Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus called the SARS-CoV-2 virus. This virus spreads from person to person mainly via close contact and through respiratory droplets produced when an infected person sneezes, coughs or talks.
The main symptoms of COVID-19 infection are fever, cough or a loss or change to your normal sense of smell or taste. More severe symptoms of infection include shortness of breath and confusion. However, some may not experience any symptoms at all (asymptomatic infection).
As there is currently no available vaccine yet for the prevention of COVID-19 disease, the best way to prevent illness is to avoid being exposed to the virus. Steps that you can take to achieve this include:
From the existing medical knowledge, it does not appear that pregnant women are at a higher risk of getting infected with COVID-19 compared to the non-pregnant population.
Testing for COVID-19 infection is done via a nasopharyngeal swab polymerase chain reaction (PCR) test that looks for the SARS-CoV-2 virus.
Currently, there are no specific vaccines or medications for COVID-19 infection, although various treatments are being researched.
Management of COVID-19 infection in pregnancy involves admission to hospital under the care of a multi-disciplinary team for close monitoring of both mother and baby. Investigations in the form of blood tests and imaging tests may be performed. Treatment of COVID-19 is supportive, for example, providing oxygen therapy if required, administering medications to relieve symptoms, and managing other complications such as bacterial infections. Decisions surrounding timing of delivery are made together with obstetricians (specialists who look after pregnant mothers) and neonatologists (specialists who look after babies) such that the interests of both you and your baby are considered together.
Risks to the pregnant mother
The virus affects pregnant women in a similar manner to non-pregnant women. There is currently no evidence that pregnant women are more likely to get seriously ill from COVID-19 infection compared to their non-pregnant counterparts. Worldwide, the majority of mothers have recovered well with a small proportion requiring oxygen supplementation and more specialised Intensive Care Unit (ICU) care.
Pregnant women with a greater risk of complications are those who are older, obese or have medical conditions like diabetes and hypertension. If a mother does become very ill as a result of COVID-19 infection, it is possible for the illness to cause a miscarriage or cause labour to start prematurely. In some situations where the mother is very unwell, the baby may need to be delivered to help with the mother’s heart and lung functions, possibly at a premature gestation.
Risks to the fetus/baby
There is a small possibility of the virus passing from the mother to the baby in the womb or upon birth (vertical transmission). However, studies across the world have shown the risk of vertical transmission to be low, and most infected babies recover well. To date, in Singapore, none of the babies born to COVID-19 infected mothers have had the infection.
There is currently no evidence that COVID-19 infection in pregnancy leads to a higher risk of babies developing abnormalities. COVID-19 infection does not affect the baby’s risk of having a genetic or chromosomal abnormality such as Down syndrome.
Having a baby – the delivery process
The current evidence shows that the risk of neonatal COVID-19 infection is not higher with vaginal deliveries compared to Caesarean deliveries. Hence, COVID-19 infection is not a specific reason for requiring a caesarean delivery, unless there are other circumstances that necessitate it.
After the delivery
Based on the existing scientific evidence, babies do not seem to have an increased risk for COVID-19 infection. The risk of neonatal infection also does not seem to be greater even when the baby remains with the mother after delivery or if the baby is breast-fed. If the usual safety precautions are undertaken, for example, through wearing a mask and maintaining good hand hygiene at all times, Mothers with COVID-19 do not routinely need to be separated from their babies and breastfeeding can continue.
Thinking of having a baby
A common question is whether one should delay pregnancy till after the COVID-19 pandemic has passed.
As described above, the current evidence shows that pregnant women are not at higher risk of acquiring COVID-19 infection compared to non-pregnant individuals, and that babies are not at higher risk of developing abnormalities even if the mother is infected during pregnancy.
Fertility is time-sensitive and diminishes with age, especially after the age of 35. As it is uncertain at this point in time when the pandemic will be over, waiting indefinitely may reduce one’s chances of pregnancy due to increasing age. Do be reassured that it is safe to engage in antenatal care in clinics and hospitals because of all the precautions that are being undertaken in the form of strict screening and preventative policies such as safe distancing.