Special Patient Populations
Syed H Rahman MD
To date, there have been very limited reports of pregnant women with COVID-19. Retrospective studies have studied 34 such reports, the majority had symptoms of fever and cough. To date, none of the children born to COVID-19 positive mothers have tested positive themselves. Placenta, cord blood, and breast milk were all tested and did not contain the virus. There have been no maternal deaths noted but there have been mothers requiring ICU level care.
We currently have no data on how COVID-19 affects early pregnancies. Pregnant women are considered an “at risk’ population and extra precautions should be taken. Generally, infections early in pregnancy can increase the risk of spontaneous abortions and birth defects, whether COVID-19 specically increases the risk has yet to studied.
After a baby is delivered to a COVID-19 positive mother, extra care may be taken to prevent infection to the infant. This may include temporary separation or use of personal protective equipment. Breast milk can be expressed and fed to the infant by a healthy caregiver. Temporary separation can be ended 24 hours after resolution of fever without antipyretics (fever lowering medications) and two negative COVID-19 nasal swabs taken 12 hours apart.
Children with COVID-19 tend to have milder symptoms, similar to the SARS outbreak of the early 2000s. At the onset only about 2% of the confirmed cases in China were children. Since then, that number has risen to close to 13% in some areas. The majority of children infected had it transmitted by a family member in the house. Between 50-80% reported fevers and typical respiratory infection symptoms. Co-infection with other bacteria/viruses such as RSV, Streptococcus, or H. Influenza has been documented. Recently, some reports of gastrointestinal symptoms of cramping, diarrhea, or vomiting prior to URI symptoms have been seen. There are cases of children requiring ICU level of care, although rare.
The NIH has started trials of the antiviral remdesivir to treat COVID-19. The trials are still in early phases of study but at this time it is not being offered to pregnant women or children.