A new paper published in the medical journal JAMA offers more encouraging news for pregnant women. Researchers at the University of Texas Southwestern Medical Center in Dallas published a study titled Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

The results show that 95% of women who tested positive for Covid-19 during pregnancy had no adverse outcomes. Five percent of infected women experienced severe complications such as pneumonia and respiratory distress.

This study also showed a low rate of newborn infections (3%) consistent with our previous reporting. Previously published data from the PRIORITY Study(Pregnancy Coronavirus Outcomes Registry) showed babies born to Covid-19-positive women do well with no increase in negative metrics such as low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

Based on current scientific understanding of Covid-19 infection in pregnancy, there is no evidence at this time indicating pregnant women are more at risk for severe illness from Covid-19 than the general public. In general, viral infections in pregnancy can lead to poor outcomes in mothers and newborns.

Pregnant women have a suppressed immune system and experience changes in the way the respiratory system functions. These physiological changes are essential but put pregnant women at a higher risk for respiratory problems when they contract other similar viruses such as MERS, SARS, influenza, or pneumonia.

This paper from UTSW adds to the growing body of medical evidence that most women who contract Covid-19 will do well. The authors acknowledge the scientific consensus that viral infections place pregnant women at risk but highlight the low number of sufficiently powered, large-scale studies conducted to accurately assess the specific risks associated with SARS-CoV-2. The purpose of this study was to address this gap in scientific research.

This large urban county health system’s research compared outcomes in 252 SARS-CoV-2-positive and 3,122 negative pregnant women. The data was collected from March 18 through August 22, 2020. The study population included 2,520 Latinx (75%), 619 Black (18%), and 125 White (4%) women. The statistical analysis controlled for variables such as age, parity, body weight, and other medical conditions.

The study found SARS-CoV-2 positivity was more common in Latinx women, accounting for 90% of the cases. Latinx women make up 75% of the 12,000 women delivering at UTSW.

Thirteen women (5%) developed severe respiratory complications requiring interventions, and one patient developed venous thromboembolism.

There was no difference in preterm birth rates, preeclampsia, C-section rates, or stillbirth in women with Covid-19. This data is further supportive evidence that pregnant women who test positive for Covid-19 and their newborn babies have a low risk of developing severe symptoms.

This study also evaluated the placenta for evidence of pathological changes. Scientists have been concerned the viral illness could lead to placental vasculopathy and inflammatory infiltrates. Pathologists studied the placentas of patients infected with Covid-19. This study found the majority were not affected by the virus.

NIH research indicates that in utero mom-to-baby transmission is rare because the placenta is missing key components the virus needs to enter the fetal circulation, namely ACE2 receptors and the TMPRSS2 enzyme. Both the ACE2 receptor and TMPRSS2 are present in the placenta but only in tiny amounts. The low levels likely explain why SARS-CoV-2 is unlikely to cross the placenta from mom to baby.

How do pregnant women protect themselves from Covid-19?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations:

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.
9. Get your flu shot.

Adhikari EH, Moreno W, Zofkie AC, et al. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open. 2020;3(11):e2029256. doi:10.1001/jamanetworkopen.2020.29256

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The U.S. Centers for Disease Control and Prevention (CDC) provided an early release document on November 6th titled Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy. This paper verifies growing scientific consensus that pregnant women are at a higher risk of preterm labor if they acquire Covid-19 during pregnancy.

Based on current data, there is no evidence at this time indicating pregnant women are more at risk than the general public. We know that viral infections in pregnancy and postpartum can lead to poor outcomes in mothers and newborns.

Preterm labor most likely results from the severity of the maternal illness and is not caused by the virus itself.

Data so far indicates a pregnant woman who contracts Covid-19 has a low risk of passing the virus to her baby. The PRIORITY study(Pregnancy Coronavirus Outcomes Registry) showed that only 1.1% of infants contract the virus. The PRIORITY study also showed babies born to Covid-19 positive women do well. These babies showed no increase in key metrics such as low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

This new CDC paper adds to our current understanding of the effects of Covid-19 during pregnancy, showing an increase in preterm labor and providing more information on infant infection rates.

During pregnancy, women have a temporarily suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk of respiratory problems when they contract similar viruses, such as influenza or pneumonia. OB-GYNs, therefore, consider pregnant women to be an at-risk group for respiratory compromise if they contract Covid-19.

