L'epidemiologia per la sanità pubblica
Istituto Superiore di Sanità
Epidemiologia per la sanità pubblica - ISS

COVID-19: pregnancy, delivery and breastfeeding - February 27th 2020

Pregnant women are considered a population at risk of viral respiratory infections, such as such as COVID-19 (Corona Virus Disease) infections and seasonal flu, for possible consequences on the mother and foetus. For seasonal flu, the vaccine during pregnancy is recommended. In the absence of vaccine against SARS-CoV-2, the virus responsible for COVID-19, common primary prevention actions are recommended for pregnant women and their contacts. These actions require frequent and accurate hands hygiene and attention to avoid contact with sick or suspect subjects, according to the recommendations of the Ministry of Health and international institutions [1,2,3]. At present, there is no information on the susceptibility of pregnant women to the pathology of the new coronavirus SARS-CoV-2 [4].

 

The transmission of the SARS-CoV-2 virus occurs through direct contact, through the breath droplets that can be transmitted with the saliva, cough or sneezing of infected people and through the contaminated hands (not washed) brought to the mouth, nose or eyes [5,6]. It is unknown whether vertical transmission, from mother to foetus, of SARS-CoV-2 occurs. Among the first 19 cases of pregnant women and infants born from mothers with clinical symptoms of COVID-19 described in the literature, the virus has not been detected in amniotic fluid or neonatal blood of the umbilical cord. Therefore, currently there is no evidence to support a vertical transmission of the SARS-COV-2 virus [7,8,9]. At the current state of knowledge and if there are no specific maternal or foetal clinical indications, for women with suspected SARS-CoV-2 infection or with COVID-19 the caesarean section does not seem appropriate. The current indications for carrying out vaginal or surgical delivery are valid.

 

Concerning the hospital management of suspicious or certain cases, please refer to what is recommended for the management of infectious conditions including, if necessary, the isolation of mother and/or newborn.

 

Any temporary separation of the infant from the mother during hospitalization must be carefully considered by the health professionals with the mother, evaluating the risks and benefits of this choice, including the protective potential of colostrum, mother milk and breastfeeding [10].

 

The virus responsible for COVID-19 was not detected in breast milk collected after the first feed (colostrum) of the affected women; in one case, however, antibodies to SARS-CoV were detected [4,7,11]. Due to the scientific information currently available and the protective potential of breast milk, in the case of a woman with suspected SARS-CoV-2 infection or affected by COVID-19, in positive clinical conditions and according to mother desire, breastfeeding should be started and/or maintained, directly or with expressed breast milk [10,12].

 

To reduce the risk of transmission to the child, it is recommended to adopt preventive procedures such as hand hygiene and the use of a mask during breastfeeding, according to the recommendations of the Ministry of Health. In the case in which mother and child must be temporarily separated, it is recommended to help the mother to maintain milk production through manual or mechanical extraction which must be carried out following the same hygienic indications [10,12].

 

For all operators and professionals who take care of pregnant women and infants, it is recommended to follow the preventive recommendations [10]. Refer also to the Operational Guidance "Feeding infants and young children in emergencies" for aspects related to the management of infants (0-2 years) in the case of a new SARS-CoV-2 coronavirus emergency [13].

 

References

  1. Ministry of Health. Nuovo coronavirus. Prevenzione e trattamento.
  2. Ministry of Health. Nuovo coronavirus - Dieci comportamenti da seguire.
  3. World Health Organization. Q&A on coronaviruses (COVID-19).
  4. CDC. Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy [Internet]. [cited 2020 Feb 25].
  5. Ministry of Health. Nuovo coronavirus. Modalità di trasmissione.
  6. WHO Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. 25 jan 2020.
  7. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020;0(0).
  8. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. 2020;
  9. Qiao J. Comment What are the risks of COVID-19 infection in pregnant women? 2020 [cited 2020 Feb 25]; Available from: https://doi.org/10.1016/S0140-6736
  10. CDC. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. Retrieved February 25, 2020, from
  11. Robertson, C. A., Lowther, S. A., Birch, T., Tan, C., Sorhage, F., Stockman, L., … Bresnitz, E. (2004). SARS and Pregnancy: A Case Report. Emerging Infectious Diseases, 10(2), 345–348.
  12. CDC. Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19 [Internet]. [cited 2020 Feb 25].
  13. Infant Feeding in Emergency Core Group. (2017). Infant and Young Child Feeding in Emergencies. Operational Guidance for Emergency Relief Staff and Programme Managers. Version 3.0. 2017
Resources

 

Data di creazione della pagina: 27 febbraio 2020

Autori: Angela Giusti*, Serena Donati*, Marco Silano**, Fortunato “Paolo” D’Ancona*** – ISS
* Centro nazionale per la prevenzione delle malattie e la promozione della salute
** Dipartimento Sicurezza Alimentare, Nutrizione e sanità pubblica Veterinaria
*** Dipartimento Malattie infettive