Coronavirus: Information for parents and pregnant women

COVID-19 – What is it?

COVID-19 is an illness caused by a coronavirus: Severe Acute Respiratory Syndrome Coronavirus 2, or SARS-CoV-2. Coronaviruses are a subset of viruses which have distinct characteristics that set them apart from other infectious agents.

If we were to look at coronaviruses under the microscope, we would see that they have spikes surrounding the outer edge, which allow the virus to invade and infect cells. The crown-like shape these spikes give the particles is how these viruses get their name: corona means “crown” in Latin. SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome) are other examples of coronaviruses. As the names of these related viruses suggest, coronaviruses affect the lungs, causing respiratory symptoms. In the case of COVID-19, milder symptoms include a dry cough and a fever, which are the two tell-tale signs health officials are asking citizens to be most wary of. More serious signs of infection include pneumonia and severe inflammation of the lungs, which can be fatal.

Believed to have originated in an animal market in Wuhan, China, the SARS-CoV-2 can travel from animals to humans (making it a ‘zoonotic’ virus, such as bird flu, swine flu, and Ebola) as well as from human to human, which explains how it has managed to spread so quickly and become a pandemic in a little over two months.

So far, the data has shown that the elderly, particularly those with underlying health conditions, are most at risk of dying from the virus. Reassuringly for parents and parents-to-be, at the time of writing, the evidence so far has shown that children generally aren’t severely affected by COVID-19 and there appears to be no increased risk for pregnant women, although the situation is being carefully monitored. Let’s take a closer look at what the studies conducted in the first few months of the outbreak have told us.

How COVID-19 affects pregnant women: The evidence so far

Concern over the wellbeing of pregnant women in relation to the novel coronavirus is understandable. Science already shows that viral infections, such as the flu, are often worse for pregnant women. This is because during pregnancy parts of the immune system are suppressed so that it doesn’t attack the developing foetus, making the woman more susceptible to severe pneumonia and heightening the risk of complications, such as preterm birth, stillbirth, or neonatal death during the baby’s first week of life.

However, this new virus is not the flu, and there has so far been nothing to suggest that Covid-19 carries any additional risks to pregnant women, nor is there any evidence that the virus can be passed to the baby during pregnancy (vertical transmission). There have been a small number of cases, including one in the UK, where mothers with the virus have given birth to a baby who also tested positive, but it is not clear whether the baby caught the virus while it was still in the womb or if it was infected because of close contact with the mother after birth.

Much like the vast majority of the population, if a pregnant woman catches the virus, she is most likely to suffer from only mild cold and flu symptoms. At the time of publishing this article, there have been no deaths of pregnant people related to the virus. Furthermore, the UK government’s Coronavirus action plan published on 3 March has stated that there is no “obvious sign” that they are more likely to be seriously affected, but experts are remaining wary as this fact is not known for certain.

The concern, of course, is that the available evidence is still only very limited. This conclusion in the action plan was based on a study involving only nine pregnant women diagnosed with Covid-19, which found that the pregnant women had a similar pattern of symptoms to non-pregnant patients, and not one of them developed severe pneumonia. What’s more, none of their amniotic fluid, cord blood, and breast milk samples tested positive for the virus. Throat swab tests on their babies after birth also tested negative. It’s worth noting that all nine women gave birth via a caesarean section. Discussing the results, the study’s authors said that “there is currently no evidence to suggest that development of COVID-19 pneumonia in the third trimester of pregnancy could lead to the occurrence of severe adverse outcomes in neonates” and that the results did not support the idea of intrauterine vertical transmission.

An even smaller study by Yalan Hiu at the Huazhing University of Science and Technology in China came to a similar conclusion, finding that the newborns of four women with COVID-19 were born healthy with no signs of infection themselves. Three of these four women had caesarean sections, while one had a vaginal delivery. One baby did experience a minor breathing problem that it recovered from with non-invasive mechanical ventilation and two had body rashes which cleared up without any treatment. The researchers were unsure whether these issues were linked to the mother’s Covid-19 infection, but all four babies are now healthy and the mothers have made full recoveries.

Studies following four and nine pregnant women are clearly not using large enough samples to draw any definite conclusions, and there is still the possibility that the complications of coronavirus in pregnancy are yet to be observed. We are, after all, still within the first few months of the outbreak. The largest sample of pregnant women has been seen in the report of the WHO-China Joint Mission on Coronavirus Disease (published in February 2020). This reported an investigation of 147 pregnant women (64 of whom were confirmed cases, 82 were suspected, and 1 was asymptomatic) and showed that only 8% had severe disease and 1% were in a critical condition. This incidence of severe disease is lower than that of the general population, but, again, far more evidence is needed before medical professionals are confident.

The guidance from the UK government and medical professionals

Speaking to the BBC on March 17, the government’s chief medical adviser Professor Chris Witty said that “there is a small but appreciable additional risk” for pregnant women, and because it’s still “very early in what we know about this”, it’s best for them to take stricter precautionary measures until follow-up studies give a clearer picture of the precise amount of danger to expectant women.

