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  • Pregnancy and breastfeeding

Advice and information for women who are pregnant or breastfeeding

Published Updated

Pregnant women have a slightly higher risk of admission to hospital with COVID-19 than young women who are not pregnant. However, the risk is very low.

Pregnant women have a slightly higher risk of admission to hospital with COVID-19 than young women who are not pregnant. However, the risk is very low.


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Pregnancy

Pregnant women may have an increased risk of a more severe course of certain viral infections, such as influenza. It appears that pregnant women with COVID-19 who develop symptoms have a slightly higher risk of needing treatment in a hospital, intensive care unit and with a respirator compared with non-pregnant women of the same age. However, young women have a very low risk of severe COVID-19 disease course.

Studies have so far shown:

  • It is possible that a larger proportion of pregnant women infected with COVID-19 do not develop symptoms, but it may be because healthy pregnant women are being tested to a greater extent. The most common symptoms among pregnant women are coughing and difficulty breathing. It appears that fever and moderate general symptoms are not as common as in non-pregnant women.
  • It appears that pregnant women with COVID-19 who develop symptoms have a slightly greater risk of needing treatment in hospital, intensive care units and with a respirator.
  • The risk groups for severe course of COVID-19 are the same as for others: underlying conditions such as diabetes, cardiovascular disease and / or obesity. See Risk groups and their relatives
  • Some studies suggest that the risk of premature birth is somewhat higher if the mother has COVID-19. However, this does not apply to spontaneous births, and may be related to how pregnant COVID-19 patients have been treated in different places.
  • COVID-19 has not been shown to increase the risk of miscarriage during pregnancy.
  • There have been some cases of transmission from mother to child before or during birth but this is extremely rare. In the cases where it has happened, all has gone well with the child.

In the studies, the incidence and risk of a severe disease course among pregnant women with COVID-19 is partly compared with the risk among pregnant women without COVID-19, partly with the risk among non-pregnant women in the same age group, and partly only observed and described. It is stressed that the figures are uncertain, because many countries test pregnant women for coronavirus regardless of symptoms to a large degree. Some countries have had routines for delivering babies from pregnant women with confirmed COVID-19 infection by Caesarean section and also in treating them differently than other pregnant women. The uncertainty is great, which is reflected in the researchers' conclusions. Read more in the research review of the study.

To prevent infection with the new coronavirus among pregnant women, the same advice applies as for the general population: good hand hygiene and limit contact with others than your closest contacts (you can decide who is "closest" yourself, but they should not be too many, and should be the same over time). You can discuss the possibility of working from home with your employer.

If any of your closest contacts have symptoms of a respiratory tract infection, you should limit contact with them if possible, and otherwise have good hand hygiene and follow other basic infection control tips.

Pregnancy check-ups

All pregnancy check-ups should follow normal guidelines. 

Women who have symptoms of respiratory infection or who have confirmed COVID-19 must contact the healthcare service before check-ups to discuss how these should be carried out.

If pregnant women are concerned for their own health or the health of the foetus, extra check-ups can be carried out according to the usual criteria. The Norwegian Gynaecological Association has issued advice about pregnancy check-ups for women during the COVID-19 outbreak.

Pregnant women with chronic diseases or pregnancy complications should discuss with their doctor whether or not there is reason to exercise extra care and if workplace adjustment is necessary. In the event of an increased risk of transmission in society and in work where it is not possible to follow advice on the recommended distance to others, transfer to other tasks should be considered.

Vaccines

There is still little experience with vaccination of pregnant and breastfeeding women.

Studies to date indicate that vaccination is safe for the pregnant woman and / or foetus. Vaccination of pregnant women can therefore be considered where the advantages outweigh the disadvantages. It is especially important that pregnant women who are at risk of a severe disease course due to another underlying illness / health condition, consider vaccination in consultation with a doctor when the pregnant woman is offered a vaccine. In addition, it may be relevant to consider vaccination of pregnant women in geographical areas with widespread transmission and cannot limit their contact with others, even if the pregnant woman herself does not have a risk condition. The risk of a severe disease course in the pregnant woman should be weighed against a possible unknown risk when vaccinating the mother and child. Any vaccination of pregnant women should, as a general rule, not be done in the first trimester of pregnancy. The pregnant woman's partner and other household members can reduce the risk of infection to the pregnant woman by being vaccinated when / if they are offered it.

