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Coronavirus risk for pregnant women and babies


Anastasia Tsirtsakis


20/03/2020 12:24:37 PM

As the outbreak continues, expectant mothers have found themselves growing increasingly anxious.

Pregnant woman
Based on the limited data available, the impact of coronavirus on the majority of pregnant women has not been severe.

Due to physiological changes that occur in pregnancy, such as reduced lung function, increased oxygen consumption and changed immunity, pregnant women are potentially at increased risk of complications from respiratory disease.
 
However, unlike with influenza and varicella, which can be more severe in pregnant women, especially as the pregnancy advances, they do not appear to be more severely unwell than the general population when it comes to COVID-19.
 
‘It is expected that the large majority of pregnant women will experience only mild or moderate cold or-flu-like symptoms,’ the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) said in a statement, issued on 19 March.
 
In addition, there has been no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission of COVID-19.
 
While this is optimistic, Dr Wendy Burton, GP and Chair of the RACGP Antenatal/Postnatal Care Specific Interests network, told newsGP the fact the available data is insufficient remains a challenge.
 
There have been several studies in China looking at the impact of COVID-19 on pregnant women and their babies, but the cohorts have been small, one including nine women and the other just four.
 
‘Those numbers are way too small for us to give proper advice,’ Dr Burton said.
 
‘I think we need to err on the side of caution and proactively protect the pregnant women in our midst.’
 
Given there is currently no evidence that the virus is carried in breast milk, RANZCOG recommends women who wish to breastfeed their babies should be encouraged and supported to do so.
 
While it is not yet certain, Pat O’Brien, Vice President of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), told New Scientist that women who recover from COVID-19 before giving birth may develop antibodies against the virus and pass on some protection to their babies through their breast milk.
 
One possible concern highlighted by RANZCOG is the possibility of premature birth. Some babies born to women with symptoms of coronavirus in China were born prematurely; however it is currently unclear whether the virus was the causative factor, or whether it was determined to decided to deliver the baby early as a result of the woman being unwell.
 
Dr Burton says that this possibility makes the whooping cough vaccine (dTpa), administered from 20 weeks, particularly important.
 
‘Should it be that this is a cohort at increased risk of prematurity … we need to get that baby ready on the off chance that, if they are premature, then we’ve got some pertussis [antibodies],’ she said. ‘I will also be immunising all women for influenza as soon as possible’.’
 
Dr Burton stresses that it is particularly important for high-risk patients to have a dedicated time booked in for vaccines to be administered to ensure they are not sitting in the waiting room.
 
To reduce the risks of contracting coronavirus, RANZCOG has advised the following preventive measures for pregnant women:  

  • Handwashing regularly and frequently with an alcohol-based hand rub or soap and water 
  • Avoidance of anyone who is coughing and sneezing
  • Avoid touching eyes, nose and mouth
  • Social distancing and reducing general community exposure
  • Early reporting and investigation of symptoms
  • Prompt access to appropriate treatment and supportive measures if infection is significant
  • Avoid all non-essential overseas travel
When it comes to employment during this period, pregnant women should be reallocated to lower-risk duties, or have the opportunity to work from home or take a leave of absence.
 
RANZCOG has also issued recommendations for healthcare workers who are pregnant and on the frontline of the pandemic:
 
  • Allocated to patients and duties that have reduced exposure to patients with, or suspected to have, COVID-19
  • All personnel should observe strict hygiene protocols and have full access to personal protective equipment (PPE)
RANZCOG has encouraged public and private hospitals and private practitioners to pro-actively implement the following strategies in order to minimise risks posed to pregnant patients:
 
  • Reducing, postponing and/or increasing the interval between antenatal visits
  • Shortening the duration of antenatal visits
  • Using telehealth consultations as a replacement, or in addition, to routine visits
  • Avoiding face-to-face antenatal classes
  • Limiting visitors (partner only) while in hospital
  • Earlier discharge from hospital than would otherwise be planned
Dr Burton said the use of telehealth is particularly important up until 20 weeks’ gestation.
 
‘Usually, when we first meet a woman for her pregnancy we break that into two visits, so one for the pregnancy diagnosis and establishment discussion of testing and the second for review of the testing and referrals,’ she said.
 
‘I will be breaking that into one telehealth and one face-to-face.
 
‘I will be striving to keep all of my face-to-face interactions down to 15 minutes or less.’
 
To minimise time spent at a clinic or hospital setting after 20 weeks, Dr Burton suggests women weigh themselves at home, and take their own blood pressure by borrowing or buying a machine.
 
‘But we will need to measure the growth of the baby and listen for the baby’s heart, check on movements. So I think, like RANZCOG is thinking, space those appointments out,’ she said.
 
‘If the blood pressure is good and the weight is fine and baby’s moving, I’ll probably see women face-to-face no more than every four weeks, where we usually go to every three weeks and every two weeks.’
 
During a period of such uncertainty, it is natural that pregnant women may become increasingly anxious about their health and that of their unborn baby. These feelings may be heightened due to social distancing.
 
Dr Burton suggests referring patients to resources such as Head to Health and Smiling Mind, and highlighted the need to reframe the discussion to ‘healthy spacing’ and creating ways to stay connected.
 
‘We need to be contacting people, we need to be looking out for each other, we need to be talking to each other over the back fence, we need to be singing – join a virtual choir,’ she said.
 
‘We need to look out for one another because that’s how we’ll get through. It was the firefighters, now it’s the medical workers.
 
‘It’s our turn to do our nation proud.’


Recognising that healthcare resources and personnel will be limited during this period, RANZCOG has recommended the following gynaecological conditions merit Category 1 classification:
 
  • Assessment and treatment associated with gynaecological cancers
  • Early pregnancy assessment for risk of miscarriage and ectopic pregnancy
  • Timely access to abortion services, both medical and surgical
  • Acute pelvic pain, eg risk of ovarian torsion
Useful resources The RACGP has more information on coronavirus available on its website.

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