Clinicians spent over a year researching the unique risks of infants born to women with a confirmed SARS-CoV-2 infection. While some dangers have been identified, other study findings are promising.
Last year, pregnant women made up one-quarter of women ages 15 to 49 years old hospitalized with COVID-19 between March 1 and Aug. 22, according to the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). During the early stages of the pandemic, little was known about how this new disease would impact pregnant women and newborns. Now, several studies have emerged that establish evidence-based recommendations for standards of care.
Bad news: Possible Increased Risk of Premature Birth
Pregnant women who become ill with COVID-19 may be at increased risk for having a premature birth. According to the CDC’s Morbidity and Mortality Weekly Report, out of 445 births reported, 12.6% of infants were born premature in women hospitalized with COVID-19. The CDC states this rate is approximately 25% higher than the rate of premature birth in women without COVID-19.
While more studies are needed to understand why premature births are occurring more frequently in patients with COVID-19, researchers urge healthcare providers to counsel women on the potential link of severe COVID-19 illness and adverse pregnancy outcomes, as well as educate them on strategies to prevent infection.
Good news: Low Risk of COVID-19 Transmission After Birth
In early 2020, women with active COVID-19 infections who just gave birth were advised to isolate from their newborn for two weeks and asked not to breastfeed. These recommendations came out of little knowledge of the illness and fear of the mother transferring the virus to the newborn. With greater knowledge available, the guidelines have changed. One observational cohort study published in The Lancet Child & Adolescent Health was instrumental in changing the guidelines by discovering more about neonatal management and outcomes during COVID-19.
“This is a respiratory illness that is transmitted through respiratory droplets,” says Christine M. Salvatore, MD, Chief of the Division of Pediatric Infectious Diseases at Weill Cornell Medicine and NewYork-Presbyterian. “With the small experience [we] had with other coronaviruses, we knew that transmission through the womb or breast milk was very rare. However, you cannot base a hypothesis on assumptions. You need to study it to ensure you are correct.”
Dr. Salvatore, a contributing author to the study, and her colleagues created a clinic for babies born to mothers with COVID-19. They had three goals in mind: 1) to care for mothers with COVID-19 who may be turned away from other pediatrician offices because of the active illness; 2) to implement best infection control practices; and 3) to identify potential risk factors associated with transmission.
The clinic identified all babies born to mothers positive for COVID-19 at delivery at three NewYork-Presbyterian Hospitals from March 22 to May 17. There were 106 mothers referred to the clinic. Mothers were allowed to practice skin-to-skin care and breastfeed, but followed strict mask wearing and hygiene practices. The babies were also kept in closed isolettes next to their mothers unless medically required to be removed.
Babies were tested for SARS-CoV-2 by use of real-time PCR on nasopharyngeal swabs at one day, one week and two weeks old. Out of the 82 babies born to COVID-19-positive mothers who completed follow-ups, none tested positive for COVID-19. Findings from this study were consistent with other small case series that suggest transmission from infected mothers is rare if infection precautions are taken.
“With proper precautions, babies are going to be protected and likely not develop infection,” Dr. Salvatore says. “Breastfeeding is a beneficial tool we have for babies that should be pursued and advised. Even if the mother has a COVID-19 infection, we should not remove that nutrition element for a baby if the mother wishes to use it.”
Implications for Standard of Care
Healthcare providers can take what we now know about perinatal transmission and apply it to patient care. During prenatal care appointments, physicians can discuss the importance of following prevention measures to reduce COVID-19 risk, including frequent handwashing, mask wearing and avoiding crowds where social distancing isn’t possible.
If a pregnant woman gets COVID-19, the risk of her transmitting the infection to her baby is extremely rare if proper precautions are taken. Providers can advise mothers to wear surgical masks and follow proper hand and breast hygiene around their babies until they are no longer infectious.
Additionally, healthcare providers should also be especially sensitive as women positive for COVID-19 navigate the difficult time after birth, Dr. Salvatore says.
“This isn’t easy for new mothers,” Dr. Salvatore says. “Mothers can’t kiss their babies, and babies can’t see their mothers. It’s intense from a medical and emotional perspective for both parents and doctors.”
Especially during the first 12 months after delivery — even more so during the COVID-19 pandemic — OB/GYNs and other healthcare professionals should evaluate new mothers for mental health concerns and offer support options.
While research is still ongoing and our knowledge is building regarding this novel disease, the data that is being obtained continues to guide the standard of care and to help providers establish more evidence-based strategies to protect new-born patients.