March 17, 2020

Coronavirus and pregnancy: what to know

by

A Vanderbilt maternal fetal specialist addresses coronavirus concerns during pregnancy.

As the novel coronavirus continues community spread across Middle Tennessee and beyond, we want to address concerns pregnant women may have. We spoke to Jennifer Thompson, M.D., Maternal Fetal Medicine specialist with the Vanderbilt University Medical Center Department of Obstetrics and Gynecology. Dr. Thompson is also a member of the Infectious Diseases Society for Obstetrics and Gynecology.

What do we know about COVID-19 in pregnant women?

Women experience normal changes in their bodies and immune system during pregnancy. As with other viruses, such as those in the coronavirus family or influenza, some women may become more susceptible to infection and at higher risk of developing severe illness. But because this is a novel strain, there is not enough data yet available to predict whether pregnant women may contract the virus at a higher rate than the general public, nor what the morbidity and mortality rates may look like.

How can pregnant women protect themselves and what should they do if they have symptoms?

Pregnant women can practice the same risk-reducing activities as the general population: cough etiquette, handwashing and social distancing. They should contact their OB-GYN offices if experiencing any new respiratory symptoms (new-onset cough or shortness of breath) or have a fever. Your OB-GYN office can assess your symptoms over the phone and refer you to the proper place for further screening, depending on how far along you are in your pregnancy and how severe your symptoms. Vanderbilt Center for Women’s Health clinical guidelines outline that pregnant patients may be referred to a specially-designated location for testing or the emergency room.

Pregnant women working in industries where the potential for exposure may be higher should take special care to rigidly follow the standard guidelines and may wish to seek reasonable accommodations from her employer.

According to the Society for Maternal Fetal Medicine, “Pregnant women who have severe chronic medical illnesses such as heart, lung, or kidney disease should follow the CDC precautions for those at higher risk of severe illness. This guidance includes general practices such as stocking up on supplies, taking everyday precautions to keep space between themselves and others when out in public, keeping away from others who are sick, limiting close contact, and frequent hand washing.”

Can COVID-19 harm a fetus or newborn?

“We have some very small case study data out of the China experience. What we know when you look back at other similar pandemics such as SARS and MERS, is that we don’t see evidence of vertical transmission,” Thompson said. “There’s no indication that if mom is sick (with COVID-19) that the virus will spread through the placenta to the fetus.”

In the case of the newborn who tested positive for COVID-19 in London, which drew much media attention, it is now believed the viral transmission occurred after birth, not while baby was in the womb.

Based on the limited data we have, we do not see an increased risk of birth defects or preterm delivery. The risk of miscarriage is not known to be directly affected by COVID-19.

Will my prenatal appointments change?

Currently, we are advising our pregnant patients to keep all regularly scheduled appointments with their providers. We are re-routing some patients from locations where symptomatic patients may be going seeking information or tests.

Some maternal fetal medicine appointments may be converted to telehealth in the near future and providers are currently determining which patients would be clinically eligible to see their provider remotely. Additionally, childbirth education, breastfeeding and newborn classes operated by Vanderbilt University Hospital and held at Monroe Carell Jr. Children’s Hospital at Vanderbilt are temporarily halted. You should have been contacted or will be contacted soon if you were enrolled in any of those classes through the end of April. Classes taught by the Vanderbilt University School of Nursing Midwifery Program will be taught online.

These recommendations are changing rapidly. If at any point, you feel uncomfortable or unsure, please call your provider’s office for guidance or use My Health at Vanderbilt to send a private message. Please be patient as call volumes and message are high. We are working to triage all of our patients’ needs and handle those requiring the most immediate attention first.

All OB patients must limit the number of individuals at their appointments. We allow one adult to accompany the patient to her appointments. Unfortunately, we cannot allow children under the age of 16, in accordance with our restricted visitation policy. Both mom and supportive partner must be screened at the front desk prior to every visit. Anyone exhibiting symptoms of coronavirus will have their appointment rescheduled and undergo further medical measures.

I’m due very soon; will my delivery experience change?

The Labor and Delivery unit and postpartum unit at Vanderbilt University Hospital have implemented a restricted visitation policy, subject to change as the situation evolves. We allow one adult to be present at the birth of the baby and accompany mom to postpartum. This should be the same adult for the entirety of the hospital stay. Our restricted visitation policy is different from that of other units, so please continue to check back for the most updated information.

We understand that the birth of your child is a special moment, yet our priority is the safety of our patients and staff, and limiting visitors is a clear way to help prevent further spread of COVID-19.

If you are a Vanderbilt OB patient but are planning a delivery at Maury Regional Medical Center, Williamson Medical Center or NorthCrest Medical Center, please call those hospitals directly or visit their websites for those visitation policies.

If a mother is positive for COVID-19 at the time of her delivery, we will proactively protect her newborn by temporarily distancing the child from the parent, bringing the two together as soon as clinically indicated. We will help mom express milk for the baby.

Will COVID-19 affect my ability to breastfeed?

There’s no way to know yet if this strain of coronavirus will limit a mother’s ability to breastfeed, and we do not have enough data to know if the virus can be transferred to the child through breastmilk. Breastfeeding with COVID-19 or similar viral infections is still recommended because the benefits outweigh the risks. In fact, breastmilk is scientifically proven to protect children against illness. Preventative measures to spread the virus through droplet transmission should be taken. Consider expressing milk and having another person feed the child, wash pump parts thoroughly with clean hands, and cover your cough.

The Vanderbilt University Medical Center Department of Obstetrics and Gynecology will continue to update its patients about concerns surrounding women’s health and the coronavirus. Additional resources about this subject may be found on the CDC website.

Tennesseans who have questions about COVID-19 should call the Coronavirus Public Information Line at (877) 857-2945. This line is available daily from 10 a.m.–10 p.m. (Central Time Zone). Note: Call volume may be high, so callers are urged to call again if getting a busy signal. For information for employees and patients of Vanderbilt University Medical Center, visit: https://vumc.org/coronavirus

Jennifer Thompson, M.D.

Jennifer Thompson, M.D., is an assistant professor and fellowship director in the Division of Maternal Fetal Medicine at Vanderbilt University Medical Center. Her clinical interests include improving medical and obstetric outcomes for women with congenital heart disease.