EDITORS’ NOTE, UPDATED OCTOBER 27, 2021: The information in this story was accurate as of the publishing date, but is now outdated. We now know that unvaccinated pregnant people were admitted to hospital ICUs at an alarming rate during the third and fourth waves of the COVID-19 pandemic. In September 2021, the Centers for Disease Control and Prevention (CDC) issued an urgent warning with updated data: Pregnant people with symptomatic COVID have an increased risk of severe illness and a 70 percent increased risk of death. There’s also an increased risk of preterm birth, stillbirth or NICU admission for the baby. These poorer outcomes—especially with the Delta variant—have been noted in hospitals in Canada, the U.S. and the U.K., where media reports noted that the ICUs had filled up disproportionately with young, pregnant patients, many giving birth by C-section while hooked up to life support machines. In fact, since this article was reported, many health authorities now recommend vaccination as a way to protect pregnant people and their unborn babies, and some countries have since prioritized pregnant people for COVID vaccines, followed by a third dose or booster shot.
With the coronavirus, known as COVID-19, dominating headlines, it’s a scary time to be a parent. But pregnant women have even more to worry about, because pregnancy can make women more vulnerable to illness generally. You may also have seen images from China of fully geared health workers caring for the newborns of infected women who had given birth—could that happen to you?
The good news is, COVID-19 doesn’t seem to be worse for pregnant women than for other adults, and we aren’t likely to see infected moms separated from their babies here in North America. But there are some extra precautions that pregnant women should keep in mind.
Pregnant women are often more susceptible to respiratory illness
With the flu, and with previous viruses similar to this coronavirus, like SARS and MERS (although the data is limited), pregnant women have been more likely to get severely ill. One study found that women were three times as likely to be hospitalized with influenza, compared to the general population. (Another reason to get that flu shot!) And during the 2003 SARS outbreak, pregnant women were more likely to die, compared to the general population.
Why are pregnant women more susceptible to these viruses? Vanessa Poliquin, an obstetrician and reproductive diseases specialist at the University of Manitoba, explains that pregnancy puts pressure on the lungs, and that can reduce lung capacity. Plus, the heart beats faster as “there are more oxygen demands on a pregnant women’s body,” because it is supporting the fetus. “So for an infection to stress that whole cardiorespiratory system a little bit more can cause a pregnant woman to enter into respiratory distress more quickly,” says Poliquin.
But pregnant women don’t seem to be more at risk of coronavirus than the general population
Based on limited data so far, this coronavirus, COVID-19, doesn’t seem to be extra risky for pregnant women, compared to non-pregnant people. An analysis by a team of World Health Organization and Chinese officials included 147 pregnant women either suspected or confirmed to have COVID-19. Only 8 percent had severe disease, meaning rapid and strained breathing that required hospitalization. In addition, 1 percent of the women were in critical condition, meaning they required mechanical ventilation, and no deaths were reported. In comparison, 6 percent of the overall laboratory-confirmed COVID-19 cases in the analysis were considered critical. (The overall numbers include elderly people).
And while you may have heard that pregnant women are more immunocompromised in general, it’s more nuanced than that. Pregnancy causes immune changes that lead to more severe disease with some pathogens, but not others, explains Denise Jamieson, chair of gynecology and obstetrics at Emory University and one of the experts behind COVID-19 guidelines put out by the American College of Obstetricians and Gynecologists. In other words, simply being pregnant might not pose any additional immunity risk with COVID-19, but we’ll want to gather more data to know for sure.
Coronavirus isn’t linked to fetal abnormalities, but could harm fetuses indirectly
It’s very unlikely that this coronavirus, COVID-19 could be passed through the placenta, infect fetuses and cause fetal abnormalities, according to Poliquin. We don’t see this ‘vertical transmission’ with other respiratory viruses, like the flu, and so far, babies born to women who had COVID-19 have been born healthy and free of the virus.
That said, if a woman gets very sick in pregnancy, no matter what the cause is, that can lead to complications, like preterm labour, Jamieson explains. And fevers in pregnant women are believed to increase the risk of miscarriage and birth defects. That’s why, if a pregnant woman has a temperature above 100F, it should be treated. “We advise pregnant women to take acetaminophen and keep their fever down, particularly early in pregnancy, but really anytime in pregnancy,” says Jamieson.
Still, neither Jamieson nor Poliquin are recommending that women delay getting pregnant because of COVID-19, given there’s no indication of vertical transmission, and pregnant women so far aren’t disproportionately affected by severe illness. As to severe illness leading to adverse affects, that risk exists with the flu as well, Poliquin explains. Her point is that there will always be risk and women shouldn’t change life plans, but instead take precautions. That means washing hands frequently and staying at least three feet away from someone who is coughing.
Women who have coronavirus can still have a vaginal birth and breastfeed
While pregnant women with coronavirus have undergone C-sections in China to minimize the newborn’s risk of contracting COVID-19, American and Canadian experts say a C-section isn’t necessary (unless a woman is too sick to go through labour). That’s because the respiratory infection is spread through droplets from coughing, and touching our hands to our mouths and noses. It’s not acquired in the birth canal.
Likewise, while infants in China have been separated from their COVID-19 infected parents, we won’t see that happen here. Poliquin is one of the experts working on new guidelines for Canada’s Society of Obstetricians and Gynecologists, which were released March 13. She says women who give birth with COVID-19 will be given similar instructions to those who give birth with the flu. That means moms will be instructed to shower before skin-to-skin contact, wash hands frequently, and breastfeed with a mask. (These are the instructions in Manitoba’s already available provincial guidelines.)
Why the more relaxed recommendations here, compared to China? For one, based on limited data, there have been no reports of severe disease in infants. For another, “antibodies that can pass through the breastmilk might actually be beneficial” to protect babies from illness, says Poliquin. Furthermore, the virus hasn’t been detected in breastmilk from moms with COVID-19. That said, Jamieson points out that if a woman is coughing a lot and “unable to control” secretions with a mask, pumping and having someone else bottle feed may be appropriate. As she puts it, “There are certainly risks of COVID-19 but we have good evidence that there are benefits to breastfeeding and mother-infant bonding.” Those risks and benefits should be weighed “with shared decision making between the mother and her healthcare team.”