PREGANCY AND COVID-19

Many doctors were surprised when pregnant women were included in Government coronavirus at-risk groups.

That prompted the Royal Colleges who are experts in this field to issue statements saying the science had not changed.

Now the guidance for healthcare professionals has moved onto its third version.

Medscape UK asked the Royal College of Obstetricians and Gynaecologists (RCOG) what's new or changed in the latest guidance?

An RCOG spokesperson answered our questions by email.

Q&A 

What's new or changed in the latest guidance?

The RCOG guidance has been updated to include Government special measures for pregnant women.

Pregnant women are now considered a vulnerable risk group and should reduce social contact where possible. Where pregnant women can work from home, they should do so.

We are working with the Government and should have clearer guidance around working arrangements for pregnant healthcare professionals due to be published shortly.

Was the RCOG surprised pregnant women were added to the Government's list of at-risk groups for isolation?

The Government has announced that women who are pregnant should limit social contact. This is purely a precautionary measure, to reduce the theoretical risk to the baby’s growth and a risk of preterm birth should the mother become unwell.

There is currently no new evidence to suggest that pregnant women are at a greater risk of coronavirus than other healthy individuals, or that they can pass the infection to their baby while pregnant.

It is important to note Government advice for pregnant women – who are not showing any symptoms – is not self-isolation. Pregnant women are still able to do things that are essential to daily life, such as taking their children to nursery or school, and attend antenatal appointments which are essential to ensure a woman and her baby’s wellbeing.

Is the guidance ahead of the science, keeping pace, or lagging?

The RCOG clinical team is continually reviewing the latest evidence available and updating guidance for women and healthcare professionals.

How hard is it for colleagues to reassure women worried about the risks?

Currently no evidence suggests that pregnant women are at a greater risk of coronavirus than other healthy individuals, or that they can pass the infection to their baby while pregnant. It is important to reassure pregnant women, but also advise them to take precautionary measures, such as limiting social contact where possible, to avoid risk of transmission.

Are there special arrangements in hospitals or maternity units?

The NHS is making arrangements to ensure that pregnant women are supported and cared for safely through pregnancy, birth, and the period afterwards, even during this epidemic.

Maternity units are increasingly providing consultations via phone or video link, when appropriate, so pregnant women do not have to travel unnecessarily to the hospital. Elective gynaecology operations are being postponed and, in many units, arrangements are being made for gynaecology doctors to work in the maternity unit.

Areas are being designated for women with known or suspected COVID-19 infection. Teams of doctors and midwives are carrying out regular drills to prepare for caring for women with this infection, including dealing with emergency obstetric situations.

What information do you need from collected global experiences to make further changes?

Currently, the amount of information we have on the outcomes for pregnant women with COVID-19 and their babies is reassuring, but sparse. We are very keen to see more published evidence as soon as possible. We know that doctors in the most severely affected areas are very busy indeed and it is difficult for them to find the time to collate, write up and publish their data. But we are encouraging them to do so as soon as they can, so that we and others around the world can base our recommendations on more robust evidence.

Virtual Antenatal Courses 

In another development, the childbirth charity NCT is moving its antenatal courses online instead of face-to-face.

NCT Chief Executive Angela McConville said in a statement: "We want to support mums- and dads-to-be at a very stressful time while taking on board Government guidance about social distancing. So this week we’ve launched our antenatal classes in a virtual format and will be providing online courses for the foreseeable future. Expectant parents need social connection now more than ever.

"Our new courses are interactive, engaging and social and provide an essential lifeline in these worrying times. Our experienced course leaders continue to provide essential evidence-based information about pregnancy, birth, and the early days with a newborn. They’re still local so also enable new mums and dads to build a community support network of other parents having a baby at the same time.Infants born to mothers with COVID-19 appeared to be healthy with no clinical evidence of COVID-19, according to a case series from Wuhan, China.

This early in the COVID-19 pandemic, little is known regarding infant and childhood infections and their clinical picture.

Writing in Frontiers in Pediatrics, Dr. Yalan Liu and colleagues from Tongji Medical College, Huang zhong University of Science and Technology in Wuhan describe the clinical course of four full-term infants born to pregnant women with COVID-19 infection during the third trimester.

Three infants were born by cesarean section due to concerns about symptomatic maternal infection; the fourth was born by vaginal delivery.

All infants were isolated from their mothers immediately after birth. All had 1-minute Apgar scores of 7-8 and 5-minute Apgar scores of 8-9.

Three infants tested negative for COVID-19 in throat swab specimens by RT-PCR 72 hours after birth; the fourth infant's parents declined testing.

Two infants were healthy and clinically normal, and two had transient rashes that resolved spontaneously. One infant developed transient tachypnea of the newborn requiring nasal continuous positive airway pressure, but his breathing became regular within three days. He was taking full formula on day 5 and was discharged from the neonatal intensive care unit on day 7.

All four babies were doing well and receiving formula feeding at last follow-up.

These findings, along with an earlier report, appear to indicate that vertical transmission of COVID-19, if it occurs, is rare.

There has been a case report of neonatal COVID-19 infection in China 36 hours after birth, but it remains unclear whether this is a case of vertical transmission from mother to child.

Dr. David A. Schwartz from Medical College of Georgia in Augusta, who recently reviewed potential maternal and infant outcomes from SARS-CoV-2, the causative agent in COVID-19, told Reuters Health by email, "At this time in the evolution of the SARS-CoV-2 pandemic, pregnant women with COVID-19 do not appear to be at risk for transmitting the virus to their fetus during the 3rd trimester. However, there remains little or no information available on the effects of COVID-19 infection occurring early in pregnancy."

"According to my analysis of a large number of pregnant women with COVID-19 and their infants, which is soon to be published in the Archives of Pathology & Laboratory Medicine, the journal of the College of American Pathologists, no maternal deaths have occurred and there are still no confirmed cases of intrauterine transmission of the virus to the fetus," he said. "I am also not aware of confirmed cases of intrauterine transmission from personal communications with my colleagues in China and elsewhere."