Pregnancy Related Questions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Aisha Adigun, B.Sc., M.D.[2]Nuha Al-Howthi, MD[3]

Frequently Asked Inpatient Questions Microchapter

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## Pregnancy Related Questions

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#### Does hospital delivery increase the mother or baby's chances of contracting COVID-19?

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* No. Healthcare practitioners and hospitals are committed to making sure that mothers and babies are safe during this pandemic. All necessary precautions are being taken against exposure to COVID-19in the majority of hospitals. Pregnant women and their health care providers should discuss the mother's concerns. [1]

#### Should intrapartum fever be considered as a possible sign of COVID-19 infection?

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* Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Fever is the most commonly reported sign; most patients with confirmed COVID-19 have developed a fever and/or symptoms of acute respiratory illness (cough, difficulty breathing).[2]
* Data regarding COVID-19 in pregnancy are limited; according to current information, presenting signs and symptoms are expected to be similar to those for non-pregnant patients, including the presence of fever.

Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 infections. As part of the evaluation, clinicians are strongly encouraged to test for other causes of respiratory illness and peripartum fever.[2]

#### Are unborn babies of COVID-19 patients already infected with the virus?

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* With COVID-19 being due to a novel virus, there is limited evidence regarding how it affects pregnancy. Current/recent studies, however, show no evidence of mothers diagnosed with COVID-19 in the third trimester, passing the virus to their babies while in the uterus.[3]

#### What is the guidance available for labor and delivery Health Care Personnel (HCP) with potential exposure in a healthcare setting to patients with COVID-19 infection?

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* According to the CDC "HCP in labor and delivery healthcare settings should follow the same infection prevention and control recommendations and personal protective equipment recommendations as all other HCP. If HCP are exposed to patients with COVID-19 infection, guidance is available for HCP and healthcare facilities on steps to take."[2]

#### Are Pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19 infection?

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* It is advised that all pregnant health care personnel should follow established risk assessment and infection control guidelines when exposed to all patients with or suspected of having COVID-19. Because the literature and information on pregnancy and COVID-19 are still being investigated, facilities can consider limiting the exposure of their pregnant health care personnel to patients with COVID-19 when possible.[4]

#### Should patients proceed with a scheduled cesarean delivery if hospitalized with COVID-19?

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* Yes, scheduled cesarean delivery and induction of labor can be performed as indicated despite the pandemic. Pregnant women can communicate with their providers on any concerns that they may have.[5]

#### Are glucocorticoids contraindicated in pregnant patients with COVID-19?

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* According to recommendations by the American College of Obstetricians and Gynecologists,[5]
* "Due to the well-established benefit of antenatal corticosteroids administration with reduced neonatal morbidity and mortality, corticosteroids should continue to be administered in pregnant patients with suspected or confirmed COVID-19 who are between 24 0/7 weeks and 33 6/7 weeks of gestation and at increased risk of preterm birth within 7 days". It is advised that modifications to care should be individualized based on the neonatal benefits of antenatal corticosteroid with the risks of potential harm to the pregnant patient.
* "The benefits of antenatal corticosteroids in the late preterm period are more modest. As such, and weighing this against any potential harm to the pregnant patient, antenatal corticosteroids should not be offered to pregnant patients with suspected or confirmed COVID-19 who are between 34 0/7 weeks and 36 6/7 weeks of gestation and at risk of preterm birth within 7 days". It is advised that modifications to care should be individualized based on the neonatal benefits of antenatal corticosteroid with the risks of potential harm to the pregnant patient.

#### Are pregnant women more susceptible to infection or at increased risk for severe illness, morbidity, or mortality with COVID-19?

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* Literature and previous studies have shown that pregnant women are at increased risk of adverse outcomes when exposed to respiratory infections. With COVID-19 being a novel virus, the literature and evidence available are limited. Current evidence however does not indicate that pregnant women are at increase risk of infection or severe morbidity. The same cannot be said for pregnant women with underlying comorbidities hence, all pregnant women should adhere strictly to already established social distancing and sanitation guidelines.[5]

#### Are hospitals testing all women who arrive at the hospital in labor for COVID-19 even if they show no symptoms

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* With guidance from infection control specialists and other organizations, most hospitals, will begin testing all women arriving at Labor and Delivery. This means that some patients who have no symptoms will be identified as COVID positive. It is believed that this will allow all necessary precautions to be put in place and the best possible care of all the mothers and babies.[6]

#### Can nursing mothers with COVID-19 breastfeed their child?

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* In the limited studies available, COVID-19 has not been found in breast milk. However, babies can get the virus from contact with mothers or other caregivers. The CDC recommends breastfeeding or feeding expressed breast milk to babies while taking precautions to avoid spreading the virus. Breast milk protects babies from getting sick and is the best source of nutrition for most babies. Breastfeeding helps strengthen the baby’s immune system because breast milk contains antibodies and other important components.

