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Royal Colleges update national guidance on COVID-19 and pregnancy

News 19 February 2021

Risk of severe illness remains more common in later pregnancy with premature birth more than twice as likely in pregnant women with symptoms.

The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have today released updated national guidance to healthcare professionals about managing COVID-19 infection in pregnancy.

The guidance has been updated to reflect a comprehensive review of the evidence base globally on COVID-19 and pregnancy, and considers the impact on pregnant women who contract COVID-19 in the UK during this current wave of the pandemic.

Key points included in the guidance update:

  • About two thirds of pregnant women who have COVID-19 don’t have any symptoms, and those who experience symptoms will usually have mild or moderate cold and flu-like symptoms. Though uncommon, severe illness can occur and is more likely to happen in later pregnancy.
  • Compared to non-pregnant women with COVID-19, pregnant women with COVID-19 seem to have higher rates of intensive care unit (ICU) admission, although the absolute risk is still low (around 1 in every 5000 pregnant women). This might reflect a lower threshold for admission to ICU, rather than more severe disease. 
  • Compared to pregnant women without COVID-19, pregnant women who are symptomatic and require hospital treatment have overall worse maternal outcomes, including an increased risk of death, although that risk remains very low. In the UK, the maternal mortality rate from COVID-19 is 2.2 per 100,000 maternities.
  • Pregnant women with symptoms of COVID-19 are two to three times more likely to give birth to their baby prematurely.

The guidance provides up-to-date information and advice on how COVID-19 affects pregnant women and their unborn babies, how labour and birth should be managed in women with suspected or confirmed coronavirus, as well as information on neonatal care and infant feeding. 

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: 

“While we want to stress that the majority of pregnant women with COVID-19 experience only mild or moderate symptoms, this important update to our guidance confirms that pregnant women who are in their third trimester of pregnancy or have pre-existing medical problems are at a higher risk of developing severe illness. We encourage pregnant women to continue to pay particular attention to social distancing measures and good hygiene, and contact their maternity team if they have any concerns about their or their baby’s health. 

 “We’re now almost a year into the pandemic and while new data is emerging around COVID-19 and pregnancy, there is still currently no robust data from the UK comparing pregnant and non-pregnant women with COVID-19. This data gap extends to the COVID-19 vaccine and whether pregnant women will routinely be offered it. So far none of the vaccines have undergone specific clinical trials in pregnant women, something that urgently needs to change. We hope this guidance will be useful for the JCVI and others thinking about how to consider offering COVID-19 vaccination to pregnant women.”

Commenting, Gill Walton, CEO of the Royal College of Midwives (RCM), said:

“The priority of midwives and maternity services is to keep women and their babies safe and well during pregnancy. That’s even more important during the pandemic, when we know that while most women who contract COVID-19 during pregnancy will recover just fine, in a small majority of cases they will need specialist care and may be admitted to ICU. Managing COVID-19 infection early in pregnancy is key to ensuring better outcomes for women and their babies, which is why this newly updated national guidance will be invaluable to maternity staff. We understand it’s an anxious time for women and their families, but midwives are here to support you. It’s vital that you continue to attend your appointments, whether they’re in person or online, not only so midwives can monitor the health of you and your baby, but also so you can raise any questions or concerns you might have.”

“We know that women have been doing all they can to reduce their exposure to COVID-19 during their pregnancy and may have questions about whether or when they might be able to receive a vaccine. At the moment, because of their greater chance of experiencing more severe COVID-19 symptoms, only pregnant women who are classed as clinically extremely vulnerable or are frontline health or social care workers are eligible for the vaccine. Women who are either planning a pregnancy or who have had their baby and are breastfeeding should be reassured that the vaccines are safe for them and will have no impact on either their fertility or their breastmilk.” 

Professor Marian Knight, Professor of Maternal and Child Population Health at the National Perinatal Epidemiology Unit of the University of Oxford, said:

“The UK national data show that a substantially higher number of pregnant women have been admitted to hospital with COVID-19 in this second wave compared to the first wave. Sadly, a small number of women have already died. Around 1 of every 3 pregnant women admitted with symptomatic COVID-19 will require oxygen or other help to breathe and around 1 in every 10 will be admitted to an intensive care unit. Importantly 1 in 5 of the pregnant women admitted with symptomatic COVID-19 will give birth to a pre-term baby. Being born preterm can have lifelong consequences.

“The majority of pregnant women are currently not eligible to receive a COVID-19 vaccine. We have neither data from trials nor comprehensive studies following up pregnant women who have received the vaccine. It is likely pregnant women will continue to be denied access to the vaccine on the basis of an absence of evidence to allow them to make an informed choice. We are in the unacceptable situation that pregnant women and their babies will remain unprotected from COVID-19 until trials are completed in the autumn at the earliest, while the remainder of the adult population receive protection from vaccination.”

ENDS 

Notes to Editors

For media enquiries please contact the RCOG press office on +44 (0)7986 183167 or email pressoffice@rcog.org.uk 

COVID-19 Virus Infection and Pregnancy, Information for Healthcare Professionals - read the guidance.

We have an extensive Q&A section for pregnant women and their families on the RCOG website: www.rcog.org.uk/coronavirus-pregnancy. Information about COVID-19 vaccination and pregnancy is available at: www.rcog.org.uk/covid-vaccine