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I am pregnant: what are the risks for me and my baby, before and after the birth?

Text updated on 2020-07-15

No need to stress! Pregnant women are no more likely to be infected with COVID-19 than others. The risk of transmitting the coronavirus to their baby during pregnancy is low. There is no transmission of the coronavirus to the baby through breast milk. If you have the COVID-19 virus, to avoid passing it on during delivery or afterwards, wear a mask in the presence of your newborn and wash your hands frequently!

COVID-19 is a recently discovered disease (December 2019) and there is still little data to provide the hindsight needed to answer these questions categorically. However, available data appear very reassuring for pregnant women! Pregnancy in itself does not increase the risk of being infected with COVID-19 and does not increase the risk of having a serious issue. Of course, care must be taken to respect barrier gestures, without becoming overly anxious.

If you are pregnant with COVID-19 , the risk of transmitting SARS-CoV-2 in utero to the fetus is very low. In most studies of pregnant women with COVID-19 during the third trimester of pregnancy, the coronavirus is not detected in the placenta, amniotic fluid, umbilical cord, or nasal cavity of the newborn during birth. No data on transmission in the first and second trimesters are yet available. After birth, if you wish to breastfeed, do so without any worries! If you wash your hands well before breastfeeding, there is no risk of transmitting the SARS-CoV-2 coronavirus through breastfeeding because the coronavirus is not present in breast milk. However, it is very important to wear a mask when breastfeeding to protect the baby. The risk of passing the coronavirus to your baby is the same as the risk of passing it on to others. Of course, it is difficult to maintain a distance of more than one meter from your baby, so a mask is essential during and after delivery to protect your baby because s/he does not wear one.

One last reassuring fact: if, despite all the precautions, your baby catches COVID-19, the risk of serious illness for children is very low.

Sources

116 pregnant women with HIV COVID-19 were monitored in China between 20 January and 24 March 2020. A diagnostic test for SARS-CoV-2 was performed in 86% of the newborns and all tests were negative. In 10 newborns, the amniotic fluid and umbilical cord were also tested with negative results. Vaginal secretions were tested in 6 women with negative results. In 20 women, breast milk was tested with negative results for SARS-CoV-2.

Yan, J., Guo, J., Fan, C., Juan, J., Yu, X., Li, J., ... & Lei, D. (2020). Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. American journal of obstetrics and gynecology.

9 pregnant women with COVID-19 were followed up at the Wuhan hospital in January-February 2020. The authors concluded that intrauterine transmission is unlikely to occur shortly before delivery since SARS-CoV-2 was not detected in amniotic fluid, placenta, umbilical cord, breast milk, or nasal secretions of newborns.

Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W., ... & Liao, J. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet, 395(10226), 809-815.

7 pregnant women suffering from the COVID-19 disease were followed between January 1 and February 8, 2020 until they gave birth. The newborns had a normal weight and normal APGAR score. One newborn was born with COVID-19 within 36 hours of delivery but without severe signs and recovered quickly.

Yu, N., Li, W., Kang, Q., Xiong, Z., Wang, S., Lin, X., ... & Chen, S. (2020). Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. The Lancet Infectious Diseases.

Follow-up of 38 pregnant women COVID-19 in China until they gave birth. None developed severe symptoms. There were no cases of in utero transmission of the SARS-CoV-2 coronavirus from mother to fetus. In 7 newborns tested, SARS-CoV-2 was not identified in the amniotic fluid, placenta, umbilical cord, or nasal secretions suggesting that in the last trimester of pregnancy there is no transmission of SARS-CoV-2 to the fetus.

Schwartz, D. A. (2020). An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Archives of pathology & laboratory medicine. In press

This article summarizes 33 studies involving the follow-up of 385 pregnant women: the clinical picture and severity COVID-19 during pregnancy is comparable to that observed in non-pregnant individuals.

Elshafeey, F., Magdi, R., Hindi, N., Elshebiny, M., Farrag, N., Mahdy, S., ... & Amir, A. (2020). A systematic scoping review of COVID-19 during pregnancy and childbirth. International Journal of Gynecology & Obstetrics.

Review of 20 pregnancy follow-up studies in women with COVID-19. A total of 164 pregnancies were followed. Among these pregnant women, only 2.4% developed respiratory distress. Preprint

Chamseddine, R. S., Wahbeh, F., Chervenak, F., Salomon, L. J., Ahmed, B., & Rafii, A. (2020). Pregnancy and Neonatal Outcomes in SARS-CoV-2 Infection: a systematic review. medRxiv.

UK study of a cohort of 427 pregnant women COVID-19 hospitalized between March 1 and April 14, 2020. Estimated incidence of 4.9 per 1000 maternity patients. The authors found an effect of ethnicity, presence of pre-existing co-morbidities (diabetes, hypertension, etc.), age, and obesity on the risk of being hospitalized due to pregnancy. Approximately 1 in 10 pregnant women required mechanical ventilation. The case-fatality rate in these pregnant women with COVID-19 is 1.2%. 2% of infants tested positive for SARS-CoV-2 without any indication of the time of infection that would not allow for a conclusion on the transmission during pregnancy. The positive newborns had no severe signs of COVID-19 Preprint

Knight, M., Bunch, K., Vousden, N., Morris, E., Simpson, N., Gale, C., ... & Kurinczuk, J. J. (2020). Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS). medRxiv.

Case study in a pregnant woman infected with SARS-CoV-2 during the third trimester of pregnancy. SARS-CoV-2 was found in the placenta and the newborn developed clinical signs of COVID-19 post-partum.

Vivanti, A., Vauloup-Fellous, C., Prevot, S., Zupan, V., Suffee, C., Do Cao, J., ... & De Luca, D. (2020). Transplacental transmission of SARS-CoV-2 infection. Nature Communications 11, 3572.

Data on the number of deaths in hospital (excluding EHPAD) in France (excluding Overseas Departments) by age group:

Out of a total of 18,542 deaths, there were no COVID-19 deaths in the under-10 age group and 3 deaths in the 10-19 age group in the period from February 1 to May 31, 2020.