COVID-19 Infection and Pregnancy
Knowledge about Covid 19 and pregnancy has been evolving over the past 18 months and advice/guidance changes as a result. As a group, pregnant individuals seem to be no more at risk of contracting the virus than non-pregnant populations. The virus does not seem to be regularly transmitted to baby in the bloodstream, amniotic fluid or breast milk and there has been no evidence of any increase in fetal abnormalities. There have been a small number of case reports of neonatal infection that may be potentially due to transmission during pregnancy. Postnatal transmission of SARS-CoV-2 appears to account for the majority of infections reported in neonates, likely representing exposure to the infected caregivers. At this time, there is limited evidence on the extent of SARS-CoV-2 vertical transmission (mother to baby) and its timing.
The vast majority of individuals who have COVID-19 during pregnancy show mild symptoms and will go on to deliver healthy babies. Large-scale surveillance data in the U.K. has not shown higher incidence of stillbirth. COVID-19 is however more serious in pregnancy with higher rates of ICU admission or death when compared with pregnant women without COVID-19 or similar aged non-pregnant women. More recent studies have shown infection with Covid 19 at the time of birth leads to higher rates of fetal death and preterm birth (under 37 weeks), preeclampsia and emergency Cesarean delivery, as well as prolonged maternal and neonatal admission following birth, compared to those without Covid 19. Neonatal outcomes tend to be related to prematurity rather than Covid 19 infection. Prematurity and delivery choice also tend to be in the interest of maternal wellbeing. Pregnancy itself produces changes in the woman’s cardiovascular, respiratory and blood clotting systems, which make ventilation and ICU care for any condition difficult.
More recent concerns have surrounded placental function with Covid 19 infection. The placenta itself can undergo changes labelled “ Covid related placentitis” which impacts its function. This finding has been associated with a small number of stillbirths reported in Ireland , potentially associated with a condition called ‘COVID Placentitis’ in mothers who recently had COVID-19. It is an uncommon but distinctive complication of Covid 19 infection in the mother. It is believed Covid 19 infection leads to inflammation in the placenta which can lead to poor function and fetal compromise.
Those who are pregnant or planning to become pregnant should continue to observe the recommended hand hygiene and social distancing precautions. Pregnant women within the priority groups can get vaccinated from 14 weeks to 36+6 weeks gestation. Women within the priority groups who are planning pregnancy should ideally receive the vaccine before embarking on pregnancy or fertility treatment. Women can safely commence fertility treatment within a few days of receiving their second dose of the vaccine.
Since vaccines were approved for use in December, several international bodies have given opinions regarding this topic and some of this advice has been conflicting. The consensus at present seems to be that, while the evidence is generally reassuring, there are many unanswered questions about COVID-19 and the effects of both the virus and the vaccine on early pregnancy. Ultimately, patients should be given the available information and encouraged to choose what they feel is best for their own particular situation.
On February 8th, the British Fertility Society and Association of Reproductive Clinical Scientists released a FAQ document regarding Covid-19 vaccines and fertility. These guidelines indicate that there is no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men.
It is recommended that the vaccine should not be given in early pregnancy (first 13 weeks), but there is no evidence that it is necessary to delay trying to conceive or having fertility treatment post vaccination. However, it would seem reasonable to consider deferring conception or treatment until you have completed the full course, in view of the risk of side effects such as fever in the 48 hours following the vaccine, especially the second dose.
The Institute of Obstetricians and Gynaecologists, together with the National Immunisation Advisory Committee, previously released an Information Leaflet to help guide women who are pregnant or breastfeeding and their doctors about the COVID-19 vaccine.
We will continue to monitor events and to update our advice as further information becomes available.
See HSE website for additional information: