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COVID-19 and pregnancy
Q. What is the main advice for pregnant women?
Studies from the UK show that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 may be at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester. Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution.
Pregnant women should follow the latest government guidance on staying alert and safe (social distancing) and avoid anyone who has symptoms suggestive of COVID-19. If you are in your third trimester (more than 28 weeks’ pregnant) you should be particularly attentive to social distancing.
Key advice for pregnant women during the pandemic:
Q. What should I do if I develop symptoms of COVID-19?
- The main symptoms of COVID-19 are a high temperature, a new, continuous cough or a loss or change to your normal sense of smell or taste (anosmia).
- If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland online for information and advice, and follow the guidance for households with possible or confirmed COVID-19 infection.
- You should tell your midwife or maternity team that you have symptoms of COVID-19.
- If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
- Seek medical advice as early as possible if you have any questions or concerns about you or your baby.
Q. What effect does COVID-19 have on pregnant women?
Current evidence from the UK suggests that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 may be at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester.
Studies have shown that there are higher rates of admission to intensive care units for pregnant women with COVID-19 compared to non-pregnant women with COVID-19. It is important to note that this may be because clinicians are more likely to take a more cautious approach when deciding whether to admit someone to the intensive care unit when a woman is pregnant.
At present, it is unclear whether pregnancy will impact on the proportion of women who experience ‘long COVID’ or a post COVID-19 condition.
In the UK, information about all pregnant women requiring admission to hospital with COVID-19 is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).
The first report from this study included information about the outcomes of 427 pregnant women admitted to hospital with COVID-19 and their babies during the pandemic, and was published in May 2020. While most women in the study required only ward treatment and were discharged home well, around one in ten women required intensive care, and sadly five women with COVID-19 died, although it is currently unclear if COVID-19 was the cause of their death. The study found that the majority of women who did become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing and good hand hygiene from 28 weeks of pregnancy. An update of the UKOSS report is being prepared (a draft form of the update was published in January 2021). The updated report includes information on 1,148 pregnant women admitted to hospital with COVID-19. It has similar findings to the first UKOSS study: the vast majority of women were discharged home after simple ward care, about 1 woman in 20 required intensive care, and sadly 8 women died. Six of those deaths were because of COVID-19, and two deaths were from unrelated causes.
The UKOSS study and more recent publications have found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for COVID-19. Pregnant women over the age of 35, those who had a BMI of 25 or more, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital. Living in areas or households of increased socioeconomic deprivation is also known to increase risk of developing severe illness.
Q. What research is being done to monitor the effect of COVID-19 on pregnant women and their babies?
The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for COVID-19 during pregnancy, through well-established systems already used by all maternity units – this is the UK Obstetric Surveillance System (UKOSS). Any new evidence published from this and other studies will be used to update our guidance.
Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with COVID-19. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR). You can also ask your maternity team about any local research that is taking place in your area.
The COVID-19 Symptom Study app has been developed by King’s College London and health science company ZOE. Members of the public, including pregnant women, can use this app to report on their health during the COVID-19 pandemic.
Q. Why are pregnant women in a vulnerable group?
Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution. This is because in a small proportion of women pregnancy can alter how your body handles severe viral infections, and some viral infections such as flu, are worse in pregnant women. Amongst pregnant women, the highest risk of becoming severely unwell (should you contract the virus) appears to be for those who are 28 weeks pregnant or beyond. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and they are used to caring for pregnant women in this situation.
Current evidence suggests that hospital admission may be more common in pregnant women with COVID-19 than in non-pregnant women of the same age, however this is partly because pregnant women are also admitted to hospital for reasons unrelated to COVID-19. In the UKOSS study, which examined women with COVID-19 in pregnancy during the spring and summer in the UK, the majority of pregnant women with COVID-19 admitted to hospital were in the third trimester of pregnancy. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and that this is particularly important at 28 weeks’ pregnancy and beyond.
