clear if any problems for newborns can be directly traced to a mothers’ coronavirus diagnoses.
“We do not know at this time if COVID-19 would cause problems during pregnancy or affect the health of the baby after birth,” the advisory says.
In addition, the CDC has provided guidelines for breastfeeding.
“A mother with confirmed COVID-19 or who is a symptomatic [person under investigation] should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast,” the notice says.
If using a manual or electric breast pump, the advisory says, “the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.”
The CDC says that in “limited studies” of infected mothers, the virus hasn’t been detected in breast milk. However, the agency cautions, “we do not know whether mothers with COVID-19 can transmit the virus via breast milk.”
In a joint statement, Dr. Christina Yarrington of Boston Medical Center’s department of obstetrics and gynecology and Dr. Cassandra Pierre from the hospital’s department of infectious diseases offered additional guidance.
They said being pregnant “does not appear to confer the increased risk of complications [from the virus] the way that heart disease, immunosuppression, and being over 60 years old does.”
Regarding the issue of infected mothers passing the virus to their unborn children, the BMC doctors said that “limited publications about neonatal infection suggest there is virtually no risk of in utero transmission. There are several small published case series out of China that suggest it is not transmitted during pregnancy - there was no virus found in the placenta, amniotic fluid or nasal swabs of the newborn. However there are a couple reports of babies being diagnosed in the first days of life so it is definitely possible that exposure at delivery could lead to infection.”
In addition, Yarrington and Pierre said the CDC has advised labor and delivery units to separate newborns from mothers known to be or suspected of being infected with the virus.
“It is a heart breaking idea for a new mom but there’s no question it is what is safest for her baby,” the doctors said.
They also addressed the question of whether women should delay trying to get pregnant amid the pandemic.
“The timing of pregnancy is an extremely personal decision,” the statement said. “We all have an array of new stressors in our lives right now that may change how we make such decisions. The little data we have about COVID-19 infection across the trimesters suggests a possible increased rate of miscarriage among some women but also subsequent healthy (uninfected!) babies born at term.”
Much of their advice was echoed by Dr. Kathy Diouf, associate obstetrician gynecologist at Brigham and Women’s Hospital.
In a separate statement, Diouf said that based on the medical community’s knowledge of other viruses including SARS and H1N1, pregnant women are at an increased risk of severe illness from respiratory conditions such as severe pneumonia due to physiologic changes during pregnancy.
“However, the data we have so far on COVID indicates that pregnant women do not appear to be more severely ill than the general population with the virus. It is expected that the majority will have mild or moderate flu like symptoms,” Diouf said. “Pregnant women should follow the regular precautions recommended by the CDC: wash hands, observe social distancing, etc.”
Diouf also said pregnant women do not appear to be more severely ill than the rest of the population with the virus.
“There is no evidence of transmission from mother to child of the virus in the womb based on a small series of pregnant women from China: the virus was not found in the amniotic fluid or the cord blood,” she said. “Some babies born to women with COVID were born prematurely, but it is not clear if these premature births were related to the COVID infection. There is some concern that fevers during early pregnancy could lead to birth defects but there is no information specifically related to COVID.”