SARS-CoV-2 (COVID-19) and Pregnant Women in the Health Care Workforce
A Statement from the Women in Medicine Legacy Foundation
The effects in pregnant women of SARS-CoV-2, the virus causing COVID-19, are not fully understood, although many articles on this topic can be found in the medical literature. Transmission of the virus from mother to fetus has not been demonstrated but cannot be ruled out. Stillbirths, miscarriages, placental infection, and the need for intensive care of the newborn have been reported, but it is not known whether these adverse outcomes are the result of COVID-19 infection of the mother. More data are needed. As pregnancy alone places the expectant mother at risk, pregnant women are deemed by many experts to be a high-risk population for COVID-19 infections.
There are no data at present to support the premise that pregnant women or their fetuses or newborns will not be harmed by exposure to individuals with COVID-19 infection. We do know, however, that some professional medical societies outside of the United States (in the United Kingdom and New Zealand) take a precautionary stance with regard to the possibility of harm to the mother and fetus, and those organizations recommend that pregnant healthcare workers avoid contact with patients with confirmed or suspected COVID-19.
While we await additional data in the United States, an understanding of the information available about the impact of COVID-19 on the mother and fetus, and the limitations of the data, may help inform personal decisions. For those who decide to work with patients infected with COVID-19, the wisdom of the need to access to state of the art protective equipment and other measures to reduce exposure is evidence-based. It is important to remember that the health of the pregnant woman is foremost, determinant, and essential to the health of the fetus and newborn.
Update: Research from the CDC
On June 26, 2020, the CDC published data on the SARS-CoV-2 infection and pregnancy. Read their findings in this report.
Update: Research from the International AIDS Conference
Italian researchers confirm two infections at birth, suggesting COVID-19 is transmitted to babies in utero. Read more.
References
American College of Obstetricians and Gynecologists and Society for Maternal-fetal Medicine. Joint Statement: Recent Developments Regarding COVID-19 and Pregnant Women. April 6, 2020
Baud D et al Research Letter. Second-Trimester Miscarriage in a Pregnant Woman with SARS-CoV-2 Infection. JAMA April 30, 2020
Campbell KH et al. Prevalence of SARS-CoV-2 among patients admitted for childbirth in Southern Connecticut. JAMA May 26, 2020
Chen L et al Clinical Characteristics of Pregnant Women with COVID-19 in Wuhan, China. NEJM April 17, 2020. Mild disease in 109 of 118 women, 92%
Chen H et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 8-9-815
Donders F et al. ASIDOG Recommendations concerning COVID-19 and Pregnancy. Diagnostics 2020; 10: 243
Favre G et al 2019 nCoVepidemic: what about pregnancies? Lancet 2020; 395 (10224): e 40
Narang K, Ibirogba ER, Elrefaei A. et al. SARS-CoV-2 in Pregnancy: A Comprehensive of Current Guidelines. J. Clin. Med May 18, 2020, 9, 1521; doi:10.3390/jcm9051521
Royal College of Obstetricians and Gynaecologists. Updated Advice for Pregnant Healthcare Workers and Employers during the Coronavirus Outbreak. March 21, 2020 https://www.rcog.org.uk/en/news/updated-advice-for-pregnant-healthcare-workers-and-employers-during-coronavirus-outbreak/
ANZICS COVID-19 Working Group. The Australian and New Zealand Intensive Care Society COVID-19 Guidelines. 16 March 2020. http://cec.health.nsw.gov.au/__data/assets/pdf_file/0004/572512/ANZICS-COVID-19-Guidelines-Version-1.pdf