Q. Should I take Vitamin D supplementation?
Vitamin D supplementation is recommended to all women during pregnancy.
There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop COVID-19. However, there is not enough evidence to show that taking vitamin D prevents COVID-19 infection or is an effective treatment.
Most people living in northern hemispheres will have low levels of vitamin D. Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D. We therefore advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep their bones and muscles healthy.
Vitamin D supplements are available from most pharmacies and supermarkets and for eligible families, through the NHS Healthy Start scheme
Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.
Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.
Q. What should I do if I develop a temperature, a new cough, or both, when I am pregnant?
If you develop a temperature or a cough, or both, in pregnancy, you should arrange to have a coronavirus (COVID-19) test. While waiting for a test result you should self-isolate. If you are feeling unwell you should contact your maternity unit or NHS 111 or NHS 24 in Scotland for advice.
Please also be alert to the other possible causes of fever/temperature in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby’s movements, contact your maternity team, who will be able to provide further advice.
Q. What is the international travel advice if I am pregnant?
If you are in the UK, you should follow the advice given by the Foreign and Commonwealth Office, which is being regularly updated in line with the evolving situation.
All individuals, including pregnant women, should ensure they have adequate insurance arrangements prior to travel. You should also check that your travel insurance will provide cover for birth and care of your newborn baby if you give birth while abroad.
Q. What is the advice for pregnant women with older children attending school/nursery/external childcare?
Pregnant women were placed in the vulnerable category as a precaution during the COVID-19 pandemic. The government‘s guidance on schools and early years settings advises that: children and young people who live with someone who is pregnant (vulnerable) can attend school and early years settings. See the next question for information about pregnant women who are classed as extremely vulnerable.
All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). Pregnant women are at no greater risk of contracting COVID-19 than other healthy adults. However, there are additional concerns for pregnant women in the third trimester. This is based on evidence from the UKOSS study on pregnant women admitted with COVID-19 to UK hospitals from March – August 2020; evidence suggesting an increased risk of admission to intensive care during the pandemic for women who are pregnant; and a recognition of the challenges in caring for women who are heavily pregnant, and the risk of the baby needing to be born early for the woman’s wellbeing. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and that this is particularly important at 28 weeks’ pregnancy and beyond.
When you take your children to school/nursery/external childcare, you should ensure you practice social distancing – stay two metres away from teachers/carers and other parents and do not go inside the building. If this is difficult, then consider staggering your child’s drop off and pick up times. Remember to wash your hands when you return home and ensure that your children wash their hands when they leave the childcare setting. Alcohol gel can be used if they cannot wash their hands with soap and water.
If you are concerned about the choice of returning to school or other childcare settings based on the risk to children attending, helpful information is available from the RCPCH.
Q. What is the advice for pregnant women who are classed as extremely vulnerable (previously classed as shielding) on older children attending school/nursery/external childcare?
Some pregnant women with pre-existing severe medical illnesses have been classed as extremely vulnerable. If you are considered to be extremely vulnerable, you will have been advised of this by your medical team, in a letter informing you of the actions you need to take.
The government has published guidance on shielding and protecting people who are clinically extremely vulnerable. This guidance provides advice on measures to protect extremely clinically vulnerable people depending on the COVID alert level in your area. Even in this situation, if schools and childcare settings remain open, the UK government advice is that children and young people who live in a household where another member is shielding should attend school/nursery/external childcare if stringent social distancing, and hand hygiene, can be adhered to.
Q. Should I still attend my routine antenatal appointments and scans in the community and at Homerton Hospital?
Maternity care is essential and has been developed over many years to reduce complications in pregnant women and babies. Not attending antenatal care risks potential harm to you and your baby. It is important that you continue to attend all of your planned care as long as you remain well. Staff at Homerton follow Public Health England infection prevention and control guidance stringently and use appropriate PPE in order to promote a safe environment. Lateral flow testing prior to all scans and appointments is currently in place. Please see the drop-down section on “Visting Homerton during Covid-19” for more details.