This explains why the government is still considering pregnant people a high-risk group and has advised that they, along with people over 70 and those with chronic health conditions, should be “particularly stringent” about following the guidance issued on March 16 (avoid unnecessary travel, contact, pubs and clubs). These guidelines also state that, from the weekend of March 21-22, pregnant women should self-isolate and minimise social contact as much as possible for 12 weeks even if they do not have symptoms. If they do need to have contact with someone, they should remain 6ft apart.

The Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and the Royal College of Paediatrics and Child Health (RCPCH) have also published information on the new virus. The core message from these medical professionals is in line with the conclusions of the above studies, saying that pregnant women do not appear to be more unwell than the general population and that the virus is unlikely to lead to birth abnormalities. But they also stated that pregnant women with underlying health conditions such as diabetes and asthma may have worse symptoms.

As a sharp increase in cases could potentially endanger the lives of pregnant women, the Royal Colleges welcomed the government’s new guidance released on March 16. But they have been sure to reiterate that expectant women shouldn’t panic over officials labelling them as one of the most vulnerable groups; the lengthy isolation period is just a precautionary measure to reduce the “theoretical risk”.

However, while social distancing is effective, isolation shouldn’t, if possible, come at the expense of antenatal and postnatal care. Gill Walton, the chief executive of the RCM, has stated that pregnant women without coronavirus symptoms should keep their scheduled appointments: “We would urge all pregnant women who are well to attend their care as normal. If you are pregnant and have symptoms of possible coronavirus infection, you should call to defer routine visits until after the isolation period is over.”

Coronavirus and children

With the number of cases in the UK rising exponentially and the peak not predicted until sometime between late May and early June, it’s clear that there are many, many more confirmed cases still to come, and some of these will inevitably be young children. But medical experts are rather optimistic about the prognosis for young people.

Research has thus far shown that even though children are just as likely as adults to be infected with the virus, they are less likely to experience serious illness. A study looking at 10 Chinese children with COVID-19 found that nine had only minor symptoms, while one was asymptomatic (all the children were tested for the virus in the first place only because they had close contact with people diagnosed, not because family members were concerned about their symptoms). Interestingly, these mild effects were present even though some of the children were shown to have a large amount of virus.

With much to learn about COVID-19, precisely why children seem to be the least affected by the coronavirus is not yet fully understood.

Children may present with milder symptoms than adults because of the different way their immune system responds to the virus that avoids the development of acute respiratory distress syndrome (ARDS), where the immune system overreacts and causes life-threatening inflammation to the lungs as it tries to fight the virus. As children’s immune systems are still developing, their immune system does not trigger such an extreme response.
It’s crucial not to become complacent, however, as new figures from China have revealed that severe pneumonia has been seen in children, where some have required hospitalisation and a teenager has died. Children with autoimmune conditions are also at increased risk of experiencing worse symptoms. Young people should, therefore, follow the same precautions as everyone else for the duration of the pandemic.

Reassuring your young children

Understandably, the wave of media-induced panic is likely to have affected children emotionally. Young children, like the rest of us, have probably taken notice of the mass coverage and may be feeling anxious. If the headlines are causing your children distress, there are ways to help calm them. Stay abreast of new evidence and be honest with your children. Give them the scientific facts if they ask about them and debunk any myths they may have picked up from classmates or social media. It’s crucial not to exaggerate the threat and keep everything in perspective to help counterbalance the fear-mongering seen too often in the headlines.

Preventing the spread and severity of coronavirus infection

Although they are the age group least at risk of life-threatening complications, children can get infected – there have been confirmed cases of newborns just days old – and therefore they can contribute to the spread of the coronavirus.

One issue is that many healthy young people with strong immune systems will only ever experience very slight symptoms, so slight that they may not even realise they have it. This puts them at high risk of transmitting the disease to the most vulnerable groups who are far likelier to require hospitalisation. These very mild cases are why the government has warned that the true number of infected people in the UK is likely to be much higher than the number of confirmed cases. Adding to this issue is the fact that a person may be infected but not show any symptoms for a period of up to five or six days. During this asymptomatic period, they could potentially spread the virus to many other people unknowingly. This is why social distancing measures have come into play, with the government asking everyone (not just the most at-risk groups) to reduce their use of pubs, restaurants, theatres, cinemas, and public transport.

It’s therefore very sensible to take precautions to keep all your loved ones safe, including older relatives such as grandparents with whom your children may have frequent contact.
The single most important thing you can do and teach your children to do is, as you’ve no doubt already heard, wash your hands regularly with antibacterial soap and warm water for at least the amount of time it takes to sing ‘Happy Birthday’ twice (about 20-30 seconds).

But it’s not only the length of time that’s crucial. You should also make sure your children practise thorough hand washing technique. This involves creating a lather with the soap and cleaning the back of your hands, your palms, your wrists, your fingertips, your thumb, and in between your fingers.

If you’re not self-isolating, hand sanitizer gel is very useful to have on your person when you’re outside or travelling. Apply it frequently. Get into a routine of washing your hands regularly throughout the day. To help yourself get into the habit, you could try to pair the action of washing your hands with something else you know you do regularly, which can act as a cue to remind you to wash your hands. You should also be washing them every time you enter and exit a building. Be cautious of other actions such as touching your face and rubbing your eyes with unwashed hands.

