Pregnancy: COVID-19 Frequently Asked Questions

Every day we learn more about COVID-19. We are now also gaining knowledge of COVID in pregnancy from obstetrical caregivers across Canada as well as within the Maritime provinces. We see that most women with COVID in pregnancy will have a mild illness and carry on as usual with their pregnancy.

This is a summary of what we understand at this time.

Pregnancy does not seem to increase a woman’s chances of becoming infected.

We recommend that pregnant women follow the same practices as other adults to prevent infection: practice physical distancing, wash hands often with soap and water, avoid touching your face, cough or sneeze into your elbow rather than your hands, avoid others who are unwell, and stay home when you are sick.

Are you concerned about a possible COVID-19 exposure or infection during pregnancy?

• DO NOT attend your regular prenatal appointment or the Labour and Delivery Department for care.
• You should call 811 or your health care provider for direction. 
• If your symptoms are severe, call 911 and provide relevant travel or exposure history to dispatch. 

Pregnant women should practice physical distancing while working.

We recommend that pregnant women discuss with their employers whether they can work from home or otherwise modify their work duties to limit public exposure. This may be especially important if a pregnant woman has other underlying health concerns.

Health care professionals (HCP) who have received appropriate PPE and training may continue to work. Wherever possible, however, HCP who are pregnant should avoid providing care for persons with COVID-19 as well as avoiding areas where aerosol-generating procedures occur. It is recognized that repeated exposures to COVID-19 may increase the risk of transmission for all HCP. 

Pregnancy does not appear to increase the chance of serious complications such as pneumonia or sepsis should infection occur.

The majority of pregnant women who become ill can expect to have only mild to moderate cold or flu symptoms such as fever, dry cough, sore throat, headache or gastrointestinal symptoms. Women with underlying health problems, as well as pregnancy, may become more unwell with this infection. If more severe symptoms such as shortness of breath or difficulty breathing are present, these should be treated promptly.

The best way to take care of the fetus is to take care of the mother! 

Many medications and tests can be used in a way that is safe for both mom and baby.

• Acetominophen (Tylenol) can usually be used in pregnancy if a woman is otherwise healthy and can help with fever, sore throat and other pain. 
• Anti-inflammatories (Advil, Aleve, Ibuprofen, etc.) are generally to be avoided in pregnancy.
• It is important to drink well and stay hydrated in pregnancy.

Infection does not appear to pass from the mother to the baby in utero (called vertical transmission).

There is no strong evidence that vertical transmission of COVID-19 occurs. Viral particles have not been found in the amniotic fluid, placenta or cord blood. If an infection does not pass to the baby on the inside, then it is unlikely that the infection can cause birth defects to occur.

Infection does not appear to cause early pregnancy loss or miscarriage, although the chance of preterm birth may be higher in the setting of active illness. 

Preterm delivery has been noted in some of the reported cases. There is increasing evidence that this may have happened out of concern for the mother and baby rather than actual illness before we understood as much as we now do about this disease.

Self-Isolation and Pregnancy

If you are pregnant and self-isolating due to a COVID-19 infection, call your provider for further instructions. 

An otherwise-normal, low-risk pregnancy may not require a follow up, and special arrangements may be made if an appointment is necessary before then. 

Ultrasound(s) for fetal growth and well-being may be recommended after the resolution of the illness.

How will COVID-19 affect my prenatal office appointments?

You may notice that your prenatal care has been transitioned earlier than usual to an OBGYN. This is to allow our family medicine and nurse practitioner colleagues time to concentrate on other health issues while your care continues.

Prenatal appointments may either be booked as usual or perhaps spaced out or even provided by telephone to allow you to continue physical distancing. To further minimize the gathering of many individuals, for routine appointments, you may be allowed to have one person attend with you. Please call ahead if you have questions about who can accompany you to a prenatal appointment. Changes to your visit schedule will be decided in a safe manner according to expert guidance as the situation unfolds.

Delivery

Both vaginal and cesarean deliveries are acceptable methods of delivery.

The type of delivery recommended by your care provider will be based on your own personal situation and not on the basis of infection alone. Delivery will not always have to occur simply because of a COVID-19 infection. The majority of deliveries in women with COVID-19 infections in published reports have been by cesarean section; however, as we learn more about this disease, more safe vaginal deliveries are being reported.

Delivery is recommended in a hospital setting rather than at home.

This will allow for the appropriate monitoring of both mother and baby. There may be a higher chance that babies will show heart rate abnormalities if the mother is ill with COVID-19, and timely intervention may be necessary.

Early epidural may be recommended.

Experts agree that it is important to limit the airborne spread of the virus by trying to avoid situations where general anesthesia is necessary. A timely epidural can help with this.

Breastfeeding may be considered.

The virus has not yet been found in breast milk, although the number of cases is small; therefore, the many benefits of breastfeeding may outweigh the risks to the newborn. 

If breastfeeding is chosen, care should be taken to prevent transmission of COVID-19 to the newborn through close contact with the infected mother (i.e. good hand hygiene, use of a facemask, feeding of expressed milk by the healthy caregiver). 

Consideration may also be given to establishing and/or maintaining your milk supply to ensure the success of feeding once the illness has resolved.

How will COVID-19 affect my hospital visit/stay?

We are working hard at both the QEH and PCH to continue to provide good quality care to families. Just as in the office, we have a screening process in place to be sure that everyone is treated with the care they require. For routine appointments, you may be allowed to have one person attend with you. Please call ahead if you have questions about who can accompany you to a prenatal appointment. 

When you are in labour, you may have up to two support persons with you. The hospital staff will complete a COVID-19 screening on the support persons.  We understand the importance of having a loved one with you at this time. We are encouraging women and their partners to think ahead about their physical distancing practices in the time leading up to their due date to try to keep illness (i.e. from travel) from limiting participation in the big day.

Movement around the hospital may be fairly limited, so please consider this while packing - your support person may wish to bring extra clothes, toiletries, food, snacks, own medications etc. for their comfort and well-being. And don’t forget your cameras, cellphones and charging cables. As always, we know lots of people are waiting to meet your new baby!

You may find that you wish to be discharged early from the hospital following delivery. Arrangements are being made to provide support for new moms and their babies in the community to safely allow you to go home early.

I am pregnant and/or breastfeeding, should I be vaccinated? 

The Society of Obstetricians and Gynaecologists of Canada state that, "Women who are pregnant or breastfeeding should be offered vaccination at any time during pregnancy if they are eligible and no contraindications exist."

Pregnant and breastfeeding women may want to contact their prenatal care provider to assist in making decisions weighing the risks and benefits so that they might arrive at a well informed decision that is right for them as an individual.

For more details, read the SOGC Statement on COVID-19 Vaccination in Pregnancy and Breastfeeding.

Information in this area is changing rapidly and this advice may continue to change as more becomes known.