Expert / 11 January, 2021 / Dr Ellie Rayner
Congratulations on your pregnancy and for coping so well during this challenging time. As a practicing obstetrician working full time within the NHS throughout the pandemic, I completely understand how difficult this time has been for expectant parents and how going into a third lockdown may feel. If you are pregnant and worried about COVID-19 then read on to learn more about how the pandemic might impact you, how COVID-19 affects pregnancy, and what steps you can take to remain healthy and well during this time. Be reassured that all maternity services and staff are committed to providing safe and effective maternity care throughout the pandemic and are here for you day and night should you need advice or support.
The majority of pregnant women will only experience mild or moderate symptoms should they catch coronavirus however, as a precaution, pregnant women have been included in the list of people at moderate risk (clinically vulnerable) of COVID-19 as pregnant women can sometimes be at more risk of viruses like flu compared to a woman who is not pregnant.
If you are pregnant at the moment, you should follow the latest guidance on staying alert and safe using social distancing, hand washing, appropriate use of face coverings and avoiding anyone who has symptoms suggestive of coronavirus. Amongst pregnant women, the highest chance of becoming severely unwell appears to be in those greater than 28 weeks of pregnancy so it is particularly important to follow social distancing and hygiene measures if you are in your third trimester.
The main symptoms you should look out for include temperature or cough and if you develop either of these symptoms you should arrange a test straight away. As with anyone who is not pregnant, you should self-isolate while you are waiting for the result. If you feel unwell or have any other symptoms you are not sure about, including non-COVID-19 symptoms such as pain when you pass urine or vaginal bleeding, please contact your maternity unit straight away or the NHS telephone helplines for advice. There are other possible causes for your symptoms, such as a urine or chest infection, so if your COVID-19 test result is negative, please do still seek advice if you are unwell or symptomatic. There may be other tests or treatments your midwife or doctor might recommend to ensure you and your baby are well.
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Research evidence suggests that pregnant women are at no greater risk of becoming seriously unwell and the majority of pregnant women will only experience mild or moderate symptoms should they catch coronavirus. A study conducted within the UK during the pandemic confirmed that pregnant women from Black, Asian and minority ethnic groups were more likely than other women to be admitted to hospital. Pregnant women who had a Body mass index (BMI) more than 30, aged more than 35 years and who had pre-existing medical problems, such as diabetes or high blood pressure, were also at greater risk of developing severe illness and requiring an admission to hospital.
The current research suggests that there is no evidence that having COVID-19 during early pregnancy increases the risk of miscarriage and current evidence suggests that it is unlikely to cause problems with your baby’s development.
If you were diagnosed with COVID-19 and experience only mild or moderate symptoms and did not require admission to hospital your remaining antenatal care throughout your pregnancy will remain unchanged. If you were seriously unwell and/or required hospital admission, then you will be offered a follow-up appointment for a growth scan of your baby at least 14 days after you have recovered to ensure your baby’s growth hasn’t been affected. Any other antenatal appointments or scans you may have missed whilst unwell may also be arranged and you should check with your midwife and doctor regarding these.
Antenatal and postnatal care is still vitally important for you and your baby throughout the pandemic and your local hospital unit will have made arrangements to ensure they can still provide all of the appointments you need whilst keeping you, your baby and the staff working in the maternity unit safe. These appointments may be in a different place than usual, or via a different method, such as video or telephone call appointment, but they are all necessary. The current guidance in England is that pregnant women should be able to have one person with them ‘at all times in their maternity journey’. This guidance, however, is still subject to local maternity unit discretion so it is important to check what the policy for support at scans, antenatal appointments or to the inpatient wards is in your area and maternity unit.
If you are worried that you have symptoms of COVID-19, have been in contact with someone that does or has been told to isolate, then call your maternity unit as soon as possible and discuss your situation and make a plan directly with them for your appointment. Depending on the nature and urgency of your appointment and the exact circumstances they will advise you accordingly. This may include attending a different area or rearranging for a different day.
Maternity services in the UK are available 24/7, even throughout the lockdown. If you have any concerns over yours or your baby’s wellbeing in between your appointments, there will always be someone you can talk to if you have any concerns or questions. The NHS is working hard to ensure that maternity services are running and have safeguards in place to make sure you can access the care that you need when you need it. Even if you are symptomatic of coronavirus, self-isolating or shielding, please do not hesitate to call your local maternity unit if you have symptoms such as pain, bleeding, suspect your waters have broken or not feeling your baby move as much as normal. Whatever your concern, your maternity unit will be happy to advise and see you when needed.
