There’s conflicting evidence about whether pregnant women infected with the new coronavirus pass the disease to their babies.
It can possibly happen, though it's unclear whether this transmission occurs in the womb, according to a small study, published in JAMA Pediatrics on March 26. It found that of 33 women in China who were confirmed to have the coronavirus while pregnant, three gave birth to newborns who were then diagnosed with the virus. All three infants recovered.
The data at this point are "not conclusive and do not prove in utero transmission," an accompanying editorial said.
In a previous small study, published March 16 in Frontiers in Pediatrics, Chinese researchers followed four pregnant women who tested positive for COVID-19 in Wuhan, China — where the outbreak first began — who gave birth to full-term infants.
None of the three infants whose parents gave consent for them to be checked for the illness tested positive for the virus. None of the four babies developed fever, cough, diarrhea or any other serious symptoms, and all were alive when they were discharged from the hospital.
“All of the four babies are doing well and have been formula feeding since birth,” the study authors wrote.
Another small study of women diagnosed with COVID-19 late in their pregnancies in Wuhan, published in February in The Lancet, found no evidence of the virus in samples of amniotic fluid, umbilical cord blood and breast milk from six moms, and throat swabs from six babies.
U.S. public health officials still don’t have a definitive answer as to whether a pregnant woman with COVID-19 can pass the virus to her baby during pregnancy, delivery or breastfeeding, or if the disease poses a risk to the fetus, according to the Centers for Disease Control and Prevention.
There currently are no recommendations about how COVID-19 should be evaluated or managed specifically in pregnant women, the American College of Obstetricians and Gynecologists noted.
In a practice advisory issued Friday, ACOG said even though pregnant women don't seem to be at increased risk for COVID-19, they should still be considered an at-risk population given that other respiratory infections like the flu can pose a danger to them.
OB-GYNs should offer telehealth appointments as much as possible and be aware they may face “a decreased health care workforce, potential shortage of personal protective equipment, limited isolation rooms,” the advisory cautioned.
Meanwhile, maternity wards across the U.S. are adding precautions to keep expectant mothers safe as the coronavirus outbreak grows.
Hospitals including Jefferson Health in Philadelphia and UC San Diego Health in California are suspending tours of their facilities. Many now require patients to undergo risk assessment screening before entry, including whether they are coughing or have a fever. Hospitals are also reassuring patients that anyone with COVID-19 will be treated in a separate area of the building designated for this type of care.
Dr. Iffath Hoskins, an OB-GYN at NYU Langone Medical Center in New York, said the facility has restricted the number of people who can enter the maternity ward. In the past, a woman may have brought her husband and a doula with her, but now, visitors are restricted to one support person per pregnant patient. Many other hospitals are implementing a similar policy.
“The patients are clearly very concerned — every mother is concerned for her fetus,” Hoskins, the chairwoman for ACOG in New York, told TODAY.
“We know that pregnant women have decreased immunity so we’re very, very careful with these patients through the pregnancy. But it is a wonderful opportunity to tell everybody you have a much higher chance of getting the flu, so make sure you take the flu precautions first before you do anything else.”
The flu vaccine is safe to get at any time during the pregnancy, but only one-third of pregnant women get it, Hoskins said. She encouraged those who haven’t yet been vaccinated to seek out the flu shot now to rule out influenza if they develop any respiratory symptoms.
“Every cough is not coronavirus,” she noted. It could be the flu or an allergy.
Hoskins hasn’t seen any shortage of staff, medical supplies or beds in maternity wards. But concern about the outbreak looms large for doctors. For example, Hoskins’ colleagues were recently scrambling to figure out why a patient suddenly developed a fever — “Could it be related to the coronavirus?” they worried.
But it turned out the woman had been given a medication designed to make the uterus contract. One of the side-effects is fever, which caused extra alarms during the pandemic.
“When a patient comes in, the minute she coughs, everybody’s eyes get really wide,” Hoskins said of the underlying tension in the maternity ward.
“Pregnant women are in a high-risk category because their immune system is lower and there are two patients: the mother and the fetus.”
Doctors are also worried about how they’ll cover for each other in the event physicians get sick themselves, but they’re ready to pitch in as best they can, she added.
Expectant moms “should feel very reassured the entire medical system all over the country is very geared towards keeping every single patient as safe and healthy as possible,” Hoskins said.
She urged pregnant women to wash their hands often, not touch their face and practice social distancing when going for prenatal visits, ultrasound and lab testing. It's a good idea to book medical appointments at less busy times and sit at least six feet away from others in the waiting room.
"Be very careful, be sensible," Hoskins urged.