There is no known risk of transition to breast milk for non-live vaccines such as mRNA vaccines and viral vector vaccines. Breastfeeding women can be vaccinated.

 

What do we know about COVID-19 vaccination of pregnant women?

Very few vaccines are given to pregnant women. Live virus vaccines can cause viremia in both mother and child, and are therefore generally not used in pregnancy. These risks are not known for other types of vaccines. Non-live vaccines, such as the mRNA vaccines, cannot replicate and neither the mother nor the foetus can be infected by the vaccine. Animal studies of the mRNA vaccines indicate no direct or indirect harmful effects with respect to pregnancy, foetal development, childbirth or postnatal development.

Pregnant women were not included in the vaccine studies, but there is increasing experience with vaccination of pregnant women, especially with the mRNA vaccines in countries such as the USA and Israel. Data from vaccinated pregnant women in the USA have not shown any signs of adverse side effects1. Preliminary, small studies show that pregnant women have the same vaccine response as non-pregnant women2, and that antibodies are transmitted to the child by vaccination in the third trimester3.

The NIPH has opened up for vaccination of pregnant women where the benefits outweigh the risks, and this is in line with the recommendations in other countries and the product information from the manufacturers. It is still most important that pregnant women who are at risk for a severe COVID-19 disease course consider being vaccinated.

The risk of a severe COVID-19 disease course increases if the pregnant woman has underlying diseases such as diabetes, cardiovascular disease and / or obesity4. Nordic studies support this, and have shown an increased risk for women with obesity or who had an immigrant background5.

References

  1. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. 2021. 
  2. Gray KJ, Bordt EA, Atyeo C, et al. COVID-19 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol. 
  3. Rottenstreich A, Zarbiv G, Oiknine-Djian E, Zigron R, Wolf DG, Porat S. Efficient maternofetal transplacental transfer of anti- SARS-CoV-2 spike antibodies after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination. Clin Infect Dis. 2021. 
  4. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. 
  5. Engjom H, Aabakke AJ, Klungsøyr K, et al. COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries. medRxiv. 2021:2021.2002.2005.21250672.

 

What do we know about COVID-19 vaccination of breastfeeding women?

For most vaccines, there is little documentation of transmission to breast milk. There are still few studies on breastfeeding women who have been vaccinated with the coronavirus vaccines.

Breastfeeding women have a good immune response to the vaccine (1). When the mother is vaccinated, the baby will be able to obtain antibodies through breast milk (2-4). It is still uncertain to what extent these antibodies will protect the child from infection.

Two studies did not find mRNA in breast milk (5, 6), while a non-peer-reviewed study using an even more sensitive method found extremely limited amounts of mRNA in breast milk (4). However, it is very unlikely that even tiny amounts of vaccine in breast milk could have any effect, as the vaccine does not contain live viruses and any small residues will be broken down in the digestive system.

The WHO does not recommend any restrictions on breastfeeding. Women who are vaccinated should continue to breastfeed.

Collier A-rY, McMahan K, Yu J, Tostanoski LH, Aguayo R, Ansel J, et al. Immunogenicity of COVID-19 mRNA Vaccines in Pregnant and Lactating Women. JAMA. 2021;325(23):2370-80.

Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol.

Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers. Vaccines (Basel). 2021;9(6).

Low JM, Gu Y, Ng MSF, Amin Z, Lee LY, Ng YPM, et al. BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA. medRxiv. 2021:2021.04.27.21256151.

Mattar CN, Koh W, Seow Y, Hoon S, Venkatesh A, Dashraath P, et al. Addressing anti-syncytin antibody levels, and fertility and breastfeeding concerns, following BNT162B2 COVID-19 mRNA vaccination. medRxiv. 2021:2021.05.23.21257686.

Golan Y, Prahl M, Cassidy A, Lin CY, Ahituv N, Flaherman VJ, et al. Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk. JAMA Pediatr. 2021.

