In the last week, there’s been a rapid increase in the number of cases of COVID-19. On Monday, the World Health Organization’s (WHO) Director-General Tedros Adhanom Ghebreyesus called the pandemic, “The defining global health crisis of our time,” emphasizing the need for testing of all suspected cases. WHO has issued coronavirus pregnancy guidelines. Here’s what pregnant women need to know.
Consideration for Specialized Care for Pregnant Women
It is possible to have the disease and not have any symptoms. WHO advises that all women who have had contact with someone who has COVID-19 should be monitored. “Pregnant women with suspected, probable, or confirmed COVID-19, including women who may need to spend time in isolation, should have access to woman-centered, respectful, skilled care, including obstetric, fetal medicine and neonatal care, as well as mental health and psychosocial support, with readiness to care for maternal and neonatal complications.”
There is very little data available on the clinical presentation of COVID-19 in pregnant women. To date, there has been no difference seen in the clinical presentation of pregnant with COVID-19 compared to women with the virus who are not pregnant. Despite this, WHO recommends testing pregnant women who are symptomatic should be a priority in order to provide them with access to specialized care.
The WHO guidance states, “There is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness.” However, there are immunologic and physiologic adaptations during and after pregnancy that need to be taken into consideration when pregnant women or women who have recently given birth are treated.
One physical adaptation is the recommended positioning of pregnant women with acute respiratory distress syndrome (ARDS). ARDS is one of the possible complications in severe cases of COVID-19. Non-pregnant patients with ARDS are positioned on their abdomen to help improve oxygen levels. WHO guidance states, “There is little evidence on prone positioning in pregnant women.” Their recommendation is that pregnant women be placed on their left side.
Testing of amniotic fluid, cord blood, vaginal discharge, neonatal throat swabs, or breastmilk has provided no evidence of transmission of the disease from a mother to her infant when infection occurs in the third trimester.
“All recently pregnant women with COVID-19 or who have recovered from COVID-19 should be provided with information and counseling on safe infant feeding and appropriate IPC measures to prevent COVID-19 virus transmission.”
Thorough hand-washing and social distancing are the best protections that pregnant women have in keeping themselves healthy.
The Coronavirus and Breastfeeding
Breastfeeding provides strong protection against infectious diseases. This virus has not been detected in breast milk. It has been recommended that an infected mother wear a mask when handling her infant. A woman who has been infected with COVID-19 is still considered contagious even if she no longer feels ill. Protective measures should continue for at least two weeks after symptoms disappear.
*Author Andrea Tran RN, MA, IBCLC is a nurse and lactation specialist.