Coronavirus in pregnancy: current knowledge and background information

Status: March 3, 2020

As the coronavirus spreads in Germany, concern is growing here as well. We have compiled some important information about the coronavirus for you.

Coronavirus During Pregnancy

So far, it has become clear that embryos appear to be protected from infection with the novel SARS-CoV-2 coronavirus while in the womb. A small observational study from China suggests that the unborn fetus is not infected, as the research team reports in the journal *The Lancet* (Chen 2020). The researchers concluded that SARS-CoV-2 is not present in amniotic fluid, umbilical cord blood, or breast milk, nor can it be transmitted through these routes. According to the study results, there is also no cause for concern regarding adverse effects on the newborn. The nine women studied from the Chinese city of Wuhan had developed Covid-19-induced pneumonia during the third trimester of pregnancy. The babies were all born healthy via cesarean section and had not been infected. However, the study authors emphasize that it is not yet clear how the novel coronavirus affects the early stages of pregnancy. It also remains unclear whether the virus can be transmitted to the child during a vaginal birth. Further observational studies with significantly larger sample sizes are needed to address these questions.

The concern that the coronavirus could be transmitted from the mother to the unborn child stems from reports of a newborn who tested positive for COVID-19 within 36 hours of birth. However, the infant had only become infected after birth through droplet transmission from the mother.

Symptoms of illness

Infection with the novel coronavirus can lead to symptoms such as cough, runny nose, headache, sore throat, and fever. In rare cases, those affected also experience diarrhea. Among the cases reported so far from China, four out of five cases were mild. In a small proportion of patients, the virus can cause a more severe course of the disease, leading to breathing difficulties and pneumonia. However, deaths have so far occurred primarily among patients who were older and/or already suffered from chronic underlying conditions. No deaths have occurred in Germany yet. According to a Chinese study, 80.9% of those infected experienced a mild course of the disease. The data comes from the Chinese Center for Disease Control and Prevention (Görmann 2020). Since the symptoms of coronavirus and the flu are virtually indistinguishable, a history of travel to a high-risk area or contact with infected individuals has so far been the determining factor for testing for coronavirus. Samples are taken from the upper and lower respiratory tracts. This is done, for example, through multiple swabs.

Transmission

Coronaviruses are primarily transmitted through droplet transmission. When an infected person exhales, sneezes, or coughs, they release microscopic droplets into the air that may contain the virus. Contact transmission is also possible: If someone sneezes into their hands and then touches, for example, a doorknob, another person can become infected if they subsequently touch the same doorknob and then touch their mouth with their hand. That is why good hand hygiene is an important part of prevention.

Who is particularly at risk?

Current findings on the novel coronavirus show that people over the age of 60 and those with chronic illnesses are particularly at risk. They are considered part of the so-called vulnerable groups. Children and healthy adults generally develop only mild symptoms, such as a runny nose and a slight fever, or may not even realize they have been infected. This is also why the virus is able to spread so rapidly. Men appear to be affected slightly more often than women. According to a report in The New York Times, women generally have stronger immune systems, so they seem to be better able to fight off respiratory illnesses (Rabin 2020).

Are children affected as well?

Children are rarely affected by the disease, but they can still become infected and transmit the virus. Covid-19 typically appears to cause only very mild symptoms in children. This clearly distinguishes the new pathogen from influenza and other respiratory illnesses, which are often particularly dangerous for children. Daycare centers and schools are in close contact with the relevant authorities.

How can I protect myself from getting infected?

Pregnant women should follow the same precautions that the Robert Koch Institute recommends for the general population to protect against flu infections: These include, first and foremost, frequent, thorough handwashing and avoiding handshakes when greeting others. Proper “cough and sneeze etiquette” (always sneeze and cough into the crook of your arm or a tissue, never into your hand) and maintaining a distance (1–2 meters) from people suspected of being sick are also important. The World Health Organization (WHO) recommends avoiding touching your eyes, nose, and mouth. This helps prevent the virus from entering the body through the mucous membranes. However, these measures are advisable everywhere and at all times, especially during the flu season. In addition, during this season of infections, it is advisable to ventilate rooms frequently and to avoid touching elevator buttons, (daycare) doorknobs, etc., with bare fingers. Experts consider the use of standard face masks to be less effective.

Stay calm, don’t panic

Virologist Prof. Drosten stated at the federal press conference on March 2, 2020: “There are many mild cases. It’s basically like a cold.” For individuals, therefore, the disease is not a major problem if they do not belong to a high-risk group. Influenza viruses, which cause seasonal flu in our region, were responsible for approximately 25,000 deaths during the major flu wave of 2017–2018, as pneumonia can also be a threat in severe cases. Still, no one here panics anymore—we’ve simply grown accustomed to the danger. So much so that many pregnant women forego the flu vaccine despite the recommendation of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute. During pregnancy, however, influenza can increase the risk of growth retardation as well as miscarriage or premature birth in the unborn child. Unvaccinated pregnant women can still get vaccinated against influenza now, which can help prevent the coronavirus and influenza from “coming together.” Consult your gynecologist for advice. You can find information on the influenza vaccine during pregnancy from the Professional Association of Gynecologists at here.

