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What Should Pregnant & Nursing Women Know About COVID-19?

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Pregnancy and new parenthood can be an exciting time for families. But even in the best of circumstances, they can also be fraught with concerns about health and safety. The global pandemic and the rollout of vaccines to protect against COVID-19 add another layer of stress and uncertainty about how expectant and nursing women should protect their babies and themselves.

Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, shares his recommendations based on the latest research on COVID-19, pregnancy, vaccines and breastfeeding.

KIDS VT: Does pregnancy increase the complications of COVID-19?

LEWIS FIRST: Although the risk of severe illness and death among pregnant women remains low, it's still higher when compared to nonpregnant women in the same age group. Recent data from the U.S. Centers for Disease Control and Prevention indicate that pregnant women are at higher risk for severe complications, including preterm birth, intensive care admissions and death. However, the numbers of complications and deaths are still lower than those seen in adults 60 and older.

KVT: Should pregnant women get vaccinated against COVID-19?

LF: Yes. Because of the complications that can ensue, it's all the more reason why pregnant women should get vaccinated. If a woman is thinking of getting pregnant, there is no reason why she should not get one of the available vaccines. According to the CDC, the vaccines do not adversely affect fertility, nor do they increase the risk of birth defects. While we are learning about rare blood clotting possibly associated with the Johnson & Johnson vaccine, these are "one in a million" or rarer incidents. Sadly, the risk of having severe complications or dying from this virus is much higher. There are anecdotal reports that the vaccines also may be associated with menstrual cycle irregularities such as heavier bleeding. These irregularities, which appear to be short-lived, are now being studied.

If a woman is pregnant or becomes pregnant within 30 days of getting the vaccine, she automatically gets enrolled in the CDC's V-safe After Vaccination Health Checker program, which will track her health and her baby's health until the infant is 3 months old. At least 30,000 women have become pregnant after receiving the vaccine and are now enrolled. The good news is, their reported side effects are identical to those of nonpregnant women — that is, no serious adverse reactions to date.

KVT: Can an unvaccinated mother give COVID-19 to her unborn child?

LF: According to a recent CDC study, only 2.6 percent of infants born to mothers who were positive at the time they gave birth tested positive for COVID-19 within their first week of life. We're still not sure when or how those infants got the virus, but it's most likely that the babies contracted it after they were born. A newborn testing positive for COVID-19 has occurred so infrequently that the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that the benefits of newborns and COVID-19-positive mothers being together after birth far outweigh the small risk of infection to the baby.

These risks can be mitigated by a mother taking proper precautions, including wearing a mask, washing hands thoroughly with soap and water before breastfeeding, and keeping the infant six feet away from her in a separate Isolette in the room until it is time to feed. If a mother wants to separate herself from her baby and have a COVID-negative caregiver take care of her infant until she tests negative or has recovered, that's a decision she should make with her health care provider.

KVT: Does COVID-19 spread through the mother's breast milk?

LF: No. Thus far, researchers have been unable to find the virus itself, nor active pieces of the vaccine, in breast milk. We already know that breastfeeding is ideal for newborns for many reasons, including the benefits it provides to the baby's immune system. A new benefit we're seeing is that, if the mother has had COVID-19 or has been vaccinated, those antibodies show up in her breast milk — in fact, even more so after vaccination. For this reason, breastfeeding is actively encouraged. If a COVID-positive mother is reluctant to directly breastfeed her baby, she can still pump her milk, assuming she takes proper precautions beforehand, including thoroughly cleaning all the pumping equipment. Ideally, we'd love to have all mothers breastfeeding their babies if they feel able to do so, whether they're COVID-positive or not.

KVT: Are there benefits a COVID-positive mother might get from breastfeeding?

LF: While breastfeeding won't prevent a mother from getting COVID-19 or speed up her own recovery from the virus, breastfeeding can help relieve stress and anxiety. Breastfeeding can also give her peace of mind in knowing that she's helping to protect her baby.

KVT: Should newborns be kept away from unvaccinated people?

LF: New parents should limit their baby's exposures and take the same COVID precautions as they would with anyone who is unvaccinated. Visits should be limited to people who've been fully vaccinated, unless those who are unvaccinated are immediate caregivers. You don't want to invite other people into the home who can bring in the virus and expose not just the baby, but the parents, as well. And babies should never wear a mask due to the risk of suffocation.

Unless a visitor is a close friend or relative who is part of that family's "bubble" of key contacts and has been vaccinated, it is safer to introduce them to the baby through online technology. Asking if someone has been vaccinated before they hold or touch your newborn may feel awkward, but it could be life-saving.

KVT: If parents or other designated infant caregivers aren't vaccinated, should they wear a mask when they're six feet or less from the baby?

LF: Yes. Parents should also talk to their care provider or call the Vermont Department of Health's help line for additional guidance if they have questions about infant care and COVID-19 (802-863-7240 or toll-free at 833-722-0860). These guidelines may become less stringent as more people are immunized and we reach herd immunity, but we're not there yet.

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