How Does Coronavirus Affect Pregnancy?

As of March 16, there are nearly 3,000 cases of the novel coronavirus known as Covid-19 in the United States. Georgia has 99 confirmed cases—a figure that has doubled nearly every day, suggesting that the virus may soon spread to millions. Epidemiologists have advised people across the nation to stay home, limit outings, minimize social contact, and practice aggressive handwashing to help flatten the curve and avoid overwhelming medical resources. So how is this virus affecting pregnant people? The truth is that we don’t know much. Though many websites make confident assertions that the virus is no more severe in pregnant people or that there are no special risks to people giving birth, we simply don’t have the data to support that claim. Here’s what we know for sure.

Are pregnant people more likely to get coronavirus?

We don’t know. What we do know is that the coronavirus is highly, highly contagious. A new study has found that it can live on plastic, stainless steel, and other hard surfaces for many days, and can live on cardboard for a day or longer. It remains in the air up to several hours after a person sneezes or coughs. This means that anyone who either comes into contact with someone who has the disease or with any surface that person has touched has a chance of getting the illness. And because most people do not have symptoms in the early days of illness, they can shed the virus for days or weeks. It also produces less severe symptoms in many people, most notably children. The “just a cough” or “just a cold” your child or little cousin has could be lethal to some people.

Data from China suggest that adults over the age of 30 are more likely to get coronavirus, and that elderly and disabled people are significantly more likely to get it. This could be because they have weaker immune systems. It could also be because they are more likely to get severe enough symptoms to go to the hospital. This skews the data such that younger people may never even know if they have the virus.

So what does this mean for pregnant people? There is no compelling evidence indicating that pregnant people are more likely to get the virus. If, however, you have a child—and especially if that child goes to school or daycare—you may have more opportunities for exposure.

The immune system changes during pregnancy. Some research shows that pregnant women may be more vulnerable to certain infections. They may also be more vulnerable to the sort of immune system overreactions that can cause the most serious complications of covid-19. There is no data on this point that has specifically looked at coronavirus. However, given what we know about pregnancy and immunity, it is reasonable to assume that a pregnant person exposed to the disease may be more likely to get it than a non-pregnant person.

Is coronavirus more dangerous for pregnant people?

Maybe. Previous research on related infections suggests they may increase the risk of preterm birth, miscarriage, maternal renal failure, and other complications. A small study that looked at nine pregnant people with the virus found that their babies did as well as, or better than, the babies of people without the disease. Coronavirus-related complications were not higher in this group of mothers, and there were no serious complication in the group of nine. However, all of the women gave birth via c-section. The study does not clarify why this happened. It is possible that doctors may urge pregnant people with the virus to choose surgical birth.

Because this disease is so new and the limited number of studies have been so small, we just don’t know how coronavirus might affect pregnant people. We do know that pregnant women are more vulnerable to cardiovascular and respiratory problems, as well as diabetes, even if they are otherwise healthy. Pregnancy-related health conditions, especially if they are not well-managed, may increase the risk of complications.

Can I give coronavirus to my baby?

Yes. The disease can be transmitted to babies in the same way it transmits to adults—by contact with secretions from the nose, mouth, and maybe the eyes. Because mothers and their babies are in close contact, the risk of transmission is fairly high. The good news is that, so far, young people have lower rates of infection and no one under the age of 9 has died from the virus. That doesn’t mean the disease is safe, especially for newborns and premature infants. So parents must engage in diligent hygiene to avoid spreading the virus.

The benefits of contact between a mother and infant exist even when the mother is sick. For now, there is no evidence suggesting babies should be separated from mothers with coronavirus. Indeed, doing so may be harmful.

Can my baby get coronavirus in the womb?

UPDATED 4/22/20:

Probably not. Media sources continue to report alarming stories of babies who may have gotten the disease in the womb. These stories are not well-researched, and not rooted in scientific data. Only a few studies have assessed for the possibility of vertical transmission—transmission to the baby in the womb—and none have found evidence supporting it. Here’s where we are with the data:

• A small study of nine women tested for vertical transmission, though it looked at just nine women, offering little certainty. None of the women in the study transmitted the disease to their babies. Data on similar illnesses, including the flu and common cold, shows that vertical transmission is either rare or nonexistent. So it’s very unlikely that a developing baby can get this disease.

• A 2020 systematic review that analyzed all COVID-19 cases during pregnancy to date found no evidence of a baby getting the disease in utero.

• A study of 38 pregnant people with COVID-19 found that none of them transmitted the disease to their babies in utero.

• No studies have found evidence of COVID-19 in amniotic fluid or the placenta.

• A 2020 case report—not a study or systematic review—identifies the earliest onset of COVID-19 in a newborn. The newborn tested positive 16 hours after birth. Although the study’s authors expressed concerns about possible vertical transmission, the study did not directly assess whether the baby got the disease in utero.

It’s important to emphasize that this is a new disease, and there’s a lot we don’t know. There are isolated cases of the flu and other viruses passing from mother to baby during pregnancy, but this is very rare. If COVID-19 can be transmitted during pregnancy, it is likely similarly rare. For now, though, there is no evidence of vertical transmission.

Cases in which a newborn has COVID-19 do not mean the baby got the disease during pregnancy. So far, all cases in which a newborn had the disease have involved a newborn whom doctors tested shortly after birth. It is likely that the baby caught the disease from the mother or a health worker shortly after birth, producing a positive test. In most cases, the babies who tested positive for the disease did not yet have symptoms.

Mothers with COVID-19 should be very cautious when holding their babies. And just like everyone else, pregnant women should avoid going out in public as much as possible. This is the best strategy for reducing the risk of getting the disease, thereby also reducing the risk of transmitting it to the baby.

Can I still breastfeed?

We think so. So far, only one study has tested breastmilk for coronavirus. That study only looked at six samples. And while all were negative, this is not enough data on which to base medical recommendations. Breastmilk is rich in antibodies that help keep babies healthy. Mothers should consult a physician who is knowledgeable about and supportive of breastfeeding for advice. Without compelling evidence to the contrary, though, it’s wise to continue breastfeeding if you want to. Parents who are concerned about transmitting the disease via breastmilk should consider pumping and dumping until they are no longer contagious—usually about 2 weeks after symptoms appear. This can preserve the possibility of breastfeeding when the infection clears.

Uncertainty is always scary, but especially when you’re pregnant. The Georgia Birth Advocacy Coalition will continue posting new information and data on our Facebook page and blog. Follow GBAC to stay up to date.