SMFM recommends that in most cases, timing of delivery not be dictated by maternal COVID-19 infection. In women who recover, the usual timing of pregnancy should not be altered. For women infected in the third trimester who recover, it may be reasonable to attempt to postpone delivery (if no other medical indications arise) until the mother tests negative for the disease or her quarantine status is lifted. The CDC recommends that facilities consider temporarily separating a woman with either confirmed COVID-19 or who is a patient under investigation (PUI) for the infection from her infant until she can no longer transmit the virus.
In regard to breastfeeding, a small study of nine infected women found no evidence of COVID-19 in breast milk. The CDC recommends that during temporary separation, women who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. Before pumping, women should practice thorough hand hygiene and after pumping, all parts of the pump that come into contact with breast milk should be thoroughly washed, and the entire device should be disinfected according to the manufacturer’s instructions. Expressed breast milk should be given to the newborn by a health caregiver. For women and infants who are not separated, the CDC recommends that if a woman wishes to feed her infant at the breast, she should wear a facemask and practice hand hygiene before each feeding.
Because travel guidance from the CDC changes frequently, SMFM recommends that patients and providers check the CDC website frequently for guidance. Pregnant women with severe medical illnesses, such as heart, lung, or kidney disease, should follow the CDC precautions for those at higher risk and avoid crowds and keep space between themselves and others when out in public.
SMFM notes that because this is a rapidly changing situation, it is imperative for health care providers to monitor developments and make themselves aware of new information. The organization notes that it will continue to provide guidance as new data become available.
Look for a commentary on COVID-19 by Brenna L. Hughes, MD, and Sarah K. Dotters-Katz, MD, in the Contemporary OB/GYN April isssue.