When you are fully vaccinated, it is likely that you will have a lower risk of becoming ill with COVID-19. Since the vaccines prevent disease, they will also prevent transmission, but we do not yet know to what extent. Vaccinated people should therefore continue to follow the current infection control advice. Vaccination is currently not exempt from the requirement for quarantine after travel or close contact, with some exemptions.

Pregnant women in their second and third trimester, and pregnant women in their first trimester who have risk factors, are recommended to take the seasonal influenza vaccine. This advice applies regardless of coronavirus infection.

Healthcare professionals who are pregnant

The recommended personal protective equipment should be used by all healthcare professionals during contact with a patient with suspected or confirmed COVID-19 disease.

As a precaution for healthcare professionals who are pregnant, it is recommended that other healthcare professionals should take samples and treat people with probable, suspected or confirmed COVID-19 disease where possible.This also applies if the pregnant health professional has been vaccinated during pregnancy. Pregnant women who have been vaccinated before pregnancy, or who have undergone COVID-19, are assumed to be protected for at least 6 months. Workplace adjustment should be done in consultation with the employer.

For healthcare professionals who are pregnant and who have pregnancy complications or chronic diseases with an increased risk of severe COVID-19 progression (see section on pregnant women and risk factors above), work adjustment or remote working should be assessed based on individual risk.

Birth and maternity 

There is uncertainty about whether coronavirus can be transmitted from mother to child before or during birth. Babies born to mothers with COVID-19 that have been infected after birth have had mild or no symptoms. There have been some studies that can indicate that it is possible that the child can be infected before birth, even though this is extremely rare. The virus is mainly spread by droplet and contact transmission. Mothers who are sick may infect their child after birth and shall follow the infection control advice given by the healthcare personnel. 

Women who give birth and who had confirmed COVID-19 just before birth can be together with their newborn after the birth, unless the mother is seriously ill or the child is very premature or sick.

Hospitals must arrange for a partner / next of kin (defined by the mother herself) to be able to be present before and during the birth, and while in the maternity unit.

Maternity and neonatal departments in Norway are prepared to handle women with confirmed COVID-19 giving birth and her baby and procedures have been issued in collaboration with the Norwegian Institute of Public Health. 

After returning home from the hospital, it is important to remember that new mothers may be vulnerable and need support from those around them, even during the corona pandemic. Anyone who visits newborns should be healthy and without symptoms.

Breastfeeding

Coronavirus has not been detected in breast milk from women with COVID-19 infection, where this has been studied. Women with COVID-19 infection can therefore breastfeed normally. This is also the advice of the World Health Organization (WHO).

Information for the general public

For general advice about coronavirus: our topic page and helsenorge.no 

Information helpline for questions about coronavirus: 815 55 015 (weekdays 08-15.30)

The Norwegian Directorate of Immigration has answers to many frequently asked questions about travelling to Norway, and a helpline 23351600 that is open on weekdays from 10:00-14:00. 

The Ministry of Foreign Affairs also has answers to many frequently asked questions.

If you need acute medical attention, contact your doctor. If you cannot reach your doctor, contact the emergency out-of-hours clinic on 116117. If life is in danger, call 113.

History

26.07.2021: Updated with collapse box with information about vaccination of breastfeeding women in English, as per Norwegian version.

21.05.2021: Added supporting information about vaccination of pregnant women

29.04.2021: Updated text based on new knowledge. Changed advice about vaccination of pregnant women so that it can be considered if the benefits outweigh the disadvantages, also for pregnant women in areas with widespread transmission and who do not have other underlying diseases.

04.03.2021 Added that some studies may indicate that it is possible that the child can be infected before birth, although this is rare, and that the presence of partners during birth and during childbirth is important.

22.01.2021 Updated information about coronavirus vaccine

23.12.2020 Added information about coronavirus vaccine

22.09.2020: Changed "...it is recommended that other healthcare professionals should take samples and treat people with probable, suspected or confirmed COVID-19 disease where possible." 

18.09.2020: Added information from a major systematic review among pregnant women

08.06.2020
Updated knowledge basis, removed information about SARS and MERS that is no longer relevant, moved and shortened paragraph about "do some pregnant women have an increased risk" to a bullet list at the start.

23.03.2020 
Section about children and adolescents moved to a separate article, as per Norwegian version. 

20.03.2020 

Updated advice about pregnancy and birth, according to Norwegian text