March 20, 2020
The coronavirus pandemic has placed expectant mothers in the Philadelphia region under additional stress, raising concerns about the way COVID-19 affects pregnancy, delivery and the baby's health.
Much in this realm remains unknown. But Jefferson Health is advising pregnant women – and anyone in their household – to stay at home as much as possible.
Jefferson's maternal fetal medicine division released new guidelines Thursday for navigating pregnancy during the current public health emergency.
"Pregnant women might be at increased risk from complications from COVID-19," said Dr. Vincenzo Berghella, the division's director. "In particular, if they get pneumonia, they are at increased risk of miscarriage, preterm birth, preeclampsia, and their babies of stillbirth and neonatal death, as well as admission to intensive care unit.
"Pregnant women should try to remain at home as much as possible, as should those in the same home; therefore we are decreasing as much as possible in-person prenatal visits, and using instead telehealth, keeping in touch closely with them via web."
The limited published research suggests that an infected pregnant woman does not transmit the virus to the fetus. A study in Frontiers in Pediatrics reported that four pregnant women who tested positive for COVID-19 in Wuhan, China gave birth to full-term infants who didn't have the illness.
But recent news from London suggests otherwise. There, a baby tested positive for coronavirus just minutes after being born.
Jefferson's recommendations include reducing office visits and asking pregnant women to monitor their blood pressure at home, if possible. Those numbers can be reported to their physicians during telehealth visits.
Visits to measure a baby's growth and check for abnormalities should be combined whenever possible with in-person visits and laboratory tests.
Other guidelines include prohibiting a support person to accompany the patient to outpatient visits – and even delivery – unless the accompanying individual is an essential part of patient care, and creating separate areas for patients who have have COVID-19. Testing is recommended for pregnant women with any flu-like symptoms.
Patients with gestational diabetes or preeclampsia should plan weekly visits with daily blood-pressure checks at home. All lab work should be completed at the time of in-person visits.
"We know that these recommendations won't cover every situation," Berghella said. "In areas with a higher COVID-19 incidence more restrictive measures will be likely appropriate. This guidance is changing daily, in fact hourly. Stay tuned."
The recommendations were published in the American Journal of Obstetrics & Gynecology.