Additionally, preterm labor is a known risk when pregnant women contract viral illnesses such as MERS, SARS, and influenza. Preterm labor most likely results from the severity of the maternal illness and is not caused by the virus itself. In other words, preterm labor is not merely a result of contracting these viruses but rather dependent on the degree of illness that results.

Public health departments report Covid-19 pregnancy data to the CDC through the National Notifiable Diseases Surveillance System. Sixteen jurisdictions collected pregnancy and infant outcome data on 5,252 women with laboratory-confirmed SARS-CoV-2 infection.

This data was submitted to the CDC Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). SET-NET monitors the emerging and re-emerging threats to pregnant women and infants.

The authors studied 5,252 pregnancies. Three hundred nine women were still pregnant, so no delivery outcomes were available. Five hundred one pregnancies did not have a reported pregnancy outcome, or the gestational age at delivery was not available. This report analyzed the 4,442 women who had reported delivery outcomes and gestational age data.

Preterm labor rates increased in Covid-19 + Moms

Preterm labor increased by about 2% in pregnant women with confirmed Covid-19 infection.The gestational age was known in 3,912 cases. 12.9% of babies were born preterm compared to 10.2% in a national estimate of preterm labor rates. This finding suggests that pregnant women with SARS-CoV-2 infection might be at risk for preterm delivery, similar to other viral illnesses.

The authors are clear this data is preliminary and subject to change as scientists continue to learn more. These data studied mostly women with second and third-trimester infections and included a higher percentage of Non-Hispanic Black and Hispanic women.

Low rate of transmission to newborns

This report showed a low rate of neonatal transmission in line with previous reports. Among the 610 infants with SARS-Cov-2 testing results, only 2.6% of infants contracted the virus.

The neonatal infection rate was higher (4.3%) in babies born to women who tested positive for Covid-19 within 14 days of delivery.

Limitations of the study

The findings of this report are subject to at least six limitations.

1. Data collection was not standardized as interviews and medical record abstraction varied by jurisdiction.
2. The data are not nationally representative and included a higher number of Hispanic women.
3. Fetal death reporting data was dependent on linkages to existing data sources.
4. There was a lack of available information on women with first-trimester Covid-19 infections limiting long term surveillance.
5. The data did not ascertain participants’ baseline risk factors for preterm delivery.
6. Many of the infants had no SARS-CoV-2 RT-PCR results reported.

How does this report help doctors manage pregnancy?

This CDC report adds to the growing scientific literature to assist OB-GYNs in providing counsel and care to their pregnant patients. OB-GYNs can monitor pregnant women with Covid-19 for early signs and symptoms of preterm labor. Pediatricians can monitor babies born within 14 days of a maternal Covid-19 infection with extra caution.

Pregnant women with Covid-19 can also take comfort in knowing more evidence has emerged showing the risk of transmitting the virus to their baby is low.

Hospital staff can increase awareness of preterm labor risk in Covid-19 + women. This data also supports hospital policies supporting keeping mom and baby together after delivery.

How do pregnant women protect themself from Covid-19?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations.

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.

CDC Morbidity and Mortality Weekly Report, “Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020.

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Much remains unknown about the coronavirus’s effects on pregnant women and babies, but a recent pre-published manuscript titled “Infant Outcomes Following Maternal Infection With SARS-CoV-2” demonstrates highly encouraging results.

The new data shows that babies born to women with Covid-19 demonstrate no increase in low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

Based on what scientists know right now, there is no evidence indicating pregnant women are more at risk of contracting Covid-19 than the general public, but they are at a higher risk of getting sick from the virus.

During pregnancy, women have a temporarily suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk of respiratory problems when they contract similar viruses, such as influenza or pneumonia. OB-GYNs, therefore, consider pregnant women to be an at-risk group for respiratory compromise if they contract Covid-19. Additionally, preterm labor is a known risk when pregnant women contract viral illnesses such as MERS, SARS, and influenza. Preterm labor most likely results from the severity of the maternal illness and is not directly linked to the virus itself. In other words, preterm labor is not simply a result of contracting these viruses but rather dependent on the degree of illness that results.

In addition to preterm labor, OB-GYNs are concerned about a pregnant woman’s potential to pass Covid-19 to her baby during gestation. This is an example of what doctors call vertical transmission. Fortunately, data surveillance so far indicates that in utero coronavirus infections are very rare. According to the American College of Obstetricians and Gynecologists July practice advisory, “the data are reassuring that vertical transmission appears to be uncommon.”

