MRC Centre for Reproductive Health
MRC Logo JAN 2019

Debunking the myths - Coronavirus (COVID-19) Q & A from the MRC Centre for Reproductive Health

Since the onset of the pandemic, there have been many questions and concerns visible on social media and in mainstream media regarding conception, pregnancy, birth, and life as a new mum.

The MRC Centre for Reproductive Health is the only MRC-funded research establishment in the UK that focuses exclusively on reproduction.

Our highly skilled researchers carry out world-class research developing therapeutic and preventative strategies to improve health and reproductive outcomes.

Some of our reproductive health researchers have created answers to some commonly asked questions, based on their own areas of research expertise.

Please note that these answers are not intended as medical advice and if you are concerned about your own health or your baby’s health, contact your GP or phone NHS 24 on 111.

 

Professor Horne

Professor Andrew Horne, Professor of Gynaecology and Reproductive Science, MRC Centre for Reproductive Health

Q) How has your approach to the management of endometriosis changed since the start of the pandemic and how is your research feeding into the guidance available?

A) There have been many changes affecting patients across Scotland as a result of the coronavirus disease 2019 (COVID-19) pandemic. Many of our medical and allied healthcare appointments and surgeries have had to be temporarily postponed to protect our teams and patients.

I have therefore strongly encouraged patients to consider self-management strategies to combat endometriosis symptoms during the pandemic. These self-management strategies can be divided into problem-focused and emotion-focused strategies, with the former aiming to change the environment to alleviate pain, and the latter address the psychology of living with endometriosis.

Together with national and international experts in endometriosis and based on my ongoing research into endometriosis carried out at MRC Centre for Reproductive Health, I have written guidance for healthcare providers to utilise during their consultations with patients via telephone or video. Links to HR Open and Frontiers:

https://academic.oup.com/hropen/article/2020/2/hoaa028/5849477

https://www.frontiersin.org/articles/10.3389/frph.2020.00005/full

The strategies discussed are not exclusively restricted to consideration during the COVID-19 pandemic. Most have been researched before this period of time and will continue to be part of the approach to managing endometriosis long after COVID-19 restrictions are lifted.

 

Mike Rimmer

Dr Michael Rimmer, ECAT Clinical Research Training Fellow at MRC Centre for Reproductive Health

Q) What changes have been made to the structure and management of the labour wards since the start of the pandemic?

 A) Many women are concerned they won’t be able to bring a birth partner when they are in labour. In many hospitals across Scotland, women have always been allowed one partner and are now allowed 2 when they are in labour and are now allowed visitors on the antenatal and post-natal wards during the day time too.

Our goal has always been to support women during labour and help them achieve their desired birth plan, while supporting them to make an informed choice, should this need to change during labour.

However, this situation could change and may vary from hospital to hospital. It is always advisable to check individual NHS trust websites before arriving to hospital for the most up-to-date guidance.

This information is based on the current NHS guidance: 03.09.20.

Dr Rimmer was also asked:

Q) Do you treat labouring mums who have tested positive for COVID-19 differently, and if so, what procedures are put in place for mum and baby?

A) Based on guidelines, if a woman tests positive for COVID-19 she will be supported in her birth plan as much as possible, however, in many instances a designated room will be provided for delivery. This is to reduce the risk of transmission to other patients.

Members of the multi-disciplinary team will be involved in her care and will monitor her and her baby closely during labour to ensure both mum and baby are healthy during the labour.

This information reflects the current NHS guidelines: 03.09.20

 

Dr Stock

Dr Sarah Stock, Reader and Honorary Consultant Maternal and Fetal Medicine at MRC Centre for Reproductive Health

Q) Is there any evidence that I am more likely to get seriously ill if I catch Coronavirus when I am pregnant and why are pregnant women considered to be in a clinically vulnerable group?

A) Being pregnant, or recently having a baby, does seem to make women more vulnerable to severe COVID-19 disease.

Higher rates of intensive care unit admission and breathing support are seen in pregnant women than in non-pregnant women. Research findings give us two explanations for this: The reasons for this are two-fold:

Firstly, we know that the body’s response to infection is altered in pregnancy and some immune responses are damped down to help allow the pregnancy to establish and the baby to grow in the womb.

Secondly, pregnancy increases the work that the cardiovascular and respiratory systems have to do, and makes blood more likely to clot. COVID complications, which predominantly affect the heart, lungs and blood vessels, may be more likely in pregnancy as these systems are already stretched.

However, it is important to recognise that most pregnant women with COVID infection will experience only mild or moderate cold/flu-like symptoms. Although the risk of complications is greater in pregnancy, the overall risk of serious disease is still low.

There is a real necessity to collect more data to increase our knowledge base on this virus, so we know more about the impact it may have on both pregnant women and babies / children.

The COVID-19 in Pregnancy in Scotland (COPS) observational study has recently been founded by myself and a team of researchers with the aim of learning more about the impact of COVID-19 on pregnancy and new babies.

Using linked Scottish national data the research team will describe the incidence of COVID-19 in pregnancy at population level in Scotland, and aim to determine associations between COVID-19 and adverse pregnancy, neonatal and maternal outcomes; and the proportion of confirmed cases of SARS-CoV-2 infection in neonates associated with maternal COVID-19.

The study will perform analyses using definitions for confirmed, probable and possible COVID-19, and report serology results (where available). Outcomes will include congenital anomaly, miscarriage, stillbirth, termination of pregnancy, preterm birth, neonatal infection, severe maternal disease and maternal deaths.

