Public health experts at the Centers for Disease Control and Prevention (CDC) say women are more vulnerable during pregnancy to viral respiratory infections like COVID-19, and are urging pregnant women to do all they can to stay well.
“Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19,” public health experts at CDC wrote.
Women who were pregnant during past outbreaks, including SARS and MERS, were more vulnerable to infection. Therefore, public health officials urge pregnant women to do all they can to avoid getting sick by frequently washing their hands and avoiding other people who are sick.
High fevers during the first trimester of pregnancy may be detrimental, no matter the cause, said Dr. Natalie Rochester, a women’s care and obstetrics expert.
It is still unknown whether COVID-19 infection could result in long-term issues for a newborn. The CDC says that most newborns who test positive for COVID-19 have mild or no symptoms. Babies with underlying health conditions or those born prematurely may be at higher risk of severe illness from COVID-19.
For all updates and to read more about COVID-19, please visit uchealth.org/covid19
While health experts continue to learn about the effects COVID-19 has on pregnant women, UCHealth Today reached out to Dr. Natalie Rochester to answer your questions.
Rochester, an OB-GYN and medical director of UCHealth Greeley Hospital Birth Center, has practiced medicine in Colorado for the past seven years, and is also a mother of two girls.
As a pregnant woman, should I be concerned about COVID-19?
Pregnancy-related coronavirus information from the CDC is limited, but Rochester is advising her patients to treat COVID-19 similarly to other viruses, such as seasonal flu, and take precautions to prevent it.
These precautions include:
- Wash your hands frequently with soap and water. Wash for at least 20 seconds before you eat, after you sneeze and after using the bathroom.
- Use alcohol-based hand sanitizers in addition to handwashing.
- Regularly clean surfaces like counters and your mobile phone.
- Sneeze and cough into a sleeve rather than into your hand or the air.
- Avoid contact with anyone with cold or flu symptoms.
- Stay home from work or school if you are sick.
- If you’re immunocompromised, consider taking even more precautions, such as having groceries and other services delivered.
Rochester, who had preterm complications during one of her pregnancies, said she received great advice from her physician.
“He encouraged me as a patient to practice no-regrets medicine,” she said. “If you don’t do something, will you regret it? We all must continue to live life and care for our families, however, we must make smart decisions. Keeping ourselves and our family safe is important.”
Am I more susceptible to COVID-19 during pregnancy?
According to the CDC, COVID-19 spreads from person to person. It spreads:
- Between people who are in close contact with one another (within about 6 feet).
- Via respiratory droplets produced when an infected person coughs or sneezes.
- When droplets land in the mouths or noses of people nearby or are, possibly, inhaled into the lungs.
During pregnancy, women experience changes in their bodies that may make them more susceptible to viral respiratory infections, and this could include COVID-19, Rochester said.
“Pregnant women should continue to manage their pregnancy using the same preventive actions they always would to stay healthy, such as washing their hands and staying away from people who are sick,” she said.
Should I travel during pregnancy?
Women need to assess their risk for traveling any time they are pregnant.
“Pre-COVID-19, if a woman was healthy with no pregnancy complications we say they can travel up to 36 weeks (gestation), making sure they stop and walk around every 2-3 hours to prevent blood clots,” Rochester said. “We’d also ask they consider the risk involved with traveling to a remote area without a hospital.
“Now with COVID-19, there is that added risk. But if travel is still necessary, then they need to be diligent with all the precautions, such as washing hands, wearing a mask and physical distancing. We want pregnant women to do everything they can to limit their exposure to COVID-19.”
Car travel can lead to fewer exposures to COVID-19 than air travel, she added.
(Learn more about traveling and the coronavirus.)
Are there risks from COVID-19 for unborn children?
Rochester said the evidence is not yet clear on whether an unborn child will be affected, so staying as healthy as possible is best.
There is some evidence that babies might not grow at the rate they should when mom is infected in the first or second trimester, and that increases with the severity of the mother’s illness. These growth restrictions increase the risk of preterm delivery. Moms with severe COVID-19 also have an increased risk of blood clots in the lungs and legs that can be detrimental to the fetus, Rochester said.
“As always, practice good hygiene,” she said. “Covering your mouth and nose with a sneeze or cough, and washing your hands is important.”
What should I do if I start feeling flu-like symptoms during my pregnancy? Could it be COVID-19?