The new data shows that babies born to women with Covid-19 demonstrate no increase in low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

NIH research indicates that in utero mom-to-baby transmission is rare because the placenta is missing key components the virus needs to enter the fetal circulation, namely ACE2 receptors and the TMPRSS2 enzyme. Both the ACE2 receptor and TMPRSS2 are present in the placenta but only in tiny amounts. The low levels likely explain why SARS-CoV-2 is unlikely to cross the placenta from mom to baby.

Over the past few months, scientists have studied more than 1,500 cases of maternal coronavirus infections. Current management guidelines for infants born to mothers with SARS-CoV-2 are based on data from the National Registry for Surveillance and Epidemiology of Perinatal Covid-19 Infection.

Current guidelines are based on data from previous experience with maternal respiratory infections, such as SARS and MERS, combined with incoming studies on Covid-19. The PRIORITY study(Pregnancy Coronavirus Outcomes Registry), a collaborative project between researchers at UCSF and UCLA, is an ongoing effort to track outcomes of pregnant women who contract SARS-CoV-2. This data surveillance adds valuable additional infant-outcome data beyond the neonatal period to better inform management policies and guidelines.

The PRIORITY study’s first publication brings some encouraging and reassuring news to the medical community.Data indicates that infants born to Covid-19-positive mothers do well in the first six to eight weeks after birth.

The manuscript, accepted for publication in Clinical Infectious Diseases, reports the infant outcomes of 179 pregnancies complicated by Covid-19 infection compared to a control group of 84 Covid-19-negative gestations.

The PRIORITY study data showed no increase in preterm birth, NICU admission, or upper-respiratory infections. The study cohort yielded no pneumonia or lower-respiratory infection cases through the first eight weeks of life.

The babies born to mothers with Covid-19 also showed a very low rate of acquiring the infection. Only 1.1% of infants tested positive in the first six to eight weeks when born to a mother who had Covid-19, confirmed by a positive SARS-CoV-2 PCR test. The Covid-19-positive infants demonstrated minimal symptoms.

The study authors note the limitations of the paper and encourage further studies to confirm newborn incidence rates, as they “were unable to estimate the incidence of infant SARS-CoV-2 infection because infant testing was incomplete and might be biased by both false-positive and false-negative results.”

The PRIORITY study’s control group includes both symptomatic and asymptomatic women who tested positive for SARS-CoV-2. The researchers indicate this cohort may not be representative of all U.S. pregnancies. The authors also note an underrepresentation of Black and LatinX moms in the study cohort compared to the current CDC statistics of pregnant women infected with SARS-CoV-2.

To improve future study participation, PRIORITY launched a Reproductive Health Equity and Birth Justice Core to increase enrollment of underrepresented groups.

Finally, the authors note that infant admissions to the NICU were higher among infants born to Covid-19-positive moms, and the babies were born at an earlier gestational age. The study authors were unable to determine if the increase in NICU admissions was directly related to SARS-CoV-2 or if the hospital practices for the management of mothers testing positive for Covid-19 explain the difference.

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What is COVID-19?

COVID-19 is a newly discovered virus caused by a type of coronavirus called SARS-CoV-2. It affects many areas of the body, especially the lungs and breathing.

Common symptoms include fever, cough, and trouble breathing. Many have gastrointestinal symptoms like nausea and diarrhea. An odd but common problem is the loss of your sense of smell or taste.

The most common symptoms may appear 2 to 14 days after you are exposed to the virus. Many patients with Covid-19 are asymptomatic carries meaning they have no symptoms or only mild symptoms.

Does COVID-19 affect pregnant women?

Researchers around the world are working to answer the question. Here are the highlights from a CDC report released in June.

Pregnant women who contract COVID-19 may be more likely to need care in an intensive care unit (ICU) or need a ventilator (for breathing support).

Pregnant women of color may have a higher risk of severe illness or need ICU care. This is likely caused by social and economic inequity, not biological differences.

The risk of death is not higher for pregnant women with COVID-19 than for non-pregnant women with COVID-19.

How does COVID-19 affect my baby?

