Coronavirus: What pregnant women need to know now

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Pregnant women have many questions about Covid-19. Should i get vaccinated? Am I particularly at risk? Can I infect my child? How does infection affect pregnancy and childbirth? Here you will find the most important answers.

Should pregnant women get vaccinated against Covid-19?

Vaccinating pregnant women is always considered very carefully - after all, it is about protecting the health of mother and child. That is why it took a while before the Standing Vaccination Commission STIKO decided to recommend the mRNA vaccines from Moderna and BionTech / Pfizer to all pregnant and breastfeeding women from the 2nd trimester onwards. The experts only advise against vaccination in individual cases, for example if there is a known allergy to an ingredient in the vaccine.

So far, the STIKO has only given a vaccination recommendation for those pregnant and breastfeeding women who have an increased risk of severe Covid-19 courses. These include very overweight people, diabetics and high blood pressure patients as well as women with a particularly high risk of infection.

All other pregnant and breastfeeding women (i.e. those without a particular Covid 19 risk) have so far also been able to be immunized if they wish. However, some doctors were not prepared to do this without the express recommendation of the specialist groups.

According to the committee, the decision was preceded by a systematic processing of further data that have since become available. These include those on the risk of severe Covid-19 courses in pregnancy as well as on the effectiveness and safety of a vaccination for pregnant and breastfeeding women.

What are the advantages of vaccination during pregnancy?

There are many arguments in favor of vaccination:

Infected pregnant women are at greater risk of complications

With a Sars-Cov-2 infection, the risk of pregnancy complications increases. For example, a meta-analysis of 42 observational studies has shown that preeclampsia, premature or stillborn births and treatments in the intensive care unit occur more frequently in pregnant women with Sars-CoV-2 infection than in uninfected pregnant women.

Pregnancy is a risk factor for severe Covid-19 courses

Another argument in favor of the vaccination is that pregnancy is an independent risk factor for severe courses of Sars-CoV-2. The reason for this is that the activity of the immune system is somewhat reduced during pregnancy so that the body can tolerate the fetus. For this reason, flu infections are more often severe in pregnant women, which is why a flu vaccination is generally recommended for mothers-to-be (other than healthy non-pregnant women under 60 years of age).

The delta variant has increased the risk of infection considerably

In addition, the risk of a Sars-CoV-2 infection due to the rampant delta variant is now significantly higher than from the previous virus mutants. The American health authority CDC therefore urgently advised all pregnant women to have the corona vaccination as early as August. It relied on data from 180,000 vaccinated pregnant women from the United States and Great Britain, where expectant mothers have been vaccinated for months.

There is no evidence of any risks of vaccination for the child (see below).

When should I get vaccinated as a pregnant woman?

However, the vaccination should only be given from the second trimester of pregnancy. In early pregnancy there is a certain risk that a fever in response to the vaccination can, in rare cases, trigger a miscarriage.

Of course, this also applies to fever due to infections. Experts therefore advise all women who want to have children in particular to get vaccinated in good time so that they and the unborn child are well protected from the start.

Does the vaccination pose a risk for my child?

Pregnant women are vaccinated with an mRNA vaccine from BionTech / Pfizer or Moderna. Most of these vaccines migrate into the muscle cells at the site of the vaccination - only very small amounts get into the rest of the body. In addition, they are dismantled again very quickly after they have completed their task.

Overall, it is therefore extremely unlikely that the vaccination could pose a risk to the unborn child.

The vaccination protects the child

In fact, vaccination can even protect the child: vaccinated and convalescent mothers pass on antibodies to their unborn child. This applies to many diseases - and also to Sars-CoV-2. The newborns then benefit from the so-called nest protection for a few months until their own immune system develops increasingly.

No 100 percent security

However, one cannot yet be 100 percent certain that the vaccination has no side effects for the unborn child - because it has only been approved for pregnant women for a few months.

However, mothers have to weigh this very hypothetical residual risk against the known dangers associated with corona infection. These include pregnancy complications such as premature birth or miscarriage, pregnancy poisoning or stress on the child in the event of a severe Covid-19 course in the mother.

Can I get vaccinated while breastfeeding?

The vaccination does not pose a risk to the child even if they are breastfeeding. In fact, antibodies are also passed on to the child through breast milk.

Are pregnant women particularly at risk from a coronavirus infection?

Pregnant women are usually quite young. It is now known that the vast majority of them develop only mild to moderate symptoms in the case of Sars-CoV-2 disease.

However, the evaluation of the data available so far on the subject shows that pregnancy slightly increases the risk of a severe course of Covid 19 disease.

More severe courses particularly affect pregnant women who have additional risk factors such as a high body mass index (BMI), diabetes, high blood pressure or a comparatively older age.