Those who have been infected with COVID-19 have mild symptoms to severe illness and death. Symptoms include:
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
It’s entirely possible that someone with one or more of these symptoms has seasonal flu or another illness and not COVID-19. Either way, high fever during the first trimester can increase birth defects. And other respiratory viral infections during pregnancy, such as the flu, have been associated with outcomes such as low birth weight and preterm birth, according to the CDC.
“If you’re feeling sick, low-sugar hydration (such as water) is very important,” Rochester said. “You know you’re well-hydrated when your urine is a light yellow color.”
Rochester said it is OK for pregnant women to take Tylenol (not aspirin or ibuprofen) if they have a fever of 100.4 degrees or higher.
“If you’re drinking lots of fluids and have taken Tylenol but you’re not able to keep your fever down, or you’re vomiting or have other symptoms such as difficulty breathing, then we’d want you to call your health care provider immediately,” she said.
During the call, your health care provider can help advise you as to where and when you should be evaluated by a health care provider. Women with mild symptoms will most likely be asked by their provider to stay home and use conservative treatments, even if they test positive for COVID-19.
What will happen if I show up at the hospital pregnant and with COVID-19 symptoms?
Anyone with mild COVID-19 symptoms is asked to call their provider or clinic before they arrive, Rochester said.
“We will have questions about their symptoms and how far along they are in pregnancy to determine the next best steps,” she said. “Sometimes we may have you stay home, and sometimes we may ask you to come into the hospital. But we will do a prescreen to reduce the risk of you coming in and being exposed to other things when it’s not necessary.”
UCHealth recommends all women admitted to the hospital for delivery undergo a COVID-19 test. For a scheduled caesarian section, the test needs to be conducted within 5 days of their appointment.
Currently, at UCHealth hospitals, laboring women are allowed one support person with them no matter if they get a COVID-19 test or not, even if they are COVID-19 positive. Those with a negative COVID-19 test result are allowed two support people. (Visit UCHealth visitation policy for up-to-date rules).
“UCHealth has done a phenomenal job by never letting laboring moms be without support during this pandemic, which has not been the case around the country,” Rochester said.
How far along a woman is in her pregnancy, as well as severity in symptoms, will determine where she would be sent if she tests positive for COVID-19, Rochester said. When a mother is admitted, she may be placed in a special isolation room on the labor floor or within another unit.
“Providers and staff will wear protective garments when entering and will remove those garments and wash when exiting the room to help limit the spread of the virus,” she said. “And depending on the gestational age of the pregnancy, the patient may also undergo fetal monitoring.”
If I get coronavirus while pregnant, can it be passed to my unborn child? Could it hurt my unborn child?
“We have no affirmative information telling us that COVID-19 has a negative effect on babies delivered to mothers with the virus,” Rochester said and refers to the information updated regularly from the CDC.
According to the CDC, the virus that causes COVID-19 is thought to spread mostly through close contact with an infected person, via respiratory droplets.
While much is unknown about the risks of COVID-19 to newborns born to mothers who are infected with the virus that causes COVID-19, the CDC says this:
- 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.
In limited case studies of infants born to mothers with COVID-19 published in medical literature, the virus was not detected in samples of amniotic fluid or breast milk.
At this time, there is no information on long-term health effects on infants with COVID-19, or those exposed in utero to the virus that causes COVID-19.
What if I have COVID-19 during my time of delivery?
Laboring women who are positive for COVID-19 can still have one support person with them, according to current UCHealth policy. All involved in the delivery wear personal protective equipment and masks and follow the same precaution taken with other COVID-19-positive patients.
Current evidence shows the risk of a newborn getting COVID-19 from their mother is low if the mother wears a mask and washes her hands before and during care, including during breastfeeding.
Prior to your expected delivery, talk to your health care provider about the risks and benefits of your newborn staying in the same room with you if you are COVID-19 positive at the time of delivery. If a support person can help care for the child, limiting exposure to the mother, that is recommended.
“We no longer separate baby and mother, and we encourage breastfeeding,” Rochester said.
Is my newborn more susceptible to the coronavirus?
There is little data on newborns, Rochester said, so she leans on the side of caution.
“Newborns are fragile and have undeveloped immune systems, but they are also born with antibodies from mom,” she said. “I would not recommend taking a newborn out in the community until this (pandemic) has resolved.”
