How does the new coronavirus affect pregnancy?

We have received many questions about Covid-19—the infection caused by the new coronavirus—from readers who are pregnant or have a family member who is pregnant. We have tried to answer as many questions are possible in the information below.

Please note that the evidence and advice about Covid-19 is rapidly changing. The below information is a summary of what we know to date.

For more information visit the Royal College of Obstetricians and Gynaecologists’ (RCOG) guidance for pregnant women and their families. The World Health Organisation (WHO) has also provided answers to common questions on Covid-19, pregnancy, childbirth and breastfeeding.

The latest Public Health England (PHE) guidance is available here.

Scientific evidence on the risk of Covid-19 to pregnant women

Based on the limited data available, the WHO writes, there is currently no evidence to suggest that pregnant women are at greater risk of severe illness from Covid-19 than the general population. According to the RCOG, there is also no evidence that Covid-19 during pregnancy leads to any problems with the baby’s development or causes miscarriage.

There have been several reported cases of young babies testing positive for the new coronavirus in the UK and elsewhere. The WHO currently says that it is not known whether Covid-19 can be passed from mother to child before or during birth (known as vertical transmission). 

However, the RCOG writes that vertical transmission is one way that a baby may catch the new coronavirus. Whilst three early studies of pregnant women with Covid-19 in China found no evidence of vertical transmission, the RCOG reports of two cases where this type of transmission was probable.

However, as emphasised by the RCOG, “in all reported cases of newborn babies developing coronavirus very soon after birth, the baby was well” and it is unlikely that the virus causes problems with infant development.

There have been a small number of premature births reported among babies born to women with Covid-19 symptoms in China. However, it is unclear whether these babies were induced early because of their mother’s illness or whether Covid-19 directly led to premature birth. 

The RCOG reports that there is no evidence showing that the new coronavirus can be spread from mother to infant via breast milk. 

Medical experts are taking a cautious approach to advice around this new virus.

Other respiratory infections, such as influenza (the common flu) and other coronaviruses, are associated with a higher risk of severe illness in pregnant women. This is thought to be because of changes to women's bodies and immune systems during pregnancy.

Due to these outcomes from other respiratory infections, and the fact that so little is known about Covid-19, health experts are remaining cautious with recommendations to pregnant women.

The RCOG reports that “near-real-time surveillance” is being conducted on all women who develop Covid-19 during pregnancy, and any changes in evidence will be updated on their website.

Advice for pregnant women and their families from the UK government 

While the evidence doesn’t suggest pregnant women are more at risk, they are included in PHE’s list of vulnerable groups, alongside people who are aged 70 and older (regardless of medical conditions) and those under 70 with certain underlying health conditions. 

The Chief Medical Officer to the UK Government, Professor Chris Whitty, said that this was a precautionary measure because not enough is currently known about the effect of Covid-19 on pregnancy and unborn children.

Current guidance for pregnant women with no symptoms of Covid-19

PHEs advice for pregnant women is to strictly follow the social distancing measures (listed below) that have been issued to the general public.

These say to:

1. “Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough
2. Avoid non-essential use of public transport when possible
3. Work from home, where possible. Your employer should support you to do this. Please refer to employer guidance for more information
4. Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together.
5. Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
6. Use telephone or online services to contact your GP or other essential services”

Alongside other groups considered vulnerable, PHE also says to “significantly limit your face-to-face interaction with friends and family if possible”. 

The RCOG further specifies that it is women in their third trimester (more than 28 weeks pregnant) that “should be particularly attentive to social distancing and minimising contact with others”.

On 26 March, the RCOG published advice specifically for pregnant healthcare workers. This says that women at any stage of pregnancy should be offered a choice about whether they would like to work in patient-facing roles during the pandemic. From the third trimester, it is recommended that pregnant women stay at home.  

Current guidance for pregnant women with symptoms of Covid-19

For pregnant women who develop symptoms for Covid-19 (the most common being a new continuous cough and/or a high temperature), they are advised, like other members of the public, to self-isolate. 

 New advice published on 18 May now says that anyone experiencing loss of taste or smell (known as 'anosmia') should also self-isolate.

Anyone with particular concerns about themselves or their baby during self-isolation is advised by the RCOG to contact their midwife or, for out-of-hours help, their maternity team.

For women due to go to an antenatal appointment during self-isolation, the RCOG advises you to contact your midwife or antenatal clinic to inform them of your circumstances. Unless your appointment is urgent, it will likely be delayed until isolation ends.

The RCOG says that women with Covid-19 can breastfeed, but does recommend the following precautions to limit transmission of the virus whilst breastfeeding:

• “Wash your hands before touching your baby, breast pump or bottles
• Try to avoid coughing or sneezing on your baby while feeding at the breast
• Consider wearing a face mask while breastfeeding, if available
• Follow recommendations for pump cleaning after each use
• Consider asking someone who is well to feed your expressed breast milk to your baby.”