- Symptomatic and asymptomatic pregnant women should be tested if they have travelled to an affected country or have been in close contact with a person who tested positive for the disease within the last 14 days.
- The number of visits to the hospital needs to be reduced to the minimum. It is suggested to try coordinating necessary lab testing and ultrasound with in-hospital appointments.
- Postponing routine antenatal appointments needs to be considered for infected pregnant women.
- Symptomatic women should wear appropriate PPE while in an hospital setting.
- Pregnant women could be asked to provide themselves with BP cuffs to ensure adequate preeclampsia screening while at home.
- The risks of using low-dose aspirin for placental complications in a women infected with COVID-19 are still to be determined.
- Some authors suggest continuing the use of prophylactic aspirin during pregnancy. They also suggest suspending its use at diagnosis of COVID-19 and restarting it after full recovery.
Changes in gestational diabetes screening :
- Early pregnancy screening for overt diabetes should be managed the usual way.
- If lab testing and treatment are not affected by the pandemic, the screening for GDM could be done the usual way.
- In other cases, temporary recommendations suggest an alternative screening strategy using A1c and random non-fasting plasma glucose for all women.
- A1c <5.7% and random glucose <11.1 mmol/L : no GDM, no further testing required
- A1c >5.7% or random glucose >11.1 mmol/L : GDM diagnosis
- Temporary recommendations suggest delaying oral glucose tolerance test to screen for maternal dysglycemia in postpartum until after the pandemic is over.
Management in outpatient settings :
- Standard prenatal care is recommended for pregnant women who do not present any of the following symptoms: fever ≥ 38℃, cough, dyspnea, GI symptoms
- At-home symptomatic treatment is recommended at low risk of severe disease (no severe symptoms, comorbidity or obstetric complications and capable of self-care or planning follow-up.)
- Assessment in an outpatient setting is advised at moderate risk of severe disease (no severe symptoms, but presence of comorbidity, obstetric complications and/or inability to provide self-care or plan follow-up)
- Emergency care is recommended at elevated risk of severe disease (at least one severe symptom regardless of other risk factors).
This data comes from multiple sources. Boelig and al. wrote guidelines about pregnant women management in the time of COVID-19. The authors are part of the maternal-fetal-medicine division and Ob-Gyn Department at Thomas Jefferson University. Dotter-Katz and Hughes wrote an expert consensus. Elwood and al. provided guidelines for the Society of Obstetricians and Gynaecologists of Canada about management of the pregnant women during the pandemic. Favre and al. conducted a small literature review about the effects and consequences of MERS-CoV, SARS-CoV and Zika virus during pregnancy. It is based on a retrospective review of medical records of 9 COVID-19 infected pregnant women. Kwiatkowski and al. wrote a letter to the editor about the prescription of low-dose aspirin for placental complications during the time of COVID-19. Mathilde and al. wrote a letter to the editor about the prescription of prophylactic aspirin in COVID-19 positive patients. This data also comes from an algorithm developed by The American College of Obstetricians and Gynaecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM).
The data about gestational diabetes screening comes from a consensus statement based on recommendations made by the Society of Obstetricians and Gynaecologists of Canada and the Diabetes Canada clinical practice guidelines steering committee.
- Boelig RC., Saccone G. and al. (March 19 2020) MFM Guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2020.100106
- Dotters-Katz S and Hughes B.L. (March 17 2020). Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. Society for Maternal-Fetal Medicine. Retrieved on March 28 : https://s3.amazonaws.com/cdn.smfm.org/media/2267/COVID19-_updated_3-17-20_PDF.pdf
- Elwood C., Boucoiran I. et al. (April 2 2020). Updated SOGC Committee Opinion – COVID-19 in Pregnancy. The Society of Obstetricians and Gynaecologists of Canada. Retrieved from : https://www.sogc.org/en/content/featured-news/Updated-SOGC-Committee-Opinion__COVID-19-in-Pregnancy.aspx
- Favre G., Pomar L., Qi X. et al. (March 3 2020). Guidelines for pregnant women with suspected SARS-CoV-2 infection. The Lancet Infectious Diseases. https://doi.org/10.1016/S1473-3099(20)30157-2
- Kwiatkowski S., Borowski D. and al. (April 18 2020) Why we should not stop giving aspirin to pregnant women during the COVID‐19 pandemic. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.22049
- Mathilde G., Rolnik DL. and al. (April 29 2020) Should we stop aspirin prophylaxis in pregnant women when diagnosed with COVID-19? Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.22063
- The American College of Obstetricians and Gynecologists (ACOG), The Society for Maternal-Fetal Medicine (SMFM). (March 2020). Outpatient Assessment and Management for Pregnant Women With Suspected or Confirmed Novel Coronavirus (COVID-19). Retrieved from https://www.acog.org/-/media/project/acog/acogorg/files/pdfs/clinical-guidance/practice-advisory/covid-19-algorithm.pdf?la=en&hash=2D9E7F62C97F8231561616FFDCA3B1A6
Source about gestational diabetes :
- Yamamoto JM., Donovan LE. and al. (April 2020) Urgent Update – Temporary Alternative Screening Strategy for Gestational Diabetes Screening During the COVID-19 Pandemic. Canadian Journal of Diabetes. Retrieved from : https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/jcjd/JCJD_COVID_guidelines_020420-1585856697530.pdf