Next Steps

According to the Robert Koch Institute, cases of infection with the novel coronavirus have now been confirmed in nearly all federal states (as of March 3, 2020). The massive efforts at all levels of the public health system have so far been aimed at detecting individual infections in Germany as early as possible and thereby delaying the further spread of the virus as much as possible. Another goal in Germany is to buy time to prepare as effectively as possible and learn more about the virus’s characteristics. Efforts are also being made to avoid, as much as possible, a convergence with the current wave of influenza in Germany. For the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), containing the epidemic remains the top priority. At the same time, intensive research is underway to develop a vaccine against the coronavirus. However, 18–20 months is cited as the earliest possible timeframe for the development of a vaccine.

We advise everyone to stay calm above all else! Fear and panic release stress hormones that can also have a negative effect on your baby. So it’s best to talk to your OB/GYN about any concerns you may have and ask for advice on protective measures. Be sure to wash your hands thoroughly and follow proper “cough and sneeze etiquette.” Most importantly: Choose your sources of information carefully! Social media, in particular, can quickly fuel a lot of fear, and fake news is also circulating! Therefore, please be sure to choose reputable sources, such as the regularly updated websites of the World Health Organization (WHO), the Federal Center for Health Education (BZgA), the Robert Koch Institute (RKI), and Charité Berlin.

Overview of Relevant Websites

https://www.rki.de

Note: The information in this blog post is in no way a substitute for professional advice or treatment from qualified and licensed medical professionals.

References

The Spread of COVID-19: How Dangerous Is the Coronavirus During Pregnancy? In: t-online. https://www.t-online.de/gesundheit/krankheiten-symptome/id_87342884/coronavirus-ausbruch-wie-gefaehrdet-sind-schwangere-und-kinder-.html Accessed: March 3, 2020

Brasch, C. 2020. Coronavirus: What’s Important for Pregnant Women Right Now. In: Eltern.de. https://www.eltern.de/schwangerschaft/coronavirus-was-jetzt-fuer-schwangere-wichtig-ist Accessed: March 3, 2020

Federal Center for Health Education. Infection Control. Answers to Frequently Asked Questions About the Coronavirus.

https://www.infektionsschutz.de/themen/coronavirus/-sars-cov-2.html Accessed: March 2, 2020

Chen H. et al. 2020. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. In: The Lancet. DOI:https://doi.org/10.1016/S0140-6736(20)30360-3

Deutschlandfunk. Interview with Prof. Dr. Christian Drosten (Institute of Virology at Charité) on February 13, 2020. https://www.deutschlandfunk.de/virologe-zum-coronavirus-geringe-sterblichkeit.694.de.html?dram:article_id=470165 Accessed: March 2, 2020

Obstetricians and Gynecologists Online. COVID-19 and Pregnancy. https://www.frauenaerzte-im-netz.de/aktuelles/meldung/corona-virus-und-schwangerschaft/ Accessed: March 2, 2020

Obstetricians and Gynecologists Online. Flu Vaccination During Pregnancy.https://www.frauenaerzte-im-netz.de/frauengesundheit/impfschutz-impfungen/impfung-gegen-grippe-influenza-in-der-schwangerschaft/ Accessed: March 3, 2020

Görmann, M. 2020. Don’t Panic—Just the Facts. How Dangerous Is the Coronavirus to Us, Really? In: Merkur.de.

https://www.merkur.de/welt/coronavirus-deutschland-china-fakten-tote-infizierte-news-symptome-covid-19-sars-cov-2-sterberaten-zr-13566935.html Accessed: March 3, 2020

Müller-Jung, J. 2020. The Epidemic in Our Heads. In: FAZ.net. https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/coronavirus-vor-was-sollen-wir-uns-fuerchten-16653022.html?utm_source=pocket-newtab, Accessed: March 2, 2020

Rabin C. 2020. Why the Coronavirus Seems to Hit Men Harder Than Women. In: New York Times online. https://www.nytimes.com/2020/02/20/health/coronavirus-men-women.html Accessed: March 3, 2020

Robert Koch Institute. Current assessment of the situation in Germany. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikobewertung.html Accessed: March 2, 2020

Robert Koch Institute. Case numbers by state. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html, accessed March 2, 2020

SARS-CoV-2: No transmission to the fetus. In: Ärzteblatt online. 2020. https://www.aerzteblatt.de/nachrichten/109348/Sars-CoV-2-Keine-Uebertragung-auf-Kind-im-Mutterleib Accessed: March 2, 2020

Standing Committee on Vaccination (STIKO). Flu vaccination for pregnant women. https://www.impfen-info.de/grippeimpfung/schwangere/ Accessed: March 2, 2020

Mortality, Spread, Duration: Leading virologist clears up the confusion surrounding the coronavirus statistics.https://www.focus.de/gesundheit/news/unsicherheiten-abbauen-sterblichkeit-ausbreitung_id_11723764.html Accessed: March 3, 2020