The Coronavirus pandemic and lockdown has changed many of the ways we approach work and life and sadly pregnancy is no different. Under current government guidance, everyone is advised to stay home unless leaving for a specific purpose. With the latest restrictions announced, it is likely that you are staying inside more or not as active as you would normally be. If this is the case, then it is really important to make some small changes to stay well during this time. Pregnant women are at higher risk of developing a blood clot than a non-pregnant person and your midwife or obstetrician may have mentioned this to you already. Keep as mobile as you can and make sure to drink plenty of water to help reduce your risk.
All pregnant and breastfeeding women are recommended to take 10 micrograms of Vitamin D every day to help keep bones and muscles healthy and you should consider taking a supplement for this. Vitamin D is made when our skin is exposed to sunlight. Normally we only recommend taking this during the autumn and winter months when we cover up more or spend more time indoors however, in light of the pandemic, as you may have spent more time indoors than normal this year, we would encourage you start taking this straight away.
Vitamin D supplementation is particularly important if you cover your skin for cultural reasons or have dark skin (such as women who are of African, African Caribbean or south Asian origin) or if you have a BMI (body mass index) >30, as you can be at greater risk of Vitamin D deficiency. Vitamin D supplements are available from most supermarkets and pharmacies and some eligible families through the NHS Healthy Start scheme.
Keeping active and eating well are both important aspects of any pregnancy. Regular exercise during pregnancy is important for both yours and your baby’s wellbeing. It can give you more energy, improve your mood and sleep and can help reduce your risk of developing raised blood pressure or pregnancy diabetes (gestational diabetes). It also helps you cope with labour and can make labour easier.
During Lockdown, you are currently still able to leave your home to exercise once a day either by yourself, with your household or support bubble, in a childcare bubble where providing childcare or, when on your own, with one other person from another household. You should still stay two meters apart from anyone not in your household or support bubble.
During Lockdown, some of your usual classes or activities may be cancelled or limited, but it is important to try and maintain a similar level of exercise to what you were previous undertaking. Walking, jogging, at home aerobics or pregnancy yoga are all safe, there are many classes available online both live or to stream so there are lots of options available to you. If you didn’t exercise very much before pregnancy, you can still start now with 15 minutes 3-4 times a week and increase as you feel able.
The flu vaccine is completely safe throughout pregnancy and your GP, midwife or Obstetrician can arrange this for you free of charge. Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives strongly recommend the flu vaccine to all pregnant women, particularly in light of the COVID-19 pandemic, as it is possible to get infected with both infections at the same time and this could cause a more serious illness.
This advice is changing all the time as we are constantly getting more information and evidence to support any recommendations. A number of different vaccines are already routinely and safely offered to pregnant women, such as the whooping cough and flu vaccine, however, specific clinical trials have not yet been carried out of the COVID-19 vaccines in pregnant women.
Although the current available data does not suggest any safety concerns or harms, the advice from the Joint Committee on Vaccination and Immunisation (JCVI) on the 30th December 2020 is that there is currently insufficient evidence to recommend routine use of the COVID-19 vaccine during pregnancy. They do however advise that should a pregnant woman be at very high risk of serious complications of COVID-19 then they should have a risk and benefit discussion with their doctor, acknowledging the current absence of safety data for using the vaccine in pregnant women.
The initial advice released was to delay pregnancy until several months after you have had the COVID-19 vaccine. The Updated advice from the Joint Committee on Vaccination and Immunisation (JCVI) on the 30th December 2020 says that women who are trying to get pregnant do not need to avoid pregnancy after the vaccination. There is also no evidence to suggest these types of vaccines cause issues with fertility.
The Royal College of Obstetricians and Gynaecologists have a dedicated patient information section on their website regarding COVID-19 and women’s health which is updated regularly with the latest guidance and advice. Alternatively, if you do need any further information or have a specific question, please speak to your local maternity unit as they will able to advise you on up to date guidance for your area and personal situation.
Stay safe and stay well.
Dr Ellie Rayner, Obstetrician and Gynaecologist, Antenatal and Hypnobirthing Teacher and founder of The Maternity Collective.
Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective. She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.
Follow Dr Ellie Rayner @maternitymedic for the latest evidence-based information on pregnancy, birth and women’s health issues.
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