For expecting families, preparing for a new baby during a pandemic may be nerve-wracking.

Unfortunately, it's still too early to draw many solid conclusions about how the novel coronavirus affects pregnant women and their babies.

But physicians and researchers continue to observe and collect anecdotal evidence – and in the meantime, hospitals are putting in protections like limiting visitor policies out of an abundance of caution.

"This is brand new for everyone and we have very little data to guide us," says Roger Smith, M.D., an obstetrician-gynecologist and service chief for obstetrics at Michigan Medicine's Von Voigtlander Women's Hospital. "We're learning more as we go but we need further research to better understand how the virus affects moms and their babies."

"Our top priority continues to be keeping our patients safe."

Smith, who is part of the team overseeing labor and delivery policies during the pandemic at Michigan Medicine, discusses some of the top concerns about pregnancy and COVID-19.

1. Does COVID-19 impact pregnant women differently?

We have been watching this closely. Recent studies suggest that pregnant patients are at higher risk of severe disease and worse outcomes from COVID-19 than non-pregnant peers, including intensive care admission, requiring a ventilator and death. These risks are higher for women of color, including African-American and Hispanic populations.

Adverse pregnancy outcomes such as preterm birth for COVID-positive patients have also been reported but data in this area are still evolving.

People with some health conditions, such as diabetes, lung disease, or heart disease, also have a higher risk of becoming sicker from COVID-19.

2. Should pregnant women take extra precautions?

There is nothing about pregnancy itself that makes a woman more susceptible to being infected. However, given the risk of severe illness from COVID-19 during pregnancy, we recommend pregnant individuals take all precautions possible to protect themselves from the virus. This includes proper handwashing (at least 20 seconds using warm water and soap), not touching your face, nose, eyes or mouth and following aggressive social distancing (not going out unless you absolutely have to and staying six feet apart from others.)

Transmission spreads from person to person primarily through close contact with respiratory droplets (such as through coughs and sneezes) that can travel up to six feet.

The Centers for Disease Control has also recommended that community members wear cloth masks if they have to go somewhere like the grocery store. You do not need to wear a surgical mask or medical-grade mask.

3. Are there risks of transmitting the virus from mom to infant?

So far we have not seen any indications that COVID-19 can be transmitted to an unborn baby. After birth, we know that transmission is possible if there's exposure to a COVID-19-positive caregiver, including the mother.

Early observations also suggest that newborns are less likely to show symptoms of the infection or get serious forms of it. We don't have enough information to know if that's because babies are less likely to get infected after birth or just aren't getting sick as frequently from the virus as adults.

Nonetheless, we need more research to guide us and until then we must take all measures to protect newborns from exposure, including from family members who may be infected.

4. Can a baby be infected from breastmilk?

So far the virus has not been found in breastmilk and there's no evidence to suggest it's transmittable this way. However, the close contact with a COVID-19-positive caregiver while feeding a baby would increase risk of spreading the virus.

This is why we recommend that delivering moms who test positive for the virus and choose to breastfeed consider pumping milk during a temporary period after birth to protect newborns from the risk of contracting the virus.

5. Are symptoms different in pregnant women? 

A small study of 215 pregnant women at two New York hospitals recently found a surprising number of asymptomatic women who tested positive for the novel coronavirus. Of the 33 women who tested positive, 29 (88%) did not have symptoms.

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This doesn't necessarily mean COVID-19-positive pregnant women are less likely to show symptoms. It does, however, offer us clues about the prevalence of people who have unknowingly been infected with the virus and aren't showing symptoms but are still contagious – among both pregnant women and the general population.

6. Should families change their labor and delivery plans?

Talk with your provider about your birth plan. Hospitals like Michigan Medicine are adjusting policies to limit exposure risks during the pandemic, such as limiting the number of people who can be in the room during delivery.

We believe that a hospital or a hospital based birth center is still the safest place to give birth. This environment ensures access to necessary care in cases of unanticipated complications, which can happen even in the healthiest pregnancies. 

7. How are pregnant women being screened for COVID-19?

We are now recommending that all pregnant patients be tested for the virus when they arrive for delivery. This is to both inform what kind of personal protection equipment providers will need as well as caring for moms and babies. There are public health reasons to do this testing too.

For those with scheduled caesarean deliveries, we are making arrangements for patients to receive testing before they come to the hospital.

8. What should you do if you're pregnant and think you have COVID-19?

If you think you may have been exposed to the coronavirus and have a fever or cough, call your health care provider.

Symptoms to watch out for include a hard time breathing or shortness of breath that is more than what has been normal during your pregnancy, ongoing pain or pressure in your chest, blue lips, confusion or inability to respond to others.

9. What should you do if you're pregnant and diagnosed with COVID-19?

Pregnant women who are diagnosed with COVID-19 should follow the advice of their OB-GYN and the CDC. This includes staying home except to get medical care, avoiding public transportation and crowded spaces and keeping a safe distance from others in their home.

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Acetaminophen (such as Tylenol) is recommended for pain relief and fever. In general, we don't recommend ibuprofen if you're pregnant, especially during the third trimester. There have also been news reports that NSAIDS, or non-steroidal anti-inflammatory drugs, such as ibuprofen, could worsen coronavirus disease. This is still theoretical, with no scientific evidence linking the medication to worsening symptoms.

10. Should pregnant women be changing what they eat or drink?

There is likely a very low risk of spread from food products or packaging that are shipped at refrigerated, or frozen temperatures.

There is also no evidence that any specific foods or drinks help prevent being infected with the virus – which has falsely been shared on some websites and social media.

11. How will COVID-19 affect prenatal and postpartum care visits?

Michigan Medicine is among providers that have scaled back in-person visits for low-risk pregnancies. We want to assure patients that they will still receive all of their recommended care, and we know from prior research that this model of care is safe.

Our new approach to prenatal care consolidates some services, such as getting a gestational diabetes screening, the Tdap vaccine and lab tests into fewer appointments. This allows us to reduce visits to an initial prenatal visit, an anatomy ultrasound, and 28, 36, and 39-week visits.

Additional prenatal visits may be done through telemedicine platforms, such as over the phone or an online video call. However, as always, we encourage people who feel like something is off or who have questions to call their provider. High risk pregnancies will continue to need more in-person visits.

Newborns need to be examined within a few days after birth and then follow routine in-person care. This hasn't changed, and is recommended by the American Academy of Pediatrics. For women who have had routine deliveries without complications, their follow up visits may be offered virtually.

Safety is always our priority and we want to ensure expectant moms and their infants continue to receive high quality care.

12. How will the pandemic affect prenatal and postpartum care long term?

The model we're using now by necessity for prenatal care during the pandemic is actually something we had been considering for some time. This situation has allowed us the opportunity to reimagine prenatal care.

We are monitoring how this new model benefits our patients and evaluating how telehealth services may improve the way we deliver maternity care services in the future.