* If a person sick or experiencing symptoms, they should take all possible precautions to protect the baby, including washing hands before and wearing a facemask prior to touching the baby. Patients may breastfeed directly or express breast milk for a healthy caregiver to feed to the baby.

#### How many people can be present in the room during births?

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* The CDC has advised hospitals to limit the number of people allowed in hospitals, including visitors and non-essential staff to reduce exposure of patients and health care workers, to COVID-19. During labor, hospitals have generally made exceptions to allow a support person as long as they are not experiencing symptoms associated with COVID-19.

* Patients can talk to their facilities or health care provider about their policies and question if facilities are allowing any exceptions on a case-by-case basis. Primary support persons should be decided in advance and a second person should be identified in case the primary support person is experiencing symptoms of COVID-19. Plans can also be made with providers about connecting with additional support-people through platforms such as FaceTime, Google Hangouts, or Zoom.

#### Can a baby stay with a COVID-19 infected mother after delivery?

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* CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room. Temporary separation of the newborn from a mother with suspected or confirmed COVID-19 should be considered to reduce the risk of spreading the virus to the newborn. The risks and benefits of temporary separation of the mother from her newborn should be discussed with the mother by her healthcare team. Decisions about temporary separation should be made with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce the risk of spreading the virus and would like to breastfeed, she should express breast milk and have a healthy caregiver who is not at high-risk for severe illness from COVID-19 bottle-feed the newborn the expressed breast milk if possible.

* If the mother with suspected or confirmed COVID-19 does not choose temporary separation in the hospital, she should take precautions to avoid spreading the virus to the newborn, including washing her hands and wearing a cloth face covering when within 6 feet of her newborn. The newborn should be kept ≥6 feet away from the mother, as much as possible, including the use of physical barriers (e.g., placing the newborn in an incubator).

#### Can COVID-19 be transmitted via breastmilk?

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* The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

#### What should mothers do if they have been discharged, but have not med the criteria to discontinue self-isolation?

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* Mothers may choose to continue to separate from the newborn at home to reduce the risk of spreading the virus if a healthy caregiver is available. If a healthy caregiver is not available, a mother with COVID-19 can still care for her infant if she is well enough while using precautions (for example, hand washing, wearing a cloth face covering).

#### What precautions can mothers take when directly breastfeeding a child?

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* As always, before touching the baby the hands should be thoroughly washed with soap and running water for 2o seconds or more. If the mother has tested positive or suspects she has COVID-19, she should wear a face mask and wash hands before each feeding.

#### What precautions should mothers take when feeding expressed breast milk to a child?

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* If you are sick or choose to express breast milk to feed your baby, you can do so with hand expression or a breast pump (manual or electric). Be sure to use proper hand washing before touching any pump or bottle parts and before expressing breast milk. Follow recommendations for proper pump cleaning after each use and thoroughly clean all parts that come into contact with breast milk. Clean the pump after each pumping session according to the pump manufacturer’s instructions.
* If possible, or if you are too sick to feed your baby, have another healthy person feed your expressed milk to your baby. Be sure everyone feeding your baby follows proper hand hygiene and wears a face mask if experiencing symptoms. To establish and keep your milk supply, it is important to express your milk from the breast as often as your baby eats every day, typically 8-12 times a day for newborns or every 1.5 to 3 hours.

#### Should infants and new-borns wear face shields?

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* Plastic face shields for newborns and infants are NOT recommended. There is no data supporting the use of infant face shields for protection against COVID-19 or other respiratory illnesses.
* An infant face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation.
* Infants, including newborns, move frequently, which could increase the possibility of their nose and mouth becoming blocked by the plastic face shield or foam components. The baby’s movement could also cause the face shield to become displaced, resulting in strangulation from the strap.

## References

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1. ↑ "COVID-19 Pregnancy and childbirth".
2. ↑ 2.0 2.1 2.2 "Clinical Questions about COVID-19: Questions and Answers | CDC".
3. ↑ "Covid-19 virus infection and pregnancy".
4. ↑ "Are pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19?".
5. ↑ 5.0 5.1 5.2 "COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics | ACOG".
6. ↑ "Coronavirus (COVID-19) During Pregnancy: FAQs for Pregnant Patients".