There are many unanswered questions about pregnancy and Covid-19. Researchers study these issues around the world. Here’s what we know so far:

1. Preterm birth has been linked to other similar respiratory virus infections such as SARS and MERS. With COVID-19, some women have had preterm births. We do not yet know if COVID-19 was the cause.

2. Only a few cases of vertical transmission (mom passing the infection to baby) have been identified worldwide.

3. Babies can catch Covid-19 from a mom after delivery through the transmission of respiratory droplets.

How can pregnant women reduce the risk of coronavirus?

The key steps to mitigate the risk of catching the virus are to:

1. Limiting contact with other people as much as possible
2. Washing hands often with soap and water for at least 20 seconds
3. Wear a mask or cloth face-covering in public and any other needed protection while at work
4. Staying home as much as possible
5. Use hand sanitizer that contains at least 60 percent alcohol
6. Avoid touching your eyes, nose, and mouth

Pregnant women should take additional steps to stay healthy. Keeping your live or virtual prenatal care appointments are essential. Prenatal care may look and feel differently during the pandemic. OB-GYNs and midwives are reinventing prenatal care to provide safe care for all pregnant women, to limit the potential for exposure, and to reduce the risk for babies.

Expect changes. Be flexible with your providers, and please be kind to office employees and symptoms screeners working hard to keep you and your baby safe.

Do pregnant women need a mask or face covering?

As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to slow the spread of COVID-19. Studies have shown people spread the virus before showing any symptoms.

Wearing a mask protects others.

Face covers also protect the person wearing it.

Can pregnant women travel?

Covid-19 travel recommendations are updated frequently on the CDC’s Coronavirus Disease 2019 Information for Travel page.

What should a pregnant woman do if she thinks she has COVID-19?

If you think you may have been exposed to the coronavirus and have a fever or cough, call your ob-gyn or other healthcare professional for advice.

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

1. Difficulty breathing or shortness of breath (more than what has been normal for you during pregnancy)
2. Ongoing pain or pressure in the chest
3. Sudden confusion
4. Unable to respond to others
5. Blue lips or face

Call ahead before going to the hospital or office. If you have other concerning symptoms, call your ob-gyn or 911.

What should I do if I am pregnant and diagnosed with COVID-19?

The CDC provides guidelines for those diagnosed with COVID-19. Your Obgyn will help guide you through the process. The current CDC advice for all people with COVID-19 includes the following:

1. Stay home except to get medical care. Avoid public transportation.
2. Speak with your health care team over the phone before going to their office. Get medical care right away if you feel worse or think it’s an emergency.
3. Separate yourself from other people in your home.
4. Wear a face mask when you are around other people and when you go to get medical care

Will my labor and delivery plans change?

Talk with your ob-gyn or midwife about your birth plan. Hospital policies and procedures may change to help keep you and your baby safe.

Most hospitals have limited the number of allowed visitors and require face covers. Check with your hospital and ob-gyn or other health care professional about your birth plan.

What will happen during labor and delivery if I have COVID-19?

We have found labor and delivery to be the oasis in the hospital. The staff will be taking extra precautions to keep patients safe and reduce the risk of infection. We try to celebrate the joy of delivery each day.

Will I be separated from my baby if I have COVID-19?

Updated recommendations from the American Academy of Pediatrics recommend keeping baby with a mother who has Covid-19 but with certain precautions.

Can COVID-19 moms still breastfeed?

Researchers have not yet determined if COVID-19 can pass through breast milk and cause infection in the baby. The most recent data indicates it is Most safe to feed breast milk to your baby when you have COVID-19.

Breast milk is the best source of nutrition for most babies helping to protect babies against infections and boosting the immune system.

If you plan to breastfeed, talk with your ob-gyn or other health care professional to help teach techniques to reduce the risk of Covid-19 transmission.

This article was contributed by MacArthur Medical Center’s Dr. Rebecca Gray and will be featured in our newsletter the MacArthur Minute.

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Millions of pregnant women are worried and trying to understand what to do. They want to protect their babies and find out if they are at risk.

General Covid-19 information

The coronavirus is a new virus. The human race has never been exposed. We have no baseline immunity or protective antibodies. We do not have a vaccine, and there is no effective medication to treat it. We are all susceptible to becoming sick with Covid-19, the disease caused by the new coronavirus.

Covid-19 is spread through person-to-person contact via respiratory droplets. Droplets spread through coughing, sneezing, and breathing. Particles get on our clothes and hands. We then pass the virus through handshakes, hugging, kissing, and other close human contacts.

