Coronavirus (COVID-19) and Pregnancy: Q&A with Columbia Ob/Gyn Physicians

There is a great deal of uncertainty about the impact of the rapidly-spreading Coronavirus or COVID-19 on people who are pregnant. We spoke with Columbia University maternal-fetal medicine specialists Cynthia Gyamfi-Bannerman, MD, MSc and Chia-Ling Nhan-Chang, MD, to get the latest information.

What are the symptoms of COVID-19 infection, and are they different in pregnant women?

Per the CDC, symptoms related to COVID-19 present 2-14 days after exposure and include fever, dry cough, and shortness of breath. Loss of your sense of smell or taste is also common.

Additional, but less common symptoms include fatigue, stuffy nose, body aches and pain and gastrointestinal symptoms.  

At this time, not much is known about the effects of COVID-19 in pregnancy, but, in limited cases, it appears that the symptoms are identical and equal in severity with non-pregnant women.

Are there additional risks of COVID-19 infection in the pregnant population?

There is only limited information on the effects of COVID-19 on pregnant women and their babies due to a small number of cases. Pregnant women experience changes in their bodies that may increase their risk of some viral infections, but it’s not known where COVID-19 is among them.  Pregnant women have been shown to potentially carry the virus while not having symptoms, so we have recommended that women wear masks when coming to deliver their babies.

At this time, there is no data to suggest increased risk of congenital malformations in pregnant women who get COVID-19. There are some reports of increased risk of premature deliveries, but this appears to be due to increased need for emergency premature deliveries to assist maternal treatment, and not due to increased risk of preterm labor. 

How can pregnant women manage their risk of getting COVID-19?

Best practices for pregnant women to avoid infection are the same as those for the general public. The Centers for Disease Control (CDC) recommends that all people:

• Avoid people who are sick or may have been exposed
• Clean your hands often using soap and water or alcohol-based hand sanitizer
• Cover your cough (using your elbow is a good technique)
• Practice social distancing

More information is available on the CDC’s website and the World Health Organization’s website.

Can I pass COVID-19 to my fetus during pregnancy or delivery?

Data from a small number of pregnant women have not detected COVID-19 in newborns, amniotic fluid, or umbilical cord blood of infected mothers. Previous studies of a similar virus (influenza) also support that the infection does not pass to the unborn fetus.

Can I pass COVID-19 in breastmilk?

Again, the data is limited, but there are no reports of COVID-19 in breastmilk.

If you are COVID-19 positive and you deliver within the window of symptoms/infection, you and your newborn will be roomed together. Breastfeeding is encouraged and is a potentially important source of antibody protection for the infant, therefore, pumping is encouraged as long as appropriate hand hygiene is practiced.

Can I, or my family, get COVID-19 testing?

We are currently testing all patients who come for delivery for the COVID-19 virus.  This is because many symptoms of labor mimic those of COVID-19, such as fatigue or shortness of breath or diarrhea.  If your delivery is scheduled, you may get a call to get tested in an office prior to coming to the labor unit.  The information from these test results will help us protect patients and their new babies. Please see more information on new Labor & Delivery policies.

For non-delivering patients: At this time, we are acting under advisement from the CDC and only patients with fever and respiratory complaints will be tested, which involves evaluation for common seasonal respiratory viruses, influenza and for SARS-CoV-2, the virus that causes COVID-19 disease. At present, COVID-19 testing is not available for mildly ill or asymptomatic patients who are not being hospitalized. This may change once testing is widely available. Our practice cannot evaluate family members who are not patients in our practice.

What else should we know about guidelines and best practices for COVID-19 in pregnancy?

As you might expect, this is a very fluid situation and our guidelines continue to change. Expect a weekly update based on the date noted above. As we learn more, we are actively reassessing ways to ensure patient safety.