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Based on what we know at this time, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women.i A recent CDC Morbidity and Mortality Weekly Report (MMWR) study found that pregnant women are more likely to be admitted to the intensive care unit (ICU), receive invasive ventilation and extracorporeal membrane oxygenation (ECMO - a treatment that uses a pump to circulate blood through an artificial lung and back into the bloodstream of a very ill person), and are at increased risk of death compared to nonpregnant women.ii Information suggests that pregnant women with comorbidities (more than one disease or condition) such as obesity are at increased risk for severe illness as is the general population with similar comorbidities.iii Additionally, studies are finding that other factors, such as age and occupation, can further increase a pregnant person’s risk for developing severe illness.iv However, as pregnancy itself has now been identified as a risk factor for certain outcomes, more research is needed to determine the magnitude of this increased risk.ii It is therefore important for pregnant women to take extra precautions to protect themselves from illness and talk with their provider about any concerns they may have.
Updated: November 18, 2020
i Centers for Disease Control and Prevention; Coronavirus Disease 2019 (COVID-19); Pregnancy, Breastfeeding, and Caring for Newborns; updated November 3, 2020; retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
ii Centers for Disease Control and Prevention; Coronavirus Disease 2019 (COVID-19); Pregnancy Data; updated November 13, 2020; retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html
iii The American College of Obstetricians and Gynecologists; Clinical Guidance; Practice Advisory; Novel Coronavirus 2019 (COVID-19); updated July 1, 2020 with summary of key updates made November 6, 2020retrieved from https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
Although much is still unknown, emerging data, suggests that COVID-19 may activate blood clotting pathways and can lead to excessive inflammation that can cause damage to tissues throughout the body, making a pregnant woman more at risk for complications during the pregnancy and postpartum periods. “Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth.”iv
Although there are cases reported of transmission of the virus from mom to baby in-utero or during the birthing process, the data are reassuring that this appears to be uncommon.ii Transmission to the baby is thought to occur primarily through respiratory droplets during the postnatal period when neonates are exposed to mothers, other caregivers, visitors, or healthcare personnel with COVID-19v. It is critical that appropriate precautions are taken after delivery to prevent the spread of the virus from the mother to the infant. At this time, experts say there is no need to change the timing or method (cesarean vs. vaginal) of delivery to decrease the risk of spread to the infant.vii Most newborns who have tested positive for COVID-19 had mild or no symptoms and have recovered fully. However, there are a few reports of newborns with severe illness.i In the rare case of infant death, it has not been determined if it was due to the virus or other underlying (original, or already existing) conditions.
Current data [gathered through case reviews and the Perinatal COVID-19 Registry] suggest that approximately 2-5% of infants born to women with COVID-19 near the time of delivery have tested positive in the first 24-96 hours after birth. [It is] not yet know[n] if any of the newborns reported to the American Academy of Pediatrics (AAP) Registry have become ill at home following hospital discharge. There are few case series of pediatric COVID-19 published to date, but clinicians and families should be aware that there are published reports of infants requiring hospitalization before one month of age due to severe COVID-19 infection.vi
Although there is much that is still unknown about this virus and its effect on perinatal women and infants, what we do know tells us how extremely important it is for you and your baby to have frequent follow-up with your medical provider/s during the pregnancy, postpartum, and newborn periods.
A nationwide study is taking place now to help pregnant women and the medical community learn more about how COVID-19 effects pregnant women and their newborns. If you are pregnant or recently pregnant and are under investigation for COVID-19 or have been confirmed to have COVID-19, you are encouraged to participate in this study. To learn more about the study and how to enroll, please visit the PRIORITY Study website.
iv Centers for Disease Control and Prevention; Coronavirus Disease 2019 (COVID-19); Caring for Pregnant Women; revised May 20, 2020; retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
v Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19), Caring for Newborns; updated May 20,2020; retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html
vi American Academy of Pediatrics; Critical Updates on COVID-19; Clinical Guidance; FAQs: Management of Infants Born to COVID-19 Mothers; updated 7/22/20; retrieved from https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/
vii The American College of Obstetricians and Gynecologists; Patient Resources; FAQ; Coronavirus (COVID-19); Pregnancy and Breastfeeding; updated November, 2020; retrieved from https://www.acog.org/patient-resources/faqs/pregnancy/coronavirus-pregnancy-and-breastfeeding
Yes. “The AAP strongly supports breastfeeding as the best choice for infant feeding.”v Breast milk provides protection against many illnesses and is the best source of nutrition for most infants. Breastfed infants are generally less likely to have severe respiratory symptoms if they get sick. Breastfeeding is good for moms, releasing hormones during breastfeeding that promote wellness and can relieve stress and anxiety. Breast milk is readily available, and especially important during emergencies.