Because the coronavirus is a brand-new virus, we have minimal scientifically validated information.

Labor and delivery units across the country are moving at lightning speed to ensure a safe environment for childbirth.

Current information on Covid-19 in pregnancy

We do not know definitively if pregnant women are more susceptible to becoming sick with Covid-19. Based on current data, there is no evidence at this time indicating pregnant women are more at risk than the general public.

Pregnant women have a suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk for respiratory problems when they contract other similar viruses, such as influenza or pneumonia. For this reason, pregnant women are considered an at-risk group for respiratory compromise if they contract Covid-19. Influenza vaccination is critically important.

If you have not received your annual flu vaccine, you should do so now.

Preterm labor can be a risk when pregnant women contract other viral illnesses. Preterm labor likely results from the severity of the maternal illness and not a direct link to the virus itself. Limited case reports from China indicate the risk of preterm labor in women with Covid-19 is following similar patterns.

Can Covid-19 be passed to the baby?

At the current time, there is no indication that Covid-19 is passed to the baby through vertical transmission. There is no data indicating that Covid-19 is passed to the baby through the bloodstream or the placenta. This is very encouraging news for all pregnant women.

Studies to date demonstrate the virus has not been detected in amniotic fluid or placental cord blood. It has not been detected in breast milk. No infants born to mothers with Covid-19 have tested positive for Covid-19. A small study found no evidence of Covid-19 in the amniotic fluid or cord blood of six infants from infected women. Many are aware of a case report from the U.K. of one neonatal infection. This is considered the youngest patient to contract Covid-19. The case is being monitored closely. The current evidence suggests the baby acquired it through respiratory droplets and not in utero.

The CDC, American College of Obstetrics and Gynecology, and Society for Maternal-Fetal Medicine have issued statements indicating that much is unknown regarding transmission. The data available today is encouraging that mother-to-baby transmission does not occur.

Will my prenatal care change?

The reality is that the schedule for your prenatal visit schedule will change. OB-GYNs across the world are reinventing prenatal care. The goal is to provide safe care for all pregnant women, to limit the potential for exposure, and to reduce the burden on hospitals.

Pregnant women should expect changes. Visits may be less frequent. Some appointments will convert to telehealth. Be flexible as your OB-GYN providers and midwives work to make arrangements to provide safe, high-quality care based on rapidly evolving CDC guidelines.

Will my labor and delivery experience change?

Labor and delivery units across the country are moving at lightning speed to ensure a safe environment for childbirth. Changes are necessary. Most hospitals have instituted a one-visitor policy. It is crucial to limit the number of people entering hospital facilities.

Limiting visitors is for your safety. Please be flexible with your birth plans. The central goal for labor and delivery is always to end the day with a healthy mom and baby.

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations.

Can I breastfeed?

Studies thus far demonstrate that the coronavirus is not present in breast milk. The CDC has not yet released a statement on the safety of breastfeeding in a known maternal case of Covid-19.

For patients without suspected Covid-19, breastfeeding should be encouraged. Breastfeeding helps build the immune system for newborns. We should encourage extra precautions when handling a newborn. Hand-washing is key. Breast pumps or bottles must be properly cleaned.

How do I protect myself?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations.

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze. Immediately discard the tissue.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.

Should I get a Covid-19 test?

No. Please do not overwhelm the health system. Every test takes up resources and valuable personal protective equipment. If you feel sick, you do not need a test. A negative test does not mean that you do not or will not have the virus. A positive test does not change management. Regardless of the test results, the recommendations will be two weeks of home isolation and supportive measures such as fluids, rest, and acetaminophen.

Only those experiencing severe symptoms, such as difficulty breathing, need in-person medical evaluation.

What do I do if I feel sick?

1. Stay at home and away from others, including family.
2. Wash your hands with soap and water for at least 20 seconds.
3. Cover your mouth if you cough or sneeze.
4. Wear a face covering when out in public.
5. Clean surfaces in the home using household cleaning sprays or wipes.
6. Rest.
7. Stay hydrated.
8. Treat fever with Tylenol per the package instructions.
9. Monitor for worsening symptoms, and present for evaluation if you experience difficulty breathing.
10. Notify your provider before a visit so precautions can be taken.

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