Covid-19 - Pregnancy and Breastfeeding official guidance from various countries

We've aggregated from various countries the available official guidance on Covid-19 and the related risks on women during pregnancy and breastfeeding.


On 16 March, the UK government decided to include, along with the elderly, pregnant women in the group of people with increased risk of severe illness from coronavirus. The UK has warned that this decision was purely based on taking precautionary measures rather than acting upon current epidemiological data.


The announcement however started a wave of questions among families expecting babies, young families and breastfeeding women.


Countries are taking different approaches to respond to Covid-19 and are providing slightly different advice and information on risks on pregnant and breastfeeding women.


We have thus aggregated sources of data from various countries to provide you with the most up-to-date official guidance.


At the European level


In their report of 12 March (see here) the European Centre for Disease Prevention and Control ("ECDC") identified men as a vulnerable group based on epidemiological data and stated the following on the impact of Covid-19 on pregnant women:


  • There is limited scientific evidence on the severity of illness among pregnant women with COVID-19. Pregnant women appear to experience similar clinical manifestations as non-pregnant adult patients with COVID-19 pneumonia. There is no evidence of severe adverse outcomes in neonates due to maternal COVID-19 pneumonia, and the virus has not been found in breastmilk [49,50].


The sources cited are:


  • [49] Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020 2020/03/07/;395(10226):809-15. (link)

  • [50] Kam K-q, Yung CF, Cui L, Lin Tzer Pin R, Mak TM, Maiwald M, et al. A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load. Clinical Infectious Diseases. 2020. (link)


The ECDC publishes useful Infographics on:



The ECDC also provides a list of relevant European websites here.


United Kingdom


In the official guidance provided by the UK government on 16 March (see here), the following statements were made in relation to the impact of Covid-19 on pregnant women:


  • We are advising those who are at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures. This group includes those who are: [...] pregnant.

  • For those who are over 70, have an underlying health condition or are pregnant, we strongly advise you to follow the above measures as much as you can, and to significantly limit your face-to-face interaction with friends and family if possible.


The NHS also published advice relating to pregnant women (see here):


  • If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days.”

  • Everyone should do what they can to stop coronavirus spreading. It is particularly important for people who: are 70 or over, have a long-term condition, are pregnant, have a weakened immune system."


The Royal College of Obstetricians and Gynaecology also published on 13 March guidance for pregnant women (see here) based on their guidance to healthcare professionals (see here). However, these are currently being reviewed on the basis of the advice/announcement made the UK government on 16 March. Here are some of the data and guidance provided to date by the Royal College:


  • As this is a new virus, how it may affect you is not yet clear.”

  • Pregnant women do not appear to be more severely unwell if they develop coronavirus than the general population.”

  • It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

  • There are no reported deaths of pregnant women from coronavirus at the moment.”

  • There is no evidence to suggest an increased risk of miscarriage.”

  • There is also no evidence that the virus can pass to your developing baby while you are pregnant.

  • 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.”

  • There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block.”


FRANCE


On 13 March, the French Ministry of Health (Ministère de la Solidarité et de la Santé ) provided the following guidance for pregnant women (see here):


  • "Le Haut Comité de Santé Publique considère que les personnes à risque de développer une forme grave d’infection à SARS-CoV-2 sont les suivantes : [...] les femmes enceintes à partir du troisième trimestre de la grossesse." Translation: "The High Committee on Public Health considers that people at risk of developing a severe form of CoV-2-CoV-SARS infection are as follows: ... pregnant women from the third trimester onwards."

  • Les femmes enceintes par analogie avec les séries publiées sur le MERS-CoV et le SRAS en dépit d’une petite série de 18 cas d’infections à SARS-CoV-2 ne montrant pas de sur-risque ni pour la mère ni pour l’enfant.Translation: "Pregnant women by analogy to the published series on MERS-CoV and SARS, despite a small series of 18 cases of SARS-CoV-2 infections showing no over-risk to either mother or child."


You can access the official site of the French Haut Comité de Santé Publique here. However, when we last checked on 18 March the list of people at risk had not yet been updated to include pregnant women.


On 17 March, the French government in an official statement also referred to risks to pregnant women (see the official statement here):


  • En l’état actuel des connaissances, rien n’indique que ma grossesse m’expose particulièrement au coronavirus. J’applique les gestes et comportements qui permettent de freiner l’épidémie. Le Haut Conseil de la santé publique recommande cependant d’appliquer aux femmes enceintes, à partir du troisième trimestre de grossesse, les mesures préventives applicables aux personnes fragiles (par exemple : restriction voire interdiction des visites, contre-indication quant à l’usage des transports collectifs, limitation des contacts avec les enfants de moins de 10 ans).” Translation: "To the best of our knowledge, there is no evidence that my pregnancy exposes me particularly to the coronavirus. I am applying the gestures and behaviours that will help curb the epidemic. However, the High Council for Public Health recommends applying to pregnant women, from the third trimester of pregnancy, the preventive measures applicable to fragile people (for example: restriction or even prohibition of visits, contraindication regarding the use of public transport, limitation of contact with children under 10 years of age)."


GERMANY


As of 18 March, the German Ministry Health Authority made no mention of pregnant women as being a vulnerable group. See their official website here.


However on 12 March the German German Society for Gynecology and Obstetrics (see their website here) provided a specific guidance that is available in German here.


CANADA


As of 18 March, the Government of Canada did not identify pregnant women as specifically vulnerable (see official website here and vulnerable populations identified here).


USA


As of 18 March, the White House does not mention specifically women who are breastfeeding or pregnant as a group at risk. See their official website here.


As of 18 March the Center for Disease Control and Prevention ("CDC") (see website here) provides the following guidance on pregnancy and breastfeeding (see guidance here). It also states the following in relation to risks on pregnant women:


  • We do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result. Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses.

  • There have been a small number of reported problems with pregnancy or delivery (e.g. preterm birth) in babies born to mothers who tested positive for COVID-19 during their pregnancy. However, it is not clear that these outcomes were related to maternal infection.


On breastfeeding specifically, the CDC also recommends the following:


  • If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well fed the expressed breast milk to the infant.”


A general guidance from the CDC for keeping breast pumps clean is also available here.


Furthermore, the Washington Post reported on 16 March that the current data pool on pregnant women was very small (9 in total) and that there was therefore no currently available data on the associated risks of Covid-19 on pregnant women (see article here).


As of 18 March, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine did not provide any specific advice for pregnant women (see their website here):


  • "At this time, very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19."


The College has however developed an algorithm (step-by-step methodology) to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. See the algorithm here.



©2020 by COYA Partners

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