Provider Alert! Coronavirus disease 2019 (COVID-19) and Pregnancy

Provider Alert! Coronavirus disease 2019 (COVID-19) and Pregnancy

The following provider guidance is provided as a Texas Children’s Health Plan (TCHP) educational communication only. As many of our network providers are affiliated with other institutions and organizations who also set policy and procedure, this communication is not intended to replace, overwrite, amend or append to another institution’s guidance, policy or procedure. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Attention: OB/GYN Providers
Effective March 18, 2020

While the current literature about COVID-19 specific to pregnant women is limited, small reports are being published weekly. We do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the public nor whether they are more likely to have serious illness as a result. Pregnant women experience immunologic and physiologic changes, which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women have a greater risk of severe morbidity and mortality resulting from other respiratory infections. It is always important for pregnant women to protect themselves from illness. It is unknown if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery (cdc.gov).

COVID-19 and Breastmilk

There is much unknown as to how COVID-19 is spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however, we do not know whether mothers with COVID-19 can transmit the virus via breast milk.

Per the CDC1:

Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.  A mother with confirmed COVID-19 or who is a symptomatic Person Under Investigation (PUI) should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.  If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.

 

Public Health Laboratory Testing:

Amongst 50 states and the District of Columbia, 81 state and local public health laboratories have successfully verified COVID-19 diagnostic tests and are offering testing. Health care practitioners should contact their local and/or state health department for guidance on testing persons under investigation.

 

Next steps for providers:

Toolkits:
The Centers for Disease Control and Prevention (CDC) has released Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection and guidance for Evaluating and Reporting Persons Under Investigation (PUI)2.

 

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine developed an algorithm, to assist providers in assessing and managing pregnant women with suspected or confirmed COVID-19. You may access the algorithm here: https://www.acog.org/-/media/Practice-Advisories/COVID-19-Algorithm5.ashx

 

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

 

References

  1. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html
  2. https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019

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