Updated guidance: Covid-19 and pregnancy

Adapted from RCOG, Coronavirus (COVID-19) Infection in Pregnancy. Version 9: published Wednesday 13 May 2020

Whilst pregnant women are not necessarily more susceptible to viral disease, however, changes to the immune and coagulation systems in pregnancy can be associated with more severe symptoms. Current evidence suggests that pregnant women do not appear to be at higher risk than non-pregnant women of severe Covid-19 infection requiring hospital admission. The large majority of pregnant women experience only mild or moderate cold/flu-like symptoms.

An interim report of the UK Obstetric Surveillance System (UKOSS) registry for all pregnant women admitted to hospitals with confirmed Covid-19 infection was published as pre-print on 11 May 2020. A total of 427 women were included. The evidence suggests that, in the period 1 March to 14 April 2020, 4.9 pregnant women per 1,000 were admitted to hospital with Covid-19, and around 1 woman in 10 received intensive care. Sadly 5 women with Covid-19 died, representing a case fatality rate for pregnant women hospitalised with Covid-19 of 1.2%. It is still unclear if coronavirus was the cause of their death. This supports the RCOG guidance that pregnant women are at no greater risk of severe disease compared to the non-pregnant population. Interestingly the results showed that 55% of pregnant women admitted to hospital with Covid-19 were from a black, Asian or other minority ethnic background. Older pregnant women, as well as overweight or obese and those with pre-existing conditions such as diabetes and high blood pressure were more likely to be admitted to hospital.

There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to Covid-19. Although some recent evidence showed that the virus can be vertically transmitted (mother to fetus) during pregnancy or birth, there is no evidence that Covid-19 is teratogenic (ie, affects the development of the fetus and/or causes congenital malformation).

Luciano Nardo, Clinical Director at the Reproductive Health Group, said: It is fundamental that epidemiological data are collected to establish further the relationship between Covid-19 infection and pregnancy, and to understand the factors associated with increased risk in some ethnic groups. Meanwhile pregnant women should be following physical distancing and adopt adequate protective measures.