“Several published studies have detected SARS-CoV-2 nucleic acid in breast milk. It is not yet known whether viable, infectious virus is secreted in breast milk, nor is it yet established whether protective antibody is found in breast milk. Given these uncertainties, breastfeeding is not contraindicated at this time.”v For moms who are infected with COVID-19, breastfeeding directly and pumping breast milk to be fed via bottle by an uninfected caregiver are both options for providing the best nutrition (breast milk) to babies. COVID-19 spreads between people who are in close contact, mainly through respiratory droplets when an infected person coughs, sneezes, or talks. Therefore, if the person feeding the baby by breast or bottle is COVID+ or has been potentially exposed, he/she should wear a face mask or mouth/nose covering and wash their hands before each feeding, as well as during breast milk pumping and/or any bottle preparation, to reduce the risk of transmission. One should always wash hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if not COVID+. All bottle, breast pump parts and supplies should be cleaned thoroughly following CDC guidelines.
For more information please review resources about COVID-19 and breastfeeding provided by the Kansas Breastfeeding Coalition. As always, it is important to talk with your doctor and a breastfeeding support professional to weigh the risks and benefits and help determine what is best in an individual situation.
Updated: March 10, 2021
As this pandemic continues, and communities and businesses across the United States are opening and shutting down at different times and to different degrees, you may be wondering about the real risks to resuming activities, running errands, and attending events and gatherings. There is no way to ensure you have zero risk of infection, so it is important to understand the risks and know how to be as safe as possible.
People who are pregnant, and those who live with them, should consider their level of risk before deciding to go out and ensure they are taking steps to protect themselves and others. Consider avoiding activities where taking protective measures may be difficult, such as activities where social distancing can’t be maintained. Everyone should take steps to prevent getting and spreading COVID-19 to protect themselves, their communities, and people who are at increased risk of severe illness.
In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19.viii
Follow the below guidance to reduce risks of spread. Even if you have received the COVID-19 vaccine, it’s important to continue taking the below described steps to help stop the spread of COVID-19.
• Frequently wash hands with warm, soapy water for at least 20 seconds.
• Use alcohol-based hand sanitizer with at least 60% alcohol when handwashing is unavailable.
• Clean commonly used surfaces (e.g., cell phones, personal electronic devices, remote controls, countertops, cabinet handles, tables, doorknobs, light switches) regularly with disinfectant (pregnant women should wear gloves or use green (natural, eco-friendly) products with disinfectant agent, or ideally have another household member clean the surface when possible).
• Avoid contact with sick people.
• Avoid interactions with people who might have exposed to or who might be infected with COVID-19.
• Avoid poorly ventilated spaces.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Cover your coughs (coughing into your elbow).
• If you or your family has not yet received vaccines for Influenza, get vaccinated now.
• Consider getting a COVID-19 vaccine when its available to you. Talk to your healthcare provider if you have any questions or concerns.
• Practice social distancing and staying at home:
o Only go out for essential items.
o Avoid gathering in groups, if possible.
o Keep distance of 6 feet, if you must go out.
o Limit contact with other individuals as much as practicable. • Wear masks or cloth face coverings at work and in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies). KDHE recommends wearing a mask that fits snuggly around the nose, mouth and chin and has multiple layers of fabric. Alternatively, a thinner disposable mask may be worn underneath a cloth facemask to improve the fit. Visit Mask Guidance for more information. Cloth face coverings should not be placed on young children under age 2 due to risk of suffocation and strangulation. Try to avoid being around others who are not wearing masks.
Symptoms of pregnancy and postpartum related complications should always be communicated to your provider immediately. See this on the importance of staying in communication with your provider regarding concerns with your baby’s well-being during pregnancy. Related to COVID-19 concerns, call right away if you experience a fever of 100.4 or greater, cough, shortness of breath, or difficulty breathing.
Symptoms of pregnancy and postpartum related complications should always be communicated to your provider immediately. See this video on the importance of staying in communication with your provider regarding concerns with your baby’s well-being during pregnancy. Seek medical care immediately if you experience any urgent maternal warning signs and symptoms. These could indicate a potentially life-threatening complication.
