To date, there have been over 9000 pregnant patients in Canada diagnosed with COVID-19. An ongoing case count is updated regularly and can be accessed at: https://ridprogram.med.ubc.ca/cancovid-preg/. Our current understanding of this illness in pregnancy, based on Canadian and global data, is summarized below.
Risk and Severity of Illness
- Pregnancy does not increase the risk of acquiring COVID infection.
- The majority (85 to 90%) of pregnant individuals infected with COVID-19 are asymptomatic or experience mild to moderate symptoms and have a good prognosis but data on adverse outcomes is evolving
- The most common presenting symptoms are cough and fever.
- Pregnant patients infected with COVID are at risk of more severe disease including higher rates of hospitalization (RR 4.26 95% CI 3.45-5.10), intensive care unit admission (RR 11.39 95% CI 7.90-15.21), mechanical ventilation (OR 2.59 95% CI 2.28-2.94), and consideration for ECMO (OR 2.02 95% CI 1.22-3.34) than comparative nonpregnant patients.
- Similar to the general population, comorbidities including advanced maternal age (>35 years), obesity, pre-existing diabetes mellitus and hypertension put pregnant individuals at increased risk of severe COVID-19 disease, including ICU admission and need for mechanical ventilation.
- There is not yet enough data to confidently state the impact of VOCs on the severity of illness in this population.
Diagnosis, Testing and Monitoring
- Diagnosis, testing and monitoring for pregnant individuals is the same as nonpregnant individuals.
- Diagnosis can be made based on a positive RAT, positive PCR (if eligible for testing), or as per the clinical algorithm.
- Symptomatic pregnant individuals ARE eligible for PCR testing. Asymptomatic pregnant people remain ineligible at this time.
- Pregnant individuals should be risk stratified as at least moderate and may be bumped to high if there are other comorbidities. This should guide outpatient monitoring parameters (See hfam risk stratification table).
- Additionally, monitoring should include assessment of fetal movements (after 20 weeks GA) and presence of contractions (COVID is a risk factor for preterm labour).
- It is also helpful to alert the patient’s obstetrical care provider of their COVID status to facilitate any additional monitoring and/or planning regarding mode and timing of delivery if required.
- Newborns born to individuals who have confirmed COVID infection at the time of birth should be tested in the first 24hrs of life. This will be done by the in-hospital newborn care providers, including those patients that are followed by midwifery and may be discharged home prior to the 24hr period.
- The benefits of breastfeeding for both mother and baby are well established.
- A living systematic review found 9 of 84 samples of breast milk tested positive for SARS-CoV-2. Six infants were exposed to SARS-CoV-2-positive milk, and four infants tested positive for SARS-CoV-2. However, in no case could positivity in the newborn be confirmed to have occurred through transmission from consumed breast milk.
- Maternal antibodies are likely passed to the infant via breastmilk and may offer a protective benefit.
- Many organizations (including The Public Health Agency of Canada (PHAC), the World Health Organization (WHO), the Canadian Pediatric Society (CPS) and the Society of Obstetrician and Gynecologists of Canada (SOGC)) recommend mothers continue to breastfeed, if they are well enough, during infection with COVID-19.
- To decrease transmission via respiratory droplets, COVID positive mothers should be encouraged to wear a mask (surgical preferred) and wash their hands thoroughly before feeding their baby.
- If a mother chooses to pump and feed the baby expressed breast milk instead, they are still advised to wash their hands and clean all pump equipment and bottles/nipples thoroughly and wear a mask when in close contact (<6 ft) with the newborn.
- Pregnant individuals were excluded from many RCTs conducted on the currently available vaccines against COVID-19.
- Local and global studies (observational and retrospective cohort) have shown COVID-19 vaccination to be safe and effective at reducing severity of illness in this population.
- No adverse maternal or newborn effects have been found with vaccination in any trimester.
- Given the higher severity of illness in pregnant individuals and the associated perinatal adverse outcomes, pregnant individuals should be strongly recommended to get vaccinated as soon as they are able.
- More information on COVID-19 vaccines and pregnancy can be found on this page under 11. Vaccines and special populations.
- SOGC (Canada) COVID 19 Resources
- Ontario Science Table – Science brief
- PCMCH (Ontario) Maternal Newborn COVID information
- ACOG (USA) – COVID-19 FAQs
- ROM & RCOG (UK) – Coronavirus (COVID-19) Infection in Pregnancy
- CPS (Canada) – Breastfeeding and COVID-19
- Health Nexus – COVID-19 patient resources
- ACOG – COVID-19 patient resources
- PCMCH COVID -19 Vaccine Information Page
- I am pregnant or breastfeeding. Should I get the COVID-19 vaccine? (Provincial Council for Maternal and Child Health, January 25, 2022)
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