If you happen to be a smoker, quitting is one of the best actions you can take to help minimise the severity of any symptoms (not just of COVID-19, but of any respiratory disease). If you’re planning a pregnancy or are pregnant, then you may have already taken steps to quit, but if you’re a parent or pregnant and are still smoking, now is a great time to try giving up, not just for curbing any coronavirus symptoms but also to improve your future health. You can read this article by Dr Jonathan Pearson-Stuttard for more information on the cessation of smoking during pregnancy.

If you think you have COVID-19: Guidance for parents and pregnant women

The main tell-tale symptoms are a new, persistent cough and a high temperature, which will cause your chest or back to feel hot to the touch. There has also been new research indicating that some cases present with gastrointestinal symptoms, most commonly diarrhoea, before respiratory symptoms develop.

If you or your children have these symptoms, first of all, don’t panic; keep reminding yourself that in the vast majority of cases symptoms will not have serious complications and young people are a particularly low-risk group.

Do not go to a GP surgery or hospital. The current advice is that if any member of your family is showing symptoms, no matter how mild, then the whole family should self-isolate for 14 days. If someone else gets symptoms during isolation, then they should stay at home for seven days from when their symptoms started, which may mean they self-isolate for longer than 2 weeks in total.

If you are self-isolating, then testing for the virus is not necessary. If you’re pregnant, you should call your maternity team to let them know you have suspected coronavirus, and they can provide you with more information and rearrange any upcoming antenatal appointments that fall within the isolation period.

You should contact NHS 111 if you feel you cannot cope with your symptoms, you start feeling worse, or your symptoms don’t improve after a week. If you’re pregnant and are worried about your symptoms worsening during self-isolation, call your midwife or maternity team. You will only need to be tested if your symptoms are severe and you’re admitted to hospital. The test involves swabs taken from inside your mouth and nose. This test is no different for pregnant women than it is for the general population.

Coronavirus and childbirth

If you go into labour while self-isolating with suspected or confirmed COVID-19, you will need to call your maternity unit for further guidance. You will need to attend the hospital in private transport or an ambulance and will need to wear a face mask once at the hospital until you are transferred to an isolated room. Your birth partner can stay with you throughout childbirth, but you may not be able to have visitors (or, at least, you will need to minimise the number of visitors).

As seen in the limited number of small studies involving pregnant women, it appears the women with COVID-19 are likely to give birth to a perfectly healthy baby. The RCM has stated that women with suspected or confirmed COVID-19 should attend an obstetric unit for birth as a precaution (because staff can monitor the baby and mother continuously), but otherwise their birth plan should be followed as closely as possible. This includes keeping to the mother’s choice of pain relief in labour, though Entonox (gas and air) may help spread the virus, so an alternate option may have to be used.

Women with COVID-19 may fear that their newborn may be taken away from them after giving birth, since such safety measures have happened in China. However, the RCOG and the RCPCH have advised against this as long as the baby is well; skin-to-skin contact is very important for mother and baby. RCOG president Pat O’Brien says that separation is a “very difficult decision” that requires the balancing of pros and cons, and that overall the “benefits of keeping the mother and baby together outweigh the risks” of the mother infecting her child with the virus. Professor Robert Viner, president of the RCPCH, has said that the impact of separation can be “significant on both the baby and mother” and so should be avoided. Professor Viner added that there is a possibility this may change in the coming months of the outbreak.

However, your newborn will also be required to be tested for coronavirus if you have suspected or confirmed COVID-19 at the time of birth.

What about breastfeeding?

You may be particularly worried if you are breastfeeding a young baby.

There is currently no evidence indicating that the virus can be transmitted through breast milk, but if you have been diagnosed, then you can of course still pass the virus to your baby through close contact just like with anyone else.

Breastfeeding brings many benefits, helping build the baby’s immune system by transferring antibodies to them so that they can fight infection, and these can outweigh the risks of passing coronavirus to your baby, but it is up to you to decide whether you’d be more comfortable switching to formula. You can discuss the matter with your postnatal healthcare provider to help you reach a decision. It may be necessary to wear a face mask while breastfeeding to avoid transmission via coughs and sneezes. If you choose to feed with expressed milk using breast pumps and bottles, be sure to wash your hands before touching the equipment, sterilise them before and after each use and don’t share them with anyone else. If feasible, you could also ask a family member without the virus to feed your baby with a bottle of your expressed milk.

The bottom line

COVID-19 is a new virus with much unknown about it, and the unknown can be frightening. However, what we have found out so far should be reassuring to pregnant people and parents of young children.

We should all do our part to help protect the most vulnerable people of the population during this pandemic. The government’s guidelines have been introduced as a precaution, but it’s sensible to follow them as closely as you can for the duration of the outbreak. Staying vigilant of symptoms in your family and, if you’re pregnant, self-isolating for 12 weeks will help minimise your risk of exposure.

The situation is quickly changing as we find out more about the virus. We will keep this page updated as new information relating to pregnant women and parents of young children comes to light.