Dr. Mark Hyde discusses the risks and implications of the coronavirus outbreak for pregnant patients.
This blog post was originally published in April, 2020 and was updated in January, 2021 and again on March 25, 2021.
Pregnancy is one of the most exciting and meaningful times of your life. When you are faced with a pandemic at the same time, a whole new list of questions arises. We want to answer your most common questions and recommend precautions to ease your concerns so that you can focus on having a healthy pregnancy and safe delivery.
Are pregnant women more likely to contract COVID-19?
At this time, no evidence suggests pregnant women are more likely to contract COVID-19 than non-pregnant women.
Are pregnant women who contract COVID-19 at higher risk for severe illness or death?
Yes. According to the CDC, based on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks).
How can I tell if my symptoms are COVID-19 or normal discomforts of pregnancy?
The most common symptoms of COVID-19 are shortness of breath, cough, and fever. In addition, severe headache, fatigue, loss of the senses of taste and smell often occur.
Shortness of breath
Shortness of breath is also a common occurrence in the second and third trimesters of pregnancy as the uterus expands and pushes up into the diaphragm. This pushing can compress the lungs – which can make you feel like you’ve been doing strenuous exercise when you’ve only just walked up the stairs.
Increases in the hormone progesterone during pregnancy can also cause shortness of breath. High levels of progesterone cause pregnant women to breath more deeply and more often. Loss of residual capacity in the lungs also leads to a very common feeling of not being able to get a full breath, usually worsening around 25-30 weeks.
If you have severe shortness of breath (causing difficulty to speak in full sentences) or if it is accompanied by a fever of 100.4 and/or a cough, please call our office for more instructions. Stay isolated to prevent transmission to other people in case you have been infected.
While respiratory symptoms remain the most common, loss of appetite, abdominal pain, and diarrhea are symptoms of COVID-19 as well. These symptoms can also be confused with normal pregnancy digestive issues caused by hormonal changes. If you are experiencing new GI symptoms or if your GI symptoms worsen, please call our office.
Take precautions and call us with questions
If you fear that you have symptoms of COVID-19 or that you may have had an exposure to it, please self-isolate and call our office to find out whether you should come in for your next appointment or set up a virtual telehealth visit. You can also call if you have questions and want to speak with a phone nurse or reach out to your provider. If your symptoms become unmanageable, call 911 or go to the hospital.
How can pregnant women protect themselves from COVID-19?
Since pregnancy suppresses the immune system, pregnant women can be more vulnerable to severe illness from COVID-19. It is very important for you to limit interactions with people who may have been exposed or may be infected, including people in your household, as much as possible. When you do interact with others, you and other members of your household should use the following precautions:
- Wear a mask, especially when you cannot practice social distancing.
- Stay 6 feet away from others not in your household.
- Wash your hands often, using soap and water for 20 seconds, especially before eating and after being in a public place.
- Use hand sanitizer with 60% alcohol when hand washing is not possible.
Should I receive the COVID-19 vaccine?
The decision of whether to receive the vaccine is up to each patient. VPFW physicians have been vaccinated and recommend that all patients, including pregnant and breastfeeding patients, receive the vaccine when they are eligible, as long as they do not have specific situations which would make vaccination contraindicated. This is a decision tool to help you make an informed decision on whether to get vaccinated. Here are the Spanish and Russian versions of the decision tool.
According to the CDC, based on current knowledge, experts believe that mRNA COVID-19 vaccines (Pfizer and Moderna’s vaccines) are unlikely to pose a risk to the pregnant woman, the fetus, or breastfeeding infant. However, the potential risks of mRNA vaccines to the pregnant woman, fetus, or breastfeeding infant are unknown because these vaccines have not been studied in pregnant or breastfeeding women. In most clinical trials, pregnant women were inadvertently vaccinated early in their pregnancies and there have been no reported adverse effects on them or their babies.
*Update as of March 25, 2021: The COVID-19 mRNA vaccines (Pfizer and Moderna) are just as effective in pregnant and lactating women as women who are not pregnant, according to a study published in the American Journal of Obstetrics and Gynecology. Vaccine-induced antibody levels were “strikingly higher” than those resulting from coronavirus infection during pregnancy. The study also showed that women passed protective antibodies to their newborns via the placenta and breastmilk.”
For pregnant women who choose to receive the vaccine, acetaminophen may be offered as an option if they experience a fever or other post-vaccination symptoms.
How can I receive the COVID-19 vaccine?
Information about distribution of the COVID-19 vaccination is changing frequently. Check the Virginia Department of Health website for updates on when specific groups are eligible for vaccination and how they will be able to receive the vaccine. The Frequently Asked Questions page contains helpful information. (Scroll down to the “Vaccination: Vaccine Distribution” section.)
I am pregnant and I work outside the home. Should I stop working?
If it is possible to work from home, we encourage you to do so. If you are not able to work from home, please practice social distancing and the other best practices mentioned above to minimize your risk of contracting and spreading COVID-19.
