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Caring for Women Who Are Planning a Pregnancy, Pregnant, or Postpartum During the COVID-19 Pandemic

Educational Objective
To understand what to discuss with women planning a pregnancy, are pregnant, or postpartum during the COVID-19 Pandemic
1 Credit CME

Since its recognition in China in December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world and become a pandemic. Although considerable data on COVID-19 are available, much remains to be learned about its effects on pregnant women and newborns.

No data are currently available to assess whether pregnant women are more susceptible to COVID-19. Pregnant women are at risk for severe disease associated with other respiratory illnesses (eg, 2009 H1N1 influenza),1 but thus far, pregnant women with COVID-19 do not appear to be at increased risk for severe disease compared with the general population. Data from China showed that among 147 pregnant women, 8% had severe disease and 1% had critical illness, which are lower rates than observed in the nonpregnant population (14% with severe disease and 6% with critical illness).2 Case series from China consisting primarily of women with third-trimester infection have shown that clinical findings in pregnant women are similar to those seen in the general population.1 Conversely, a small Swedish study reported that pregnant and postpartum women with COVID-19 were 5 times more likely to be admitted to an intensive care unit compared with nonpregnant women of similar age.3

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Article Information

Corresponding Author: Denise J. Jamieson, MD, MPH, Department of Gynecology and Obstetrics, Emory University School of Medicine, 101 Woodruff Cir, Woodruff Memorial Research Building, Ste 4208, Atlanta, GA 30322 (djamieson@emory.edu).

Published Online: June 5, 2020. doi:10.1001/jama.2020.8883

Conflict of Interest Disclosures: None reported.

References
1.
Rasmussen  SA , Smulian  JC , Lednicky  JA , Wen  TS , Jamieson  DJ .  Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.   Am J Obstet Gynecol. 2020;222(5):415-426.PubMedGoogle ScholarCrossref
2.
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). World Health Organization; 2020. Accessed March 8, 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
3.
Collin  J , Byström  E , Carnahan  A , Ahrne  M .  Pregnant and postpartum women with SARS-CoV-2 infection in intensive care in Sweden.   Acta Obstet Gynecol Scand. Published online May 9, 2020. doi:10.1111/aogs.13901PubMedGoogle Scholar
4.
Breslin  N , Baptiste  C , Muller  R ,  et al.  Coronavirus disease 2019 in pregnancy: early lessons.   Am J Obstet Gynecol. Published online May 20, 2020. doi:10.1016/j.ajogmf.2020.100111Google Scholar
5.
Zeng  L , Xia  S , Yuan  W ,  et al.  Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China.   JAMA Pediatr. Published online March 26, 2020. doi:10.1001/jamapediatrics.2020.0878PubMedGoogle Scholar
6.
Kirtsman  M , Diambomba  Y , Poutanen  SM ,  et al.  Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection.   CMAJ. Published online May 14, 2020. doi:10.1503/cmaj.200821PubMedGoogle Scholar
7.
Kimberlin  DW , Stagno  S .  Can SARS-CoV-2 infection be acquired in utero? more definitive evidence is needed.   JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4868PubMedGoogle Scholar
8.
Groß  R , Conzelmann  C , Müller  JA ,  et al.  Detection of SARS-CoV-2 in human breastmilk.   Lancet. Published online May 21, 2020. doi:10.1016/S0140-6736(20)31181-8PubMedGoogle Scholar
9.
Newsome  K , Alverson  CJ , Williams  J ,  et al.  Outcomes of infants born to women with influenza A(H1N1)pdm09.   Birth Defects Res. 2019;111(2):88-95.PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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