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Tuesday, July 7, 2020
Home Specialties Infectious Disease Pregnant Patients & COVID-19: Risk Mitigation and Communication are Key

Pregnant Patients & COVID-19: Risk Mitigation and Communication are Key

Childbirth during the coronavirus pandemic is uncharted territory. According to the Centers for Disease Control and Prevention (CDC), though there is no evidence that the virus affects pregnant people differently than others, pregnant people are at a greater risk of getting sick from respiratory viruses than people who are not pregnant. The CDC also cautions that it has observed miscarriage and stillbirth among pregnant people infected with other coronaviruses like SARS and MERS, but the reason why is still unclear.

There does not appear to be a significant risk for vertical transmission of the virus. Rather, pregnant people with confirmed COVID-19 illness might confer SARS-CoV-2 antibodies to their infants, according to a research letter published in the Journal of the American Medical

Lacking clear guidelines, expectant mothers may experience increased stress levels and fears in unprecedented ways. The following are a few important management considerations to help pregnant patients navigate the landscape.

  • Consider telehealth appointments. While new mothers may feel anxious about fewer in-person prenatal visits, The American College of Obstetricians and Gynecologists (ACOG) recommends that providers continue to provide medically-necessary care and consultations, while maximizing the use of telehealth as much as possible. 
  • Follow guidance from the Society for Maternal-Fetal Medicine’s (SMFM) on essential ultrasounds. Ideally, the number of first trimester ultrasounds can be minimized by performing one exam at 12 weeks for dating and nuchal translucency (NT); this is especially helpful if the first prenatal visit is conducted via telehealth. Furthermore, SMFM suggests that examinations be limited to once a week when heightened surveillance is needed and that fetal echocardiography be reserved for patients at highest risk.
  • Discuss shifts in birth plans with expectant mothers. Not only have hospitals had to re-allocate resources during the pandemic, but many have enacted policies to limit or prohibit visitors accompanying patients in labor and delivery units. These types of restrictions, while necessary to protect both laboring mothers and healthcare professionals from COVID-19, can also exacerbate the normal anxiety and stress that accompanies delivery. Risk mitigation further impacts midwife and doula support. It is essential to discuss and consider these factors during all prenatal consultations, both to address anxieties and concerns, and to offer strategies that connect practitioners during birthing (e.g. FaceTime, Skype or Zoom) by using a smartphone or laptop computer.
  • Address antenatal concerns. According to SMFM guidance, any protocols for post-delivery management of neonates should be clearly communicated to pregnant people, especially if they entail the use of maternal masks/gloves, distanced bassinets or other strategies. Additionally, it is is not yet known whether COVID-19 is transmitted in breast milk. ACOG currently recommends that mothers who have had COVID-19, or are symptomatic, take necessary precautions when breastfeeding or pumping.

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