At present, we know very little about coronavirus and pregnancy, in breastfeeding moms or in newborns. There is limited data from other coronavirus outbreaks (SARS-CoV, MERS-CoV) that suggests pregnant women may be at higher risk of more severe disease with greater morbidity and mortality however, the published case studies thus far suggest COVID-19 may not be as severe as SARS and MERS were. Here is what you need to know:
- Some suggestion that severity of maternal illness is related to pre-existing maternal co-morbidities
- Adverse pregnancy outcomes are most likely correlated to severity of maternal illness
- The vast majority of reported cases in pregnant women were mild-moderate with largely good outcomes with fever being the most common presenting symptom
- Spontaneous or iatrogenic preterm labour is the most common adverse outcome
- COVID-19 positive women most often delivered via c-section for “fetal distress” (no consistent definition provided across studies for this term)
- 1 stillbirth reported (seems to be associated with severity of maternal illness)
- No documented association with teratogenicity at this time
- Vertical maternal-fetal transmission cannot be ruled out (3 reported cases from NYC, 1 from China w/potential vertical transmission) however, these newborns did well clinically
- No virus detected in breast milk of infected mothers
- Same case definitions and testing criteria should be applied in pregnant women
Reference: Zaigham M, Andersson O. Maternal and Perinatal Outcomes with COVID-19: a systematic review of 108 pregnancies [published online ahead of print, 2020 Apr 7]. Acta Obstet Gynecol Scand. 2020;10.1111/aogs.13867. doi:10.1111/aogs.13867
Breastfeeding Considerations for COVID Probably or Positive Patients
The benefits of breastfeeding for both mother and baby are well established. While data is currently limited, a small study has identified that there is no detectable coronavirus levels in breast milk despite maternal illness. Additionally, there may be some benefit as maternal antibodies are likely passed to the infant. The Public Health Agency of Canada (PHAC), the World Health Organization (WHO), and the Canadian Pediatric Society (CPS) recommend mothers continue to breast feed, if they are well enough, during infection with COVID-19. The main concern is for respiratory droplet transmission from mother to baby. To address these concerns, you should advise women to:
- Wear a mask (surgical preferred but cloth if surgical not available)
- Wash their hands thoroughly before holding their baby
- Clean their breast and chest area thoroughly with water and soap prior to each feed.
If a woman chooses to pump and feed the baby expressed breast milk instead, ensure they are still washing their hands and cleaning all pump equipment and bottles/nipples thoroughly.
Reference: Narvey M, Canadian Paediatric Society, Fetus and Newborn Committee. Breastfeeding when mothers have suspected or proven COVID-19. Canadian Paediatric Society Position Point. April 6, 2020.
Patient Resources on Having a Baby During COVID-19
If you have any questions or need further assistance with COVID in pregnancy, please reach out to us at the Maternity Centre of Hamilton (905 528 5553) and one of our clinicians would be happy to help you