Coronavirus (COVID-19) in Pregnancy and Lactation : 9 Facts You Need to Know Today

Dr. Mostafa S Hassan March 14, 2020 coronaviruses, COVID-19, SARS-CoV2

COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first reported in December 2019 in Hubei province of China. The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. Epidemiologists and Media pundits have been talking about COVID-19 pandemics since early 2020. The word pandemic is often misunderstood in the general population and even among health care providers causing unreasonable fear or unjustified acceptance that disease is out of control and the fight is over. 

As a physician leader in the community, we have a responsibility to alleviate this unreasonable fear and be truthful about what we know and don’t. In a pandemic situation, there are two early reactions that take place in the society way before medical and public health intervention become available and effective and . One of the early reactions is the “blame game” where medical professionals have very little role. But we certainly shall play a major role managing the “Panic reaction” secondary to fear of unknown that is taking place in the society. In this digital era, there is no shortage of facts and myths in the media about COVID-19, it is a burden on the society to filter those information to find the legit ones. Furthermore, not everyone has time to follow or comprehend evolving CDC or WHO guidelines. Public awareness, preparedness and containment is key to the success in this global health crisis.

Being a Neonatal Intensivist, I am getting numerous inquiries about the transmission of COVID-19 from anxious pregnant and lactating women. Those concerns are valid and reasonable and should be addressed.

Pregnant women are at increased risk for severe pneumonia and respiratory infection due to physiological and immunological changes in the body. Some studies had shown respiratory infection leading to increased risk of preterm delivery. Therefore, pregnant women should be considered an at-risk group.

COVID-19 in pregnant women:

  • Covid-19 disease is spread primarily by respiratory droplets.
  • Testing criteria for pregnant women and children are same as for adults.
  • Effects on pregnant women and fetus during first and second trimester are unknown.
  • While there are many unknown effects of COVID-19 in pregnant and lactating mothers, findings of one published study was reassuring. Based on the result of a limited study of a small cohort (9 pregnant women in the third trimester), there is no current evidence suggesting that development of COVID-19 pneumonia in late pregnancy could lead to adverse outcome in newborn or fetal infection resulting from mother to baby transmission. Additionally, no virus was detected in breast milk of those 9 mothers with COVID-19 disease.

COVID-19 and Breastfeeding

  • CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant.
  • Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed.
  • A mother with confirmed COVID-19 or who is a symptomatic person-under-investigation (PUI) for COVID-19 should 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.
  • If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use.
  • If possible, consider having someone who is well cared for and feed the expressed breast milk to the infant.

At this moment of world health emergency, we all need to play our role as a provider and educator; the society is looking for our guidance. We are in the panic phase of the COVID-19 pandemic and this is the moment we all are trained and prepared for during our lifetime of education in medical science. COVID-19 testing is available at state level now. Let us all get to work today and prepare the society for the current and any future needs.

[This discussion is primarily for public health awareness and based on frequently asked questions on COVID-19. Information provided is for guidance only and not intended for continued medical education for health care providers.]

Current CDC guidance on COVID-19 and breastfeeding is available here

Current CDC information on COVID-19 and pregnancy and neonates

Practice Advisory: Novel Coronavirus 2019 (COVID-19)

Mostafa S Hassan, MD

Dr. Mostafa Hassan is an attending Neonatologist at Nemours Children’s Hospital, Orlando. After graduating from Sylhet Osmani Medical College (class of 1983) Dr. Hassan had completed residency training in Pediatrics and fellowship in Neonatology-Perinatal Medicine from New York Medical College. Dr. Mostafa Hassan is a life member of Bangladesh Medical Association of North America (BMANA) and BMANA, FL.

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