Related to COVID-19 and potential associated complications, call right away if you experience:
• Fever of 100.4 or greater
• Shortness of breath
• Difficulty breathing
• Chills, muscle pain or body aches
• Sore throat
• New loss of taste or smell
Nausea or vomiting
• Chest pain or pressure
• Swelling or pain in only one leg
• Sudden severe headache
• Sudden confusion
• Being unable to respond to others
• Blue lips or face
Continuing to see your provider throughout your pregnancy and in the postpartum period is the number one way to ensure that both you and your baby are healthy and doing well. Due to potential complications caused by the virus in the prenatal as well as in the postpartum period, there may be need for additional monitoring and screening for women testing positive for COVID-19 during pregnancy, thus it is extremely important to stay in close contact with your prenatal care provider throughout your pregnancy and postpartum period. Some providers may choose alternative options for routine check-ups for low-risk patients, such as altering the frequency or method of appointments (for example, offering appointments virtually via telehealth). Make sure that your contact information, including phone number and email, are always up-to-date with your healthcare providers so these changes can be communicated to you timely and easily. Getting the recommended vaccines during pregnancy can help protect you and your baby. It’s also a good idea to keep a 30-day supply of medications on hand if possible.i
Updated November 18, 2020
It’s hard to predict exactly how the COVID-19 pandemic will impact your labor and delivery experience, but be prepared for likely changes, such as universal testing for COVID-19 prior to admission and limitations on visitors and/or support persons. In most cases, early discharge in an effort to reduce risk of COVID-19 infection has been found to provide no advantage to the newborn and may place additional burden on the family.vi If you are suspected or confirmed to have COVID-19, you should notify your prenatal care provider and the facility you will be delivering at, prior to arrival, to assist the healthcare team in making the appropriate infection control preparations.ii While you can expect to be required to wear a mask in the hospital or birth center, it is recommended that pregnant women do not wear a mask while pushing during labor, as this may be difficult. For this reason, your health care team should wear masks or other protective breathing equipment. They also may take other steps to reduce the risk of spreading the virus, including wearing goggles or face shields.viii
Although this may cause feelings of being anxious or scared, you can be reassured that there will be helpful support from a labor nurse throughout your labor and deliver experience. Your provider and local birth center staff can keep you up-to-date on changes to normal procedures. Although the COVID-19 pandemic may change the labor and birth experience you planned for, it will continue to be safe, special and memorable in so many ways. If you have questions or concerns about what your birthing experience may look like, ask your provider or birthing center staff to walk you through the restrictions and accommodations. During this conversation you can ask questions about having your support person with you, having your infant stay in your room after birth, breastfeeding, mask-wearing, etc.
As a KanCare beneficiary during your pregnancy, your coverage will extend beyond the typical coverage period of 60-days postpartum, until the end of the month in which the COVID-19 emergency period ends. Make sure that your contact information, including phone number and email, are always up-to-date with your KanCare provider so any changes in your benefits can be communicated to you easily.
Updated: April 3, 2020
Good hygiene (handwashing) and social distancing are the most effective ways to keep your infant safe from communicable diseases such as COVID-19. All caregivers should be reminded to wash hands thoroughly before touching bottles and other feeding supplies, and before feeding or caring for an infant or child. Continuing to follow all public health recommendations, lining up a symptom-free support person to help drop off supplies, and connecting with friends and family virtually (phone, text, FaceTime, social media) will limit the exposure of the virus/disease to you and your family. While screen time is typically not recommended for infants, connecting to loved ones via video chatting such as FaceTime is considered safe in limited amounts.
Ways of keeping your children safe:• Wash hands often with soap and water for at least 20 seconds.• Use alcohol-based hand sanitizer when handwashing is unavailable.• Reduce close contact with others by practicing social distancing. Limit public exposure and avoid unnecessary public contact.• If going out with the child is essential:o Cover the infant carrier (NOT THE INFANT) with a light-weight blanket, which helps protect the baby, but still gives them the ability to breathe comfortably.o Make the trip and time of coverage as brief as possible.o Do not leave the blanket on the carrier in the car or at any time when the baby and carrier are not in direct view by an adult caregiver.o Children only over the age of 2 should wear a mask or cloth face covering. KDHE recommends wearing a mask that fits snuggly around the nose, mouth and chin and has multiple layers of fabric. Alternatively, a thinner disposable mask may be worn underneath a cloth face mask to improve the fit. Visit KDHE’s Mask Guidance for more information.• Keep your children away from others who are sick and keep them home if they are sick.• Teach kids to cough and sneeze into a tissue or their arm or elbow, not their hands.• Clean commonly used surfaces regularly with disinfectant. Clean commonly touched surfaces (e.g., countertops, tables, doorknobs) regularly with disinfectant.• Wash stuffed animals or other plush toys in the warmest water possible, being sure to dry them completely.• Teach children to avoid touching face.• Follow local and state guidance on travel and stay-at-home restrictions.
