Implications of COVID-19 for pregnant women

 
Implications of COVID-19 for pregnant women

In the midst of a rapidly evolving outbreak that could have significant effects on our  public health and medical infrastructure, the unique needs of pregnant women should be included  in preparedness and response plans. In previous outbreaks, clinicians have at times been reluctant to treat or vaccinate pregnant women because of concerns for fetal safety.43 It is critical that  pregnant women not be denied potentially life-saving interventions in the context of a serious  infectious disease threat unless there is a compelling reason to exclude them. As with all 291 decisions regarding treatment during pregnancy, carefully weighing of the benefits of interventions for the mother and fetus with potential risks is necessary. As surveillance systems  for cases of  COVID-19 are established, it is essential that information on pregnancy status, as  well as maternal and fetal outcomes, be collected and reported 

Susceptibility to and severity of COVID-19

 in pregnancy  Although data are limited, there is no evidence from other severe coronavirus infections (SARS or MERS) that pregnant women are more susceptible to infection with coronavirus. Thus  far, in this outbreak of novel coronavirus infection, more men have been affected than women.32,33,36,37  This observed gender difference could be due to differences in reporting,  susceptibility, exposure, or recognition and diagnosis of infection.  There are no data to inform  whether pregnancy increases susceptibility to COVID-19. Previous data on SARS and MERS suggest that clinical findings during pregnancy can range from no symptoms to severe disease and death. The most common symptoms of COVID- 19 are fever and cough, with more than 80% of hospitalized patients presenting with these 305 symptoms.36 In a recent study by Chen et al.44, nine women diagnosed with COVID-19 during 306 the third trimester of pregnancy were reported. In this small series, clinical presentation was  similar to that seen in nonpregnant adults, with fever in seven, cough in four, myalgia in three,  and sore throat and malaise each in two women. Five had lymphopenia. All had pneumonia, but none required mechanical ventilation, and none died. All women had a cesarean delivery, and 310 Apgars were 8-9 at 1 minute and 9-10 at 5 minutes. In a second series of nine pregnancies with ten infants (one set of twins) reported by Zhu et al.,45 symptom onset was before delivery (1-6 312 days) in four, on the day of delivery in two, and after delivery (1-3 days) in three cases. Clinical presentation of COVID-19 was similar to that seen in nonpregnant patients. Among the nine  pregnancies, intrauterine fetal distress was noted in six, seven were cesarean deliveries, and six  infants were born preterm. Based on these limited reports, and the available data from other  respiratory pathogens such as SARS and influenza, it is unknown whether pregnant women with  COVID-19 will experience more severe disease.  

Travel guidance for pregnant women  

Travel recommendations have been instituted to limit exposure to persons in the United  States. All persons, including pregnant women, should not travel to China. On February 2, 2020, the U.S. State Department upgraded their travel advisory to level 4, the highest level of travel  advisory. Obstetric providers should obtain a detailed travel history for all patients and should specifically ask about travel in the past 14 days to areas experiencing widespread transmission of  SARS-CoV-2. Currently this is limited to China, but this situation is rapidly evolving and  obstetricians should stay alert to the global situation by consulting the CDC website and  following media coverage.  

Vaccination in pregnancy 

 There is currently no vaccine to prevent COVID-19. Since posting of a SARS-CoV-2 virus genetic sequence online on January 10, 2020, multiple organizations, including the National Institutes of Health, have been working to rapidly develop a COVID-19 vaccine.  Development of this vaccine builds on and benefits from work on SARS and MERS vaccines. However, it is not known how quickly a safe and effective vaccine may be readily available. 

 Infection control measures and diagnostic testing

Vaccination in pregnancy  There is currently no vaccine to prevent COVID-19.  Since posting of a SARS-CoV-2  virus genetic sequence online on January 10, 2020, multiple organizations, including the  National Institutes of Health, have been working to rapidly develop a  COVID-19 vaccine.  Development of this vaccine builds on and benefits from work on SARS and MERS vaccines However, it is not known how quickly a safe and effective vaccine may be readily available.  Infection control measures and diagnostic testing  All patients, including pregnant women, should be evaluated for fever and signs and symptoms of a respiratory infection. Ideally, screening procedures begin before arrival on a labor 336 and delivery unit or prenatal care clinic. For example, when scheduling appointments, patients  should be instructed what to do if they have respiratory symptoms on the day of their  appointment or if a patient calls triage prior to presentation, respiratory signs and symptoms 339 should be assessed over the telephone. Those patients with respiratory symptoms should be 16 separated from other waiting patients and a facemask should be placed on them. Patients who  meet criteria for a Person Under Investigation (Box 1) should be immediately placed in an  Airborne Infection Isolation Rooms (single-patient rooms at negative pressure). Once in  isolation, the patient’s facemask may be removed. Health care personnel should adhere to  standard, contact and airborne precautions. Infection control personnel and local/state health  departments should be notified immediately; local/state health departments can help to arrange  testing of relevant specimens (upper and lower respiratory specimens and serum are currently

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References

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