If you must take your newborn out, consider using a car seat cover that completely covers the car seat, and usually rests over the handle. This helps keep germs out, but it also helps to discourage passersby from getting too close or touching your child.
Consider having your groceries or meals delivered, and any options that can limit your exposure to public places and groups of people.
“As parents, we are the protectors of our children,” Rochester said. “It is totally acceptable to ask people to wash their hands or to limit guests the first month or two (after birth) to allow for bonding.”
You can always use your doctor as the “bad guy,” telling friends, family or neighbors that your physician recommends you limit guests and your baby’s exposure to outside people.
“Mandate people to wash their hands and don’t come in when they are sick,” Rochester said.
Mothers should take caution even among people who have received the COVID-19 vaccination. Vaccinated people, thought mostly protected against getting the virus, may still be able to spread the virus to others.
Never put a face shield or mask on your baby. Children younger than two years old should not wear a masks.
Bring your baby to follow-up care visits. Newborn visits are important in order to make sure your child is eating and growing at a healthy rate. Other risks to newborns, such as jaundice, bloodspot and heart defects are also screened at this time.
If I get the coronavirus, should I be breastfeeding or giving my child my breast milk?
There is no concrete guidance yet about a woman with coronavirus delivering and then breastfeeding, Rochester said. But there is also no evidence that coronavirus is passed on through breast milk.
“Breastfeeding is recommended, as babies receive antibodies,” she said. “Whether a mom pumps milk or does breastfeeding would be based on discussion with the pediatrician and mother prior to birth.’’
Always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don’t have COVID-19. If soap and water aren’t available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol.
If you have COVID-19, practice safe hand hygiene but also wear a mask while breastfeeding and whenever you are within 6 feet of your baby. If there is another support person who can help care for the baby to limit exposure to COVID-19, that is recommended.
What should I do if I get COVID-19 while at home with my newborn?
If you get COVID-19, isolate by following CDC guidelines. You do not need to visit your health care provider if you have mild symptoms or no symptoms at all.
You can use UCHealth’s helpful tool to determine what isolation or quarantine guidelines you should follow. These guidelines include staying home, separating from others who live outside the home, isolating from healthy household members if possible, and always wearing a mask.
It is hard to separate a mother from her newborn, Rochester said, but mothers should wear gloves and masks when caring for their newborn.
Once the isolation period has ended, those caring for the newborn should continue to wash their hands before and after caring for the child but other precautions do not need to be followed.
What if I’m pregnant and work somewhere like a hospital. Should I be concerned?
Pregnant workers should be taking the same precautions as all workers to limit exposure to illnesses.
“Use standard precautions: washing hands and avoiding people who are sick,” Rochester said. “If you work in a health care setting and you care for sick people, you need to be extra diligent.”
Pregnant health care workers, as with all health care workers, should follow risk assessment and infection control guidelines when exposed to patients with suspected or confirmed COVID-19, according to the CDC.
If I’m pregnant or trying to get pregnant or breastfeeding can I get the COVID-19 vaccination?
“There is no data showing us there is a negative effect (from the COVID-19 vaccine) for pregnant women or their babies,” Rochester said. “It is a personal choice for our patients, and we are not withholding the vaccine for pregnancy, plans to become pregnant or for breastfeeding.
“We are counseling our patients by looking at their individual risk factors, their work and exposure risk,” she added. “We talk about their risk as well as the things we don’t know about the vaccine and pregnancy. It’s a conversation about the pros and cons, and the patient decides what they are most comfortable with.”
Women who were known to be pregnant were not allowed to participate in the clinical trials for COVID-19 vaccines. But, some women who were already enrolled in the clinical trials ended up getting pregnant during the studies. There were no adverse outcomes or evidence that vaccines affected fertility.
(New research unrelated to the clinical trials now appears to show that vaccines may be safe for pregnant women and that the antibodies to COVID-19 may cross from the woman to her unborn baby. One mom in western Colorado had received the vaccine while she was pregnant. After her daughter was born, she tested positive for antibodies to COVID-19. Researchers are working to learn more about vaccines for pregnant women, infants and children as fast as they can. Right now, UCHealth medical experts do not recommend testing your baby for COVID-19 antibodies if you got the COVID-19 vaccine during your pregnancy.)
For more information regarding pregnancy and the COVID-19 vaccine, visit the CDC website.