For most women with preterm COVID-19 and nonsevere illness who have no medical/obstetric indications for prompt delivery, delivery is not indicated and ideally will occur sometime after a negative testing result is obtained or isolation status is lifted, thereby minimizing the risk of postnatal transmission to the neonate

Nonsevere illness

Whether the mother's respiratory disease will be improved by delivery and the risk of postnatal transmission in the delivery room when maternal symptoms are acute are both unclear.  On the other hand, increased oxygen consumption and reduced functional residual capacity, which are normal in pregnancy, may facilitate maternal deterioration in patients with pneumonia.The rationale is that delivery is performed before the pulmonary situation worsens and ongoing maternal hypoxemia places the fetus at risk of compromise. Most authorities do not advocate delivery prior to 32 weeks, even though the maternal situation may worsen in the second week, given the known morbidity and mortality of very preterm infants.

Severe/ critical illness

-  Nonsevere illness
-  severe/critcal illness

Ohio State University, Columbus

When pregnant women do become infected with COVID-19, they are significantly more likely to need to be admitted to the hospital and to need help with breathing (mechanical ventilation) than women infected with COVID-19 who aren’t pregnant. However, pregnant women and women who are not pregnant are equally likely to recover from the virus.

Pregnancy and Covid-19

An increased risk of miscarriage or fetal malformations has not been documented in pregnant women who are infected with COVID-19, according to the CDC. However, Based on data from other coronaviruses, such as SARS and MERS, the American College of Obstetricians and Gynecologists notes that pregnant women who get COVID-19 may have a higher risk for some complications, such as preterm birth.  The data is limited so there could be other factors that could lead to preterm birth.

Risks of miscarriage and complications

Researchers are still learning if COVID-19 can pass through breast milk and cause infection in the baby. Most information shows that it is safe to feed breast milk to your baby when you have COVID-19. Remember that breast milk is the best source of nutrition for most babies. Breast milk also helps protect babies from infections, including infections of the ears, lungs, and digestive system. For these reasons, having COVID-19 should not stop you from giving your baby breast milk.

Can COVID-19 pass to a baby through breast milk?

Among critically ill COVID-19 patients, profound acute hypoxemic respiratory failure from acute respiratory distress syndrome (ARDS) is the dominant finding. General supportive care of the critically ill patient with COVID-19 pneumonia is similar to that in patients with ARDS due to other causes. Common complications of COVID-19-related ARDS include acute kidney injury, elevated liver enzymes, and cardiac injury (eg, cardiomyopathy, pericarditis, pericardial effusion, arrhythmia, sudden cardiac death).

Maternal respiratory support

Timing of delivery in infected women

COVID-19 is not an indication to alter the route of delivery  Cesarean delivery is performed for standard obstetric indications, which may include acute decompensation of mother with COVID-19. In one study of 37 cesarean and 41 vaginal deliveries in COVID-19 patients, cesarean birth was associated with an increased risk for clinical deterioration (8/37 versus 2/41 ),. Even if vertical transmission is confirmed as additional data are reported, this would not be an indication for cesarean delivery since it would increase maternal risk and would be unlikely to improve newborn outcome.

Route of delivery

Data from the CDC isn't enough because only about 28% of 360,000 women of reproductive age in the US.   researchers found that pregnant or immediately postpartum women with COVID-19 were nearly six times as likely to land in ICUs as their nonpregnant, COVID-19–infected peers. During the H1N1 flu epidemic of 2009, pregnant women accounted for 5% of U.S. deaths, although they constituted about 1% of the population.  One study found pregnant women with severe acute respiratory syndrome (SARS), which is caused by a virus that’s a close cousin of SARS-CoV-2, were significantly more likely to be admitted to the ICU and to die than nonpregnant peers.  The immune system is critical at this time because the mother has to compromise her immune system to protect the baby.

Why pregnant women face special risks from COVID-19

Pregnant women are believed to be more susceptible to infection that non pregnant women. The state of their immune system during pregnancy increases their risk for severe outcomes. The risk to pregnant women and their unborn children may be even greater in later stages of pregnancy. This belief is based off of evidence from other viral illnesses like H1N1 and Middles East respiratory syndrome. Over one month from March 14, 2020 to April 14, 2020 a study was performed to develop a description of the general characteristics and outcomes for pregnant women with symptomatic coronavirus infection. The sample studied was based on the incidence of disease or, more specifically, the incidence of hospital admissions of pregnant women with confirmed infection by blood test or nasopharyngeal swab. The UK Obstetric Surveillance System was used to collect information on severe pregnancy complications in all 194 UK hospitals and reporting clinicians were asked for specific information like COVID-19 infection and characteristics of the admitted women. 

Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

A study of nine pregnant women infected with COVID-19 and exhibiting symptoms showed that none of their babies were affected by the virus. The virus was not present in amniotic fluid, the babies’ throats, or in breast milk. Another study with 38 women showed that none of their babies were infected. However, a case report analyzing 33 pregnant women infected with SARS-CoV-2 found that three of their newborns were also infected and had clinical signs of COVID-19.

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