Information for pregnant women in the COVID-19 era

18 March 2020

Roughly 110,000 women give birth in the Czech Republic every year, meaning there are about 300 births per day. A full-term pregnancy lasts 280 days, meaning that at any given moment there are about 85,000 women in various stages of pregnancy in the Czech Republic.
In their reporting, the news outlets and media focus on describing the general situation, which is very alarming. It may be assumed that pregnant women are even more concerned about this general information regarding COVID-19 because a heightened interest in their own health and an increased feeling of responsibility are entirely natural during pregnancy and motherhood. Some women will be less alarmed, some more, but many are absolutely terrified, as we have witnessed in our work. Their partners and relatives are often even more concerned than they are.
The purpose of this text is to provide you and your family members with information about the risks relating to COVID-19 during pregnancy. I by no means wish to downplay the situation around COVID-19 in any way, but panic can do a lot of needless harm.

Epidemiological situation

  • The epidemiological situation is changing rapidly, and more accurate information is available from other sources, e.g. from the Ministry of Health website.
  • Despite the vast numbers of infected patients around the world, only a few dozen cases of pregnant women with COVID-19 have been documented.
  • There has been no record of the death of a mother, foetus or new-born infant in connection to COVID-19.
  • Healthy women (which includes most pregnant women in the CR) are no more susceptible to the viral infection than the general population.
  • Heightened caution is required for women with other disorders (greatly weakened immunity, cancer, chronic lung disorders, etc.).
  • It is worth keeping in mind that there are very likely individuals who show no symptoms yet can transmit the virus.

Virus transmission

  • The virus spreads from person to person via the respiratory system through droplets, contaminated surfaces and conjunctiva when touched by contaminated hands.
  • The virus has been found on faeces and in vaginal secretions, but this means of transmitting the virus to the foetus during birth has not been proven.
  • Based on existing data, the virus is most likely not transmitted from mother to foetus in the womb (only 1 or 2 cases have been documented), however infection of the new-born infant after birth is possible due to the infant’s close contact with the mother.

Impact on pregnant women and new mothers

  • The course of the disease in pregnant women tends to be very moderate and is usually similar to that of a common cold. Other symptoms may include a cough, shortness of breath and a fever.
  • The worst symptoms, such as pneumonia and hypoxia (oxygen deficiency) appear mainly in the high-risk population – the elderly, people with compromised immunity and chronic illnesses such as diabetes, cancer and chronic lung disorders.
  • To date, only one case of severe disease progression in a pregnant women has been documented (this was in China). The woman was in the 30th week of pregnancy, required mechanical lung ventilation but recovered after giving birth.

Impact on early complications in pregnancy

  • At present, no data is available about an increased risk of miscarriage in the early stages of pregnancy.
  • There are no data about any increased risk of congenital defects due to coming into contact with the virus.
  • It must nevertheless be noted that viral diseases generally increase the risk of these complications, meaning it is worthwhile to protect oneself as one would from other viral diseases, e.g. the flu.
  • Experience with the MERS and SARS viruses (which are related to coronavirus) have not proven any connection with an increased risk of first- or second-trimester miscarriage.

Care for new mothers and new-born infants during and after birth

  • Care during childbirth or the birthing method do not significantly differ.
  • It is not recommended to isolate the new-born infant and mother after childbirth. The recommendation from China in the early phase of the current epidemic was the opposite and isolation of the new-born infant for 14 days was advised. The risks and consequences of such a procedure must be assessed individually – separation, impact on breastfeeding, etc.
  • Presence of the virus was not confirmed when testing samples of mother’s milk (6 cases in China).
  • The greatest risk related to breastfeeding is therefore the proximity of the new-born child and the mother and the potential risk of contagion through droplets.
  • The benefits of breastfeeding outweigh the risks associated with isolation of a new-born infant.
  • When caring for a child and breastfeeding, it is advisable to observe the following principles:
    • Hand hygiene before touching the child
    • Wear a face mask
    • If pumping breastmilk, ask a healthy person to assist when feeding the pumped milk to the new-born infant

So what are the main risks and challenges related to COVID-19 at maternity units?

  • The greatest challenge is controlling the transmission of the disease from person to person and preventing infection among healthcare staff and its subsequent spread!!!
  • Spreading of the disease among healthcare staff and the subsequent measures (the infected people must remain at home and anybody who was in contact with them must be quarantined) could lead to problems with staffing maternity and neonatal units, especially smaller ones.
  • This is not an alarmist statement. Consider the situation at the maternity unit in Frýdek Místek, which was closed for 14 days because of quarantine.
  • Please respect the preventive measures ordered by the individual hospitals.

General recommendations for pregnant women who have come into contact with COVID-19 or have symptoms of COVID-19 infection

  • The same general rules apply as for other people – see the information on the website of the Ministry of Health of the Czech Republic.
  • Patients should telephone 112 to obtain more information.
  • Patients should not automatically visit healthcare facilities, their general practitioner or gynaecologist where they are registered without giving prior notice.
  • If it is necessary to visit a maternity ward while a pregnant women is in quarantine (childbirth, essential examination at a doctor’s office, etc.), we recommend that you:
    • travel to the maternity unit in your own car, if possible
    • telephone line 112 and contact the maternity unit via telephone
    • arrive wearing your own face mask, if possible
    • contact the maternity unit again upon arrival at the hospital compound so that the staff can take care of the pregnant woman immediately she enters the ward – this helps limit free movement among other pregnant women, new mothers, other patients and healthcare staff

Wishing you all the best,

Doc. MUDr. Ondřej Šimetka, Ph.D., MBA

Head of the Perinatology Centre
Chairman of the Gynaecological – Obstetrics Clinic
Ostrava University Hospital

Information valid as at 14 March 2020