opinion: pregnancy in the time of covid-19

there is currently no evidence that covid-19 passes from mother to infant in utero, or through breast milk. a study involving nine chinese women with confirmed covid-19 infection tested samples of amniotic fluid, umbilical cord blood, breast milk and throat swabs from the newborns. no samples contained the virus. there is, however, at least one published case of a baby that tested positive for covid-19 in china . it is unknown whether the infant contracted the disease shortly after birth, or whether this could represent the first case of vertical transmission.

in a lancet publication earlier this month, some doctors suggested that mothers with covid-19 be immediately separated from their infants because of the uncertainty surrounding outcomes. however, according to more recent canadian guidance, it is not mandatory that women with confirmed or suspected infection be isolated from their babies. those who plan to breastfeed are recommended to use a mask and practise careful handwashing.

this past week, infectious diseases experts with the society of obstetricians and gynaecologists of canada (sogc) were applauded for their timely publication of a committee opinion . in it they reminded us that pregnant women are always at higher risk when it comes to respiratory illness. in pregnancy, due to hormonal changes and the physical constraints of a growing uterus, pregnant women are required to use more of their lungs, i.e. to breath more deeply. hence, pregnant women are susceptible to any insult that limits their ability to tap into this functional lung reserve.

data from previous coronavirus epidemics, severe acute respiratory syndrome (sars) and middle east respiratory syndrome (mers), may be used to inform us about covid-19. the overarching theme appears to be that the severity of maternal illness is the strongest determinant of pregnancy outcome. according to the sogc , over sixty cases of covid-19 infection have been confirmed in pregnant women and the vast majority have not experienced severe outcomes. the world health organization has stated that there is “no evidence that [pregnant women] are at higher risk of severe illness than the general population.” however, the who also advises that pregnant women take precaution to protect themselves because pregnancy is a time of unique vulnerability to the effects of respiratory compromise. pregnant women should also be carefully observed for complications of pregnancy such as preterm labour, which has been more common in some observational studies of women with coronavirus infection.

across canada, the united states and europe, fertility clinics are temporarily closing, thereby cutting off patients’ access to care and bringing their fertility journeys to a standstill. the canadian fertility andrology society has recommended delaying embryo transfers indefinitely and suspending all new fertility treatment cycles. the american society for reproductive medicine has said that, “while it would be wise for individuals with confirmed or presumed covid-19 infection to avoid pregnancy, there appears to be no cause for alarm for those already pregnant.” the directive to close fertility clinics is consistent with most health authorities’ strategy of reducing elective procedures and redirecting resources to battle the virus. as a canadian fertility doctor, i support this advice.