Antenatal classes have been suspended at the current time but resources for you to read and watch at home are available on the Homerton website. These include slide-shows and videos containing all the information which would usually be taught in our antenatal classes
COVID-19 and labour/ birth
Q. What is I have tested positive for Covid-19 when I go into labour?
As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour, are being advised to attend an obstetric unit for birth (rather than the Birth Centre or a Homebirth), where the baby can be monitored using continuous electronic fetal monitoring, and your oxygen levels can be monitored hourly.
The continuous fetal monitoring is to check how your baby is coping with labour. As continuous fetal monitoring can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife led unit, where only midwives would be present.
Women with suspected or confirmed coronavirus are advised not to use the pool during labour as it is an infection risk.
There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth plan should be followed as closely as possible based on your wishes. However, if your respiratory condition (breathing) suggested that urgent delivery would be needed, a caesarean birth may be recommended.
There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. There is no evidence that the use of Entonox (gas and air) is an aerosol-generating procedure (AGP) and so we are continuing to offer it.The labour ward team will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you.
If you go into labour, you should call your maternity unit for advice via Delivery suite on 020 8510 7351/7352, and inform them that you have suspected or confirmed coronavirus infection. If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as per standard practice. This means we would advise you to stay at home until your labour is well established.
When you and your maternity team decide you need to attend the maternity unit, general recommendations about hospital attendance will apply:
- You will be advised to attend hospital via private transport where possible, or call 111/999 for advice as appropriate
- You will be met at the maternity unit entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room
- Coronavirus testing may be arranged
- Your birth partner(s) will be able to stay with you throughout.
COVID-19 and your baby
Q. What effect will COVID-19 have on my baby if I am diagnosed with the infection during pregnancy?
Current evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far.
There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.
Transmission of the COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a newborn baby gets COVID-19 is not affected by mode of birth, feeding choice or whether the woman and baby stay together. It is important to emphasise that in most of the reported cases of newborn babies developing COVID-19 very soon after birth, the babies remained well.
Studies have shown that there is a two to three times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. In most cases this was because it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are.
The updated UK Obstetric Surveillance Study (UKOSS) report from January 2021 describes 1,148 pregnant women with COVID-19 who were admitted to hospital between March and September 2020. Nearly one in five women with symptomatic COVID-19 gave birth prematurely. However, women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely. The babies of women with COVID-19 were more likely to be admitted to the neonatal intensive care unit (NICU), but almost all these babies did well. There was no increase in stillbirth rate, and no increase in infant death for babies born to women who had COVID-19. Not all the babies were tested, but overall, only 1 baby in 50 tested positive for COVID-19, suggesting that transmission of the infection to the baby is low.
Q. What effect will COVID-19 have on my baby’s care if I am diagnosed with the infection at the time of birth?
Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth and will be able to have skin-to-skin contact.
Babies and children under two should not wear masks or other face coverings, as they may risk suffocation.
The well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk and therefore we would recommend you continue to breastfeed if this is your choice. The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.
If you choose to breastfeed your baby, the following precautions are recommended:
- Wash your hands before touching your baby, breast pump or bottles
- Try and avoid coughing or sneezing on your baby while feeding at the breast;
- Consider wearing a face mask while breastfeeding, if available
- Follow recommendations for pump cleaning after each use
- Consider asking someone who is well to feed expressed breast milk to your baby.
If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.
COVID-19 vaccination and pregnancy
Q. Should I have the Covid-19 vaccination in pregnancy?
The latest advice from the Joint Committee on Vaccination and Immunisation (JCVI) is that COVID-19 vaccines should be offered to pregnant women at the same time as the rest of the population, based on their age and clinical risk group. Women should discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances.
The latest advice and a decision-making tool can be found here on the RCOG Website:
https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19-vaccines-pregnancy-and-breastfeeding/