The research team will perform descriptive analyses and appropriate modelling, adjusting for demographic and pregnancy characteristics, and the presence of co-morbidities. The cohort will provide a platform for future studies of the effectiveness and safety of therapeutic interventions and immunisations for COVID-19, and their effects on childhood and developmental outcomes.

 

Prof Duncan

Professor Colin Duncan, Professor of Reproductive Medicine and Science at MRC Centre for Reproductive Health.

Q) How have fertility services been impacted by Coronavirus? Could catching COVID-19 impact conception or an early stage pregnancy?

A) At the early stages of the pandemic the infertility services stopped treating couples. There were three reasons for this: the first was to stop healthy people entering hospitals struggling with increasing numbers of unwell patients, the second was to free up human resources to help assess and treat COVID-19 and the third is that we were not sure what impact COVID-19 would have in pregnancy. In previous Flu pandemics pregnant women were more likely to become more severely ill and even die.

The good news is that current research indicates that pregnant women with COVID-19 are no more likely to become very unwell or die than similar women who were not pregnant. There is nothing yet to suggest that having COVID-19 during pregnancy has any impact on the baby’s growth or development.

Normally women who become very unwell with a high temperature have a higher risk of losing the pregnancy or going into premature labour. In women with COVID-19, studies indicate that only a small number of women went into premature labour, and it wasn’t certain how much of this was due to COVID-19. This is very reassuring about the risks of COVID-19 if you are pregnant. Because of this, and the falling numbers of infections and unwell patients, infertility services have now started again, with screening and enhanced patient safety procedures in place.

Research indicates that both your general health and whether you are in a high-risk group are contributing factors in successful pregnancy outcomes.

Furthermore, we know from ongoing research studies that women with underlying illnesses, obesity and those from the BAME community are at higher risk from COVID-19 if they catch it, regardless of whether they are pregnant or not.

Overall though, current data suggests that pregnancy is not a risk factor for getting COVID-19 or becoming extremely unwell with COVID-19.

 

Prof Boardman

Professor James Boardman, Professor of Neonatal Medicine at MRC Centre for Reproductive Health.

Q) Can a new mum still safely breastfeed if she has confirmed or suspected Coronavirus?

A) Yes. There are unequivocal and wide-ranging benefits of breast feeding for mother and baby, including a reduced risk of babies developing infectious diseases.

Research into all aspects of COVID-19 on pregnancy and new babies is ongoing and we are learning more about the impact of the virus every day. As present, there is no conclusive evidence that the SARS-CoV-2 virus can be passed through breastmilk or donor breastmilk and cause infant disease. The current UK recommendation is that babies born to women with suspected or confirmed coronavirus infection should be breast fed / receive breast milk if possible.

For evidence updates and sources of information about looking after newborn babies and young infants during the COVID-19 pandemic:

NHS:

https://www.nhs.uk/start4life/baby/coronavirus-covid19-advice-for-parents/

British Association of Perinatal Medicine:

https://www.rcpch.ac.uk/resources/covid-19-guidance-neonatal-settings#breastfeeding-by-covid-19-suspected-or-confirmed-mothers

Royal College of Paediatrcis and Child Health:

https://www.rcpch.ac.uk/resources/covid-19-guidance-neonatal-settings#breastfeeding-by-covid-19-suspected-or-confirmed-mothers

UNICEF UK Baby Friendly Initiative:

https://www.unicef.org.uk/babyfriendly/infant-feeding-during-the-covid-19-outbreak/

Follow up to date information from UK government coronavirus guidance and support (includes links to policies in devolved administrations):

https://www.gov.uk/coronavirus

Q) Should I take extra hygiene precautions while feeding my baby?

A) Yes, regardless of feeding method and COVID-19 status, good hygiene practice as recommended by the Scottish and UK governments should be followed.

If you have suspected or confirmed coronavirus infection wash your hands (for at least 20 seconds) before and after feeding your baby, and try to avoid coughing or sneezing on them while they feed.

Routinely clean and disinfect any surfaces touched.

Take care to avoid falling asleep with your baby.

If you are breastfeeding and feeling unwell, continuing to breastfeed rather than expressing may be easier and less stressful during this time in line with current national advice.

If you are too unwell to breastfeed or express breastmilk, you may be able re-lactate once well enough. Ask your health care provider if you need support.

If your baby is having expressed breast milk or formula, make sure you sterilise the equipment carefully before each use. You should not share a breast pump or bottles with anyone else.

If your baby is formula fed, carefully follow the manufacturer's instructions. Use the right amount of formula and water – ensuring the water is hot enough (at least 70°C) to kill any germs in the powder.

Q) Should I wear a face mask when feeding?

A) The Royal College of Paediatrics and Child Health advises that if you have suspected or confirmed coronavirus infection then you should wear a fluid-resistant face mask when handling your baby, including during feeding (whether by breast or by bottle), but you can remove it and interact visually with your baby at a safe distance.

If you do not have symptoms of coronavirus you do not need to wear a face mask when interacting with your baby.

Q) What if my baby is being cared for in a special care baby unit or neonatal intensive care unit?

A) Most babies who are small or sick and are being looked after in a Neonatal Unit should continue to receive breast milk during the COVID-19 pandemic. Your baby’s doctor or neonatal nurse will advise about the type and quantity of milk that is best for your baby.

Neonatal units in the UK are taking extra measures to ensure the safety of patients and staff during the pandemic, and this includes measures to facilitate safe infant feeding regardless of milk type or method.

 

Please note that these answers are not intended as medical advice and if you are concerned about your own health or your baby’s health, contact your GP or phone NHS 24 on 111.