Deaths are also slightly more common than non-pregnant women of the same age who contract Covid-19 - but overall there are very few.

One explanation for the slightly increased risk of severe disease in pregnant women could be that the immune system is somewhat downregulated during pregnancy. This prevents it from classifying and fighting the fetus as a foreign body.

However, this also means that pregnant women notice symptoms of a Covid 19 infection less often than usual - for example fever and muscle pain. The work of the immune system is manifested in such symptoms. Because this is regulated down a bit during pregnancy, the symptoms are also weaker - but the course of the disease can be rather difficult.

Am I at a higher risk of pregnancy complications?

According to the RKI, pregnant women with a more severe course of Covid-19 have a significantly higher risk of preeclampsia (pregnancy poisoning) and premature delivery compared to pregnant women with an asymptomatic or mild course.

Can I infect my unborn child and is it dangerous?

The risk of the coronavirus being transmitted from mother to baby during pregnancy is small - but not zero. The virus can get to the child through the placenta. So far there is no evidence that the child could develop abnormalities as a result of the infection.

Some of the infected children showed neurological symptoms after birth. So far, according to the current state of knowledge, all affected children have fully recovered.

Does the risk of premature birth or miscarriage increase?

The risk of miscarriage is slightly higher than usual in women with Sars-CoV-2 infection. However, viewed as a whole, these cases are still rare.

The risk of premature birth is also increased if Covid 19 disease is severe. According to research by British researchers, 6 percent of infected women who received hospital treatment gave birth to their child in or before the 37th week of pregnancy. According to statistics, it is usually 3 percent.

It is not entirely clear whether the infection always triggered the early birth. It is also possible, for example, that in some cases you have decided on a slightly earlier due date in order to be able to better treat a more seriously ill mother afterwards.

Another possible reason for the slightly increased risk of miscarriage and premature birth is that Sars-CoV-2 can also affect the placenta, causing it to become inflamed. Blood clots, which are more common in Sars-CoV-2 infections, sometimes migrate into the placenta. Both can worsen the baby's care and thus promote premature birth or miscarriage.

What do I do if I get infected?

Call your gynecologist to inform your gynecologist of your diagnosis. If you have no or only mild symptoms and you (or other people in your household) are not a particularly vulnerable person, you can cure yourself at home under medical care. Only if you have more severe symptoms do you need to go to hospital for treatment.

If you have to go into quarantine as a pregnant woman, inform your gynecologist about this. Routine prenatal appointments can usually be postponed until the end of the isolation without harm to you or your child.

If your midwife or doctor thinks your appointment cannot be postponed, the necessary arrangements will be made for you so that you can keep the appointment.

How does treatment for Covid-19 work during pregnancy?

Pregnancy can generally limit the scope for treating illnesses. Doctors can hardly or not at all use certain drugs in expectant mothers. This also applies in the case of Covid 19 disease.

Depending on the stage of pregnancy, it can also be difficult or even impossible to ventilate a seriously ill person lying on their stomach - a procedure that can be very helpful for patients with lung failure.

Quarantine: what to do if you have complaints or contractions?

If you feel bad during your quarantine or if you are concerned about the health of your unborn child, call your gynecologist.

If you are recommended to be treated as an inpatient, inform the clinic in advance about your (possible) infection. Do not go there by public transport, use a private vehicle or ambulance.

If you go into labor, call your maternity ward. Let them know that you may or may be infected with the coronavirus. Your delivery team will advise you on how to proceed.

It is best to coordinate with your doctor in advance how you will react if you suddenly feel unwell or go into labor outside of office hours. Discuss which hospital can admit you, what documents you will need and how to get to the hospital.

Do not go to general consultations or clinics spontaneously unless you need urgent medical care. In this case, it is essential that you announce your visit by telephone.

In case of suspicion or infection: Caesarean section or vaginal birth?

Even if you have been suspected or confirmed to be infected with coronavirus, there is currently no evidence that a caesarean section is any safer than vaginal delivery. If there are no other medical reasons against it, you can opt for a vaginal birth.

However, if you have breathing problems due to a coronavirus infection and these require a quick delivery, a caesarean section may be necessary.

There is also no evidence to suggest that a PDA could be more of a problem for you if you are infected with the coronavirus. However, we strongly advise against using nitrous oxide for anesthesia. It can encourage the virus to spread through the air you breathe.

In principle, pregnant women with suspected or confirmed coronavirus infection are recommended to give birth to their child in hospital. This enables continuous electronic monitoring of the newborn, including with regard to its oxygen supply. Home births or births in the birthing center are not recommended.

Everything you need to know about childbirth during the coronavirus pandemic can be found here.

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