9. Pregnancy and Breastfeeding

Today we’re talking about something that has been on the mind of many mothers and mothers-to-be: the impact of COVID-19 on pregnancy and breastfeeding.

 

COVID-19 and pregnancy

The national obstetrical and gynecologic societies of Canada, the USA, and UK have all issued guidance on COVID-19 and pregnancy1-3 There is no strong evidence that pregnant women are at increased risk of contracting COVID-19 compared to the general population4 Symptoms in pregnant patients are typically similar to the general population: malaise, cough, dyspnea, fever5,6 Pregnant patients are not at increased risk of severe disease; however critically ill mothers have a high risk of intrauterine fetal demise and neonatal mortality4 The most frequently documented adverse outcome in pregnant patients with COVID-19 is spontaneous or iatrogenic preterm labour7,8 There is no strong evidence for vertical transmission of COVID-191 One study reported no presence of SARS-CoV-2 in samples of amniotic fluid, placenta, neonatal throat swab, anal swab and breastmilk9 Most neonates test negative on RT- PCR, however, IgM and IgG antibodies and elevated IL-6 were found in the sera of 6 neonates born to mothers with COVID-19, despite the neonates themselves having negative RT-PCR tests7 C-sections, preferably with epidural anesthesia, have been considered safe for both the health care workers and the patients, with appropriate airborne precautions and safety measures10 FIGO guideline highlights11 Antepartum care Suggest treatment in tertiary care hospitals with effective isolation facilities and PPE  CT chest may be considered in addition to the diagnostic algorithm  Close fetal monitoring Delivery COVID-19 itself not an indication for delivery unless there is need for improving maternal oxygenation Negative pressure room for suspected/confirmed cases Vaginal delivery or C-section, but short procedure time Postpartum care Separation if mother is critically ill Co-rooming if mild disease or asymptomatic: washing hands, respiratory hygiene

 

COVID-19 and breastfeeding

The WHO provides balanced, practical guidelines on breastfeeding for patients with COVID-19, which weigh the enormous benefits of close physical contact between newborn babies and their mothers with the potential risks of COVID transmission12 Mothers with confirmed COVID-19 are encouraged to breastfeed, if they wish to do so. Mothers should use excellent respiratory hygiene, wear a mask if one is available, and routinely clean and disinfect high-touch surfaces Mothers with confirmed COVID-19 are encouraged to have close contact with their newborns, including skin-to-skin and room sharing. Mothers should use excellent respiratory hygiene, wash hands frequently, and regularly clean surfaces. For working mothers pumping while working on the front lines: there is no good evidence around this It is our personal feeling that this can certainly be done safely – weighing the benefits of breast milk with the theoretical risks of transmission Use excellent hand-hygiene and regular thorough cleaning practices

 

 

 

Sources

Elwood C, Boucoiran I, VanSchalkwyk J et al. Updated SOGC Committee Opinion – COVID-19 in Pregnancy. Updated Mar 13 2020. https://www.sogc.org/en/content/featured-news/Updated-SOGC-Committee-Opinion__COVID-19-in-Pregnancy.aspx Novel Coronavirus 2019 (COVID-19): Practice Advisory. American College of Obstetricians and Gynecologists (Immunization, Infectious Disease, Public Health Preparedness Expert Work Group). Updated Apr 23 2020. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019 Coronavirus (COVID-19) Infection in Pregnancy: Information for healthcare professionals. Royal College of Obstetrics and Gynaecologists (UK). May 13 2020. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/ Qiao J. What are the risks of COVID-19 infection in Pregnant Women? Lancet, Mar 2020. doi:10.1016/S0140-6736(20)30365-2 Beslin N, Baptiste C, Gyamfi-Bannerman C et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM,Apr 2020. doi:10.1016/j.ajogmf.2020.100118 Chen L, Li Q, Zheng D et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. New Eng J Med, Apr 2020. doi:10.1056/NEJMc2009226 Parazzini F, Bortolus R, Mauri PA et al. Delivery in pregnant women infected with SARS-CoV-2: A fast review. Int J Obstet Gynecol, Apr 2020. doi:10.1002/ijgo.13166 Gajbhiye R, Modi D, Mahale S. Pregnancy outcomes, Newborn complications and Maternal-Fetal Transmission of SARS-CoV- 2 in women with COVID-19: A systematic review. MedRxiv, pre-print, Apr 2020. doi:10.1101/2020.04.11.20062356v1 Yin M, Zhang L, Deng G et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Pregnancy In China: A Retrospective Cohort Study. MedRxiv pre-print, Apr 2020. doi:10.1101/2020.04.07.20053744 Chen R, Zhang Y, Huang L et al. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth, Mar 2020. doi:10.1007/s12630-020-01630-7 Poon LC, Yang H, Kapur A et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynaecol Obstet, Apr 2020. doi:10.1002/ijgo.13156 World Health Organization. Q&A on COVID-19 , pregnancy, childbirth, and breastfeeding. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid-19-and-breastfeeding. Updated May 7 2020.