During the COVID-19 outbreak, is it safe to have fewer prenatal visits and conduct some prenatal appointments via virtual telehealth options?
Yes. While the CDC recommends keeping all healthcare appointments, if you are low risk, some prenatal care can be performed remotely. Your blood pressure can be taken less frequently, and you can do fetal kick counts to know that your baby is okay. We can also easily discuss delivery plans via telehealth. We will provide instructions for setting up a telehealth visit as your appointment approaches if it makes sense to do so.
While we are taking every precaution to provide a clean and healthy environment in our offices, we can conduct telehealth appointments when appropriate, if you prefer.
What should pregnant women do if they have been exposed to COVID-19 or feel symptomatic?
If you believe you have been exposed to COVID-19, please self-isolate to reduce exposure to others and call our office to let us know. We will work with you to devise a plan for your upcoming appointments.
If you have any of the following symptoms—fever of 100.4, cough, difficulty breathing, shortness of breath, fatigue, muscle or body aches, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea—you should self-isolate and call our office.
When you call us, a phone nurse or your provider will ask you questions about your symptoms, possible exposure, and risk factors. If your symptoms are mild, risk factors are low and you do not have a pregnancy-related reason to be seen in the office or hospital, they may recommend that you stay home and conduct a telehealth appointment. They may also refer you to an ambulatory COVID-19 test site if you meet specific criteria.
If you have COVID-19 emergency warning signs (for example, trouble breathing, persistent chest pain or pressure, new confusion, inability to wake or stay awake, or bluish lips or face or other sever symptoms), seek emergency care immediately. Call 911.
What if I am experiencing COVID-19 symptoms and have pregnancy-related concerns (contractions, fluid leakage, decreased fetal movement, vaginal bleeding, etc.)?
Any time you have pregnancy-related concerns, call our office. Your provider will let you know if your issues require evaluation at the office and/or at a hospital, or if we can attempt to resolve them via telehealth. If you do need to come into our office, we ask that you do not bring any guests.
Is it safe to give birth at the hospital during the COVID-19 pandemic?
The hospitals where we deliver are taking extensive precautions to provide a safe and healthy environment for the birth of your baby. The labor and delivery units are all locked with restricted access from outside and from the other parts of the hospitals. All physicians, staff and patients are required to wear masks and appropriate PPE. Rooms and equipment are disinfected after each patient, and hospital staff are trained to prevent infection.
There is substantial evidence that home delivery places mothers and babies at higher risk. Our providers and all hospital staff are prepared to respond to any complications that may arise during your delivery.
Will I be able to have visitors at the hospital during the COVID-19 pandemic?
Visitor restrictions at the hospitals where we deliver currently allow 1 named adult visitor in mother-infant units, provided the visitor passes hospital health screenings. We recommend you and your named visitor stay vigilant about social distancing for the 14 days leading up to the birth of your baby, if possible.
Visitor restrictions may change. Please refer to the hospital where you plan to deliver for updates.
For specific questions, you may want to reach out to the hospital directly.
While it is difficult not to have everyone you want with you at this special time, minimizing visitors will help prevent the spread of COVID-19 to you, your baby, your family, other patients, and health care staff.
Since children are not allowed to visit, it’s important to have a plan for childcare as well as a back-up plan if the intended child caretaker becomes sick.
Can I leave the hospital early to minimize my time there?
Yes. Your baby should receive essential newborn testing around 24 hours of age. Once the testing is complete, you may be discharged from the hospital.
Can I pass COVID-19 to my baby during pregnancy?
COVID-19 is uncommon in newborns born to mothers who had COVID-19 during pregnancy. Some newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth.
Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness.
If I am COVID-19 positive when I give birth, how will it affect my labor and delivery?
You will have fewer hospital staff members coming into your room during your labor, and some communication may be done over the phone to reduce the risk of transmission to healthcare staff and providers. When healthcare staff and providers are in the room with you, they will be wearing personal protective equipment – masks, eye shields and gloves. We will do everything we can to give you the best care possible while minimizing risk of transmission.
If I am COVID-19 positive when I give birth, will I be separated from my baby?
No. Current recommendations by the CDC suggest no advantage of separation of mother/baby unless either the mother is too ill to either care for the newborn or the newborn has other conditions which raise the risk of severe disease.
Can COVID-19 be passed on to my baby through my breast milk?
Breast milk provides protection against many illnesses and many other health benefits for your baby. There is no evidence suggesting COVID-19 can be passed to a baby through breast milk. However, because the virus can be transmitted to a baby through respiratory droplets, strict skin hygiene and mask wearing during breastfeeding is recommended until the COVID-19 infection is cleared.
Can I travel while I’m pregnant during the COVID-19 outbreak?
We strongly recommend against traveling while pregnant during the COVID-19 outbreak. You should avoid international travel at all costs and avoid all non-essential domestic travel. You are subject to travel restrictions that could change at any time. Restrictions could affect your return home if you are exposed to COVID-19 or otherwise. If you have pulmonary and cardiovascular co-morbidities or immuno-suppression, you should avoid all travel.