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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
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