As the total number of confirmed global coronavirus cases continues to climb, people around the world are becoming increasingly concerned. According to data from the World Health Organization, more than 109,570 people have tested positive for the novel coronavirus, known also as COVID-19, since it first surfaced in December. And while there continues to be much we don't yet know about COVID-19, health officials are looking into how the novel coronavirus could affect pregnancy.
"It's understandable that pregnant women would be concerned about exposure to the virus and any negative effect it could have on their health and the health of their fetus," Christopher Zahn, MD, the American College of Obstetricians and Gynecologists' vice president of Practice Activities, tells Romper. "However, it is critical to note that at this time, for the general public in the United States, the immediate health risk from COVID-19 is considered low."
While the majority of coronavirus infections have been reported within mainland China, cases have been confirmed on every continent except Antartica. As of March 9, the U.S. Centers for Disease Control and Prevention (CDC) has reported more than 420 confirmed and presumptive positive cases of the virus spread across 35 states in the U.S.
Efforts to contain and mitigate the virus' spread have led to some school closures in Washington state, where more than 160 people have tested positive for coronavirus and 22 people have died as a result of the virus. But how dangerous is the novel coronavirus for pregnant women? Here's a breakdown of what is currently known and not known.
Do Pregnant Women Have A Higher Risk Of Contracting Coronavirus?
At the moment, there's very little research on pregnancy and the novel coronavirus, and no known research on pregnant women's susceptibility to catching the virus. That means there's no way to say for certain if pregnant women are more likely to contract the coronavirus compared to a non-pregnant adult.
However, the CDC has noted that the immunologic and physiologic changes women experience during pregnancy "might make them more susceptible to viral respiratory infections, including COVID-19."
If Pregnant Women Get Coronavirus, Will Symptoms Be More Severe?
While the Royal College of Obstetricians and Gynecologists (RCOG) has argued that "pregnant women do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population," other health organizations have said otherwise. Both the CDC and the American College of Obstetricians and Gynecologists (ACOG) have said that pregnant women may have a higher risk of experiencing "severe illness, morbidity, or mortality compared with the general population." This stems from research into how other coronavirus infections, such as SARS-CoV and MERS-CoV, affect pregnant women.
"As with other viruses, we believe pregnant women may be at higher risk of severe illness, morbidity, or mortality compared with the general population," Zahn tells Romper. "However, currently very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19."
The CDC has maintained that, for the general public in the United States, who are unlikely to be exposed to this virus, the "immediate health risk from COVID-19 is considered low." For those living or working in communities where community spread of the virus has been reported, the risk of exposure is "elevated though still relatively low."
Additionally, a small Wuhan University study of nine women who contracted the coronavirus while in their third trimester found that none of the women experienced especially severe symptoms. That being said, pregnant women's potential to have a higher risk for severe illness, morbidity, or mortality, means it's likely better to error on the side of overly cautious and contact a health care provider as soon as possible if they begin to experience telltale coronavirus symptoms, which include fever, cough, and shortness of breath.
Could Coronavirus Increase The Risk Of Adverse Pregnancy Outcomes?
Again, research into pregnancy and the coronavirus is severely limited and, in fact, the CDC has noted that it does not have any information on adverse pregnancy outcomes and the coronavirus. CDC health officials, however, noted that some adverse pregnancy outcomes like miscarriage and stillbirth have been recorded in cases involving other coronaviruses like SARS-CoV and MERS-CoV.
The CDC also notes that a high fever in the first trimester of pregnancy can increase an infant's risk for certain birth defects. Additionally, the ACOG has said that some adverse infant outcomes such as preterm birth have been reported "among infants born to mothers positive for COVID-19 during pregnancy." The organization has however cautioned that data remains limited and noted it was not completely clear that these outcomes were related to the coronavirus.
Can Coronavirus Be Transmitted In Utero?
Although limited by a small sample size and a retrospective method of research, scientists from Wuhan University, published in The Lancet Journal, found no evidence of intrauterine infection among women who contracted the coronavirus late in pregnancy. For their study, researchers examined the amniotic fluid, cord blood, and neonatal throat swab samples from nine mothers and infants delivered via C-section. They have noted that the effect of coronavirus on the fetus in the first or second trimester remains unknown.
Additionally, the RCOG has also noted that, currently, "there is no evidence of intrauterine fetal infection with COVID-19." As a result, the RCOG also noted that coronavirus' congenital effects on fetal development are considered to be unlikely at the moment.
What If Breastfeeding Mothers Get Coronavirus?
In their limited study, scientists from Wuhan University found no evidence of the coronavirus in breast milk samples taken from women who tested positive for the virus. Similarly, the CDC has noted that in the limited cases of women with SARS-CoV breastfeeding, the virus was not detected in their milk, and, in fact, one women's breast milk contained antibodies against the virus.
In its guidance for breastfeeding while confirmed to have the coronavirus, the CDC urged women to "take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast." When expressing milk with a breast pump, the CDC recommends the woman thoroughly wash her hands before touching any part of the pump or bottle and follow proper pump cleaning directions after each use.
How Can Pregnant Women Protect Themselves Against Coronavirus?
To limit the potential for infection, the CDC has encouraged pregnant women to practice the "usual preventive actions" one might take to avoid contracting an infection, such as washing your hands often and avoiding those who are sick. And those who come into contact with a person confirmed to have COVID-19 are urged by health officials to self-isolate for at least 14 days.
As COVID-19 is a new virus, according to CDC health officials, there is still "a lot of uncertainty" and guidances are "likely" to change as more research emerges. In the meantime, it's important to stay updated on new developments regarding the coronavirus outbreak.
If you think you’re showing symptoms of coronavirus, which include fever, shortness of breath, and cough, call your doctor before going to get tested. If you’re anxious about the virus’s spread in your community, visit the CDC for up-to-date information and resources, or seek out mental health support. You can find all of Romper’s parents + coronavirus coverage here, and Bustle’s constantly updated, general “what to know about coronavirus” here.
Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., … Zhang, Y. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet Journal, 395(10226). doi: 10.1016/S0140-6736(20)30360-3
Christopher Zahn, MD, Vice President of Practice Activities at the American College of Obstetricians and Gynecologists