Yes. It is important to continue with regularly scheduled pediatric appointments and to continue with vaccinations as scheduled. These efforts will help protect your baby/child from other illnesses and will assure your baby/child grows and develops properly. Some providers may choose alternative options for routine check-ups for low-risk patients, such as altering the frequency or method of appointments (for example, offering appointments virtually via telehealth), or providing well-child and sick-child care at different times of the day or in separate spaces. Make sure that your contact information, including phone number and email, are always up-to-date with your healthcare providers so these changes can be communicated to you timely and easily. Make sure to call and notify your baby’s healthcare provider before visiting if you or your baby have COVID-19.
If you have COVID-19 or are suspected of having COVID-19, staying in a different room from your baby is the safest way to keep your newborn healthy. A healthy caregiver should take care of the baby and can feed expressed breast milk. You can stop isolating yourself from your baby once you are fever-free without use of fever medicines (acetaminophen or ibuprofen) for at least 24 hours; when your other symptoms of COVID-19 are improving; and when at least 10 days have passed since your symptoms started. If you never had symptoms, you can stop isolating yourself after 10 days have passed since your positive COVID-19 test.i
If you and your family decide to keep your baby in the same room as you, keep a distance of at least 6 feet from your baby when possible. When closer than 6 feet, wear a mask and make sure your hands are clean by washing your hands with soap and water for at least 20 seconds before touching your newborn, or use a hand sanitizer with at least 60% alcohol when soap and water are not available.i Be sure not to touch the front of the mask, and change out the mask when it is damp.
As always, it is recommended to be in close communication with your health care provider(s) and to follow your provider’s guidance.
Most babies who test positive for COVID-19 have mild or no symptoms. Severe illness in babies appears to be rare. Babies with underlying medical conditions and babies born premature (before 37 weeks) might be at increased risk of severe illness. Reported signs among newborns with COVID-19 include fever, lethargy (being overly tired or inactive), runny nose, cough, vomiting, diarrhea, poor feeding and increased work of breathing or shallow breathing.x Monitor for fever and call your baby’s provider if he/she has a fever of 100.4 degrees Fahrenheit or higher, even if there are no other symptoms.
If your baby develops symptoms or you think your baby may have been exposed to COVID-19, call your baby’s healthcare provider within 24 hours and follow steps for caring for children with COVID-19.x Symptoms to be aware and ready to report to your provider include:
• How well is your baby feeding?
• How alert is your baby?
• How many wet diapers is your baby having?
• How hard is your baby working at breathing?
• Have you noticed any discoloration of your baby’s lips?
If your baby has COVID-19 emergency warning signs (such as trouble breathing), seek emergency care immediately. Call 911.x
Because the prenatal and postpartum periods are a very vulnerable time in families’ lives, it is important to stay connected with support services in your community. Most resources and support services, such as WIC, home visiting and mental health services, continue to be available. These services may be offered through alternative methods, such as telephonic or virtual options; therefore, it is important to stay informed through local communication (e.g., contacting the service provider/agency, visiting their website, social media, local newspapers, and radio stations) and keeping your contact information up-to-date with all service providers
Safe sleep is an important part of keeping babies healthy. During the COVID-19 pandemic, parents of babies may experience increased stress and fatigue that could affect their ability to ensure that their baby is sleeping safely. Help reduce your baby’s risk of sudden infant death syndrome (SIDS) and other sleep-related deaths by doing the following:
• Place your baby on his or her back for all sleep times – naps and at night.
• Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
• Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
• Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
• Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
• Don’t smoke or allow anyone to smoke around your baby.i
Learn more about how to reduce the risk of SIDS.
The emergency use authorization does not address the safety or effectiveness of the vaccine for pregnant or lactating women, as limited data are available until further studies and clinical trials with these populations are completed.
Currently, the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend the vaccine for pregnant and breastfeeding women if they are a priority population in the vaccine rollout plan. For more information on this guidance, please review the following resources:
• CDC’s Vaccination Considerations for People who are Pregnant or Breastfeeding
• ACOG’s Clinical Guidance on Vaccinating Pregnant and Lactating Patients Against COVID-19
• CDC’s Guidance on Who Gets Vaccinated First, When Vaccine is Limited
• Kansas COVID-19 Vaccine Plan
• Featured Resources on COVID-19 Vaccines within the CDC’s Toolkit for Pregnant People and New Parents
It is important for you, as a pregnant or breastfeeding woman, to stay informed and talk with your healthcare provider so you can make an informed decision that is best for you and your baby, based on your history, level of risk and likelihood of exposure.