Coronavirus and Pregnancy

Coronavirus (COVID-19) has a large portion of the population very worried, including all our #TTC and pregnant patients. But how worried should you really be if you’re pregnant or trying to get pregnant?

By Dr. Mare Mbaye

Updated 2/28/20

**Please realize answers to these questions may change as we learn more about COVID-19. Please see an update to this blog post here. 

Coronavirus (COVID-19) has got a large portion of the population very worried, including all our #TTC and pregnant patients. But how worried should you really be if you’re pregnant or trying to get pregnant?

The basics on coronavirus

Well let’s cover the coronavirus basics first. Coronaviruses are viruses in the same family as the common cold. They’re named for the crown-like spikes on their surface. Human coronaviruses were first identified in the mid-60s. There are seven coronaviruses in total that can infect people, four of them are human coronaviruses and three of them were once animal coronaviruses that evolved and became able to infect humans. The specific strain that we are currently dealing with is one of the animal-to-human ones, known as the coronavirus disease 2019 (COVID-19) or SARS-CoV 2.

It’s not likely to kill you: most cases of COVID-19 are mild with about 80% only causing cold symptoms.

The bottom line with this virus? It’s not likely to kill you: most cases of COVID-19 are mild with about 80% only causing cold symptoms. Another 14% of cases are severe and approximately 6% are considered critical.

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There’s plenty of people out there comparing coronavirus and the flu, and while it IS true that by the numbers the flu has been much more fatal, coronavirus actually has a significantly higher mortality rate. The flu’s mortality rate this season has been 0.1% while COVID-19’s mortality rate is somewhere between 2-4% (yes that’s at least 20x higher). This is still a much lower mortality rate than any of the SARS viruses, but it’s nothing to sneeze at it (no pun intended).

So bottom line, as long as COVID-19 remains contained, it’s of low risk to the general population, especially here in the US where there hasn’t been an outbreak (as of the publishing of this article).

This then begs the question: how does coronavirus spread, and how can we mitigate it? So far it looks like COVID-19 spreads essentially like the flu, meaning person-to-person via respiratory droplets. These can travel up to 6 feet from someone who is sneezing or coughing. Close contact with an infectious person, like shaking hands or touching a doorknob, tabletop, or other surfaces touched by an infectious person, and then touching your nose, eyes, or mouth can also transmit the virus. There’s no definitive data yet on how​ long​ COVID-19 survives on surfaces, but based on other coronaviruses​, it might be up to two days at room temperature. Research is ongoing to see if the virus is also airborne (meaning it could be transmitted by circulating in the air like measles).

Coronavirus and pregnancy

Now let’s talk about coronavirus and pregnancy. We already know that pregnancy is a state of immunosuppression, which means pregnant women might be more susceptible to viral respiratory infections, including coronaviruses.

When it comes to coronavirus though, we really don’t have a lot of data—there simply hasn’t been enough time to study it through an entire pregnancy. We therefore don’t have information on adverse pregnancy outcomes if a mom is infected, but some information can be extrapolated from other similar viruses.

Fetal anomalies, miscarriage, and stillbirth are outcomes that have been seen in pregnant women with other viruses during pregnancy, but this hasn’t been seen thus far with COVID-19, and there have been no cases of infants acquiring the virus from their mothers during pregnancy or delivery. Additionally, coronavirus has not been detected in samples of amniotic fluid or breast milk; however, it’s still not known whether mothers with COVID-19 can transmit the virus via breast milk.

One new study in the Lancet found pneumonia due to COVID-19 in third-trimester pregnant women is similar to those reported for adults who are not pregnant. It was a small sample, but the investigators reported that all of the nine babies born to women with COVID-19 tested negative for the virus. The author noted, “It appears that the transmission routes do not include amniotic fluid, cord blood, or breast milk, all of which may be routes for a vertical transmission.”

This is all reassuring information, but coronavirus is still an infection that we want to prevent from spreading, and the U.S. Centers for Disease Control (CDC) has some specific tips to share on that front:

• Avoid all nonessential travel to China and South Korea, and now Italy, Iran, and Japan (as of the publishing of this article). We recommend checking the CDC regularly for updates.
• Pregnant women, and everyone else, should engage in the usual preventive actions to avoid infection including:
• Stay home when you have respiratory symptoms (though the flu or another respiratory virus is more likely to be the cause, it’s better to be safe).
• Cover coughs and sneezes preferably with a tissue, then throw it away.
• Wash hands often with soap and water for at least 20 seconds—especially after going to the bathroom, before eating, after blowing your nose, coughing, or sneezing.
• If there’s no soap or water readily available, use an alcohol-based hand sanitizer with 60-95% alcohol.
• Make sure to clean frequently touched surfaces and objects.

Notice there’s no mention of face masks—this is because masks only help people who already have an infection from spreading it. They don’t actually protect you ​from​ being infected, however, so I wouldn’t waste the money. Instead, stock up on hand sanitizer and disinfectant wipes.

For more information, check out the ​World Health Organization​ and the ​U.S. Centers for Disease Control​ (where most of the information in this article is from). More information is coming out all the time, so stay informed, and keep those hands clean!

Image by Yan Krukov