Coronaviruses are a group of viruses belonging to the family of Coronaviridae, which infect both animals and humans. Human coronaviruses can cause mild disease similar to a common cold, while others cause more severe disease (such as MERS – Middle East Respiratory Syndrome and SARS – Severe Acute Respiratory Syndrome). A new coronavirus that previously has not been identified in humans emerged in Wuhan, China in December 2019.
Signs and symptoms include respiratory symptoms and include fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome and sometimes death. Standard recommendations to prevent the spread of COVID-19 include frequent cleaning of hands using alcohol-based hand rub or soap and water; covering the nose and mouth with a flexed elbow or disposable tissue when coughing and sneezing; and avoiding close contact with anyone that has a fever and cough.
Current evidence indicates that COVID-19 does not appear to directly impact newborns. Few novel coronavirus infections have been reported in newborns, and these were almost uniformly asymptomatic. The few that had symptoms were reported to have mild illness. There is no evidence of vertical mother-to-newborn transmission during pregnancy or via breastfeeding. The pandemic response requires redoubled efforts by health providers and facilities to ensure hygiene practices such as handwashing with soap before and after handling the newborn; frequent, routine cleaning surfaces with disinfectant; and use of masks for mothers who either have tested positive for COVID-19 or who have fever and/or respiratory symptoms typical of COVID-19.
Whereas the direct effects of COVID-19 on pregnancy and newborns are minimal, indirect adverse effects are becoming increasingly apparent and important areas of concern. These include potential disruptions of routine maternal and newborn health (MNH) care that is essential for the health and survival of mothers and newborns. Countries’ responses to the pandemic – such as social distancing measures – can pose threats to continuing best practices by health care providers, as well as to home caregiver practices that are essential to newborn health and survival. Leading examples of these threats to best MNH practices include separation of mothers and newborns instead of promoting immediate skin-to-skin contact and rooming in in facilities, immediate and exclusive breastfeeding, and Kangaroo Mother Care (KMC) for preterm and small babies. Thus, pandemic mitigation by social distancing should not result in unintended harm to mothers and their newborns.
There is also a risk to mothers and babies that pandemic responses limit needed psychosocial support to mothers during pregnancy, delivery, and in the postpartum period. Additionally, the economic toll of the pandemic response poses serious risks to many families – especially mothers and newborns – living in poverty or near-poverty. Policies and programs must recognize and take steps to prevent or ameliorate these important risks which may otherwise be overlooked.
The World Health Organization (WHO) and partners continue to monitor the evidence and provide guidance accordingly.
Current WHO guidelines for babies of mothers with COVID-19:
- Infection prevention and control are the first line of defense against COVID-19.
- Strict hand hygiene before and after contact with the infant and routinely cleaning and disinfecting surfaces are critical.
- Mothers should breastfeed and not be separated from their infants unless the mother is too sick to hold her baby.
- If the newborn is ill and requires specialized care, the mother should be allowed access to the specialized care unit with proper infection prevention and control measures.
- Breastfeeding mothers should be helped to clean their chest with soap and water if they cough on it before breastfeeding.
- Mothers do not need to wash their breasts prior to every breastfeed.
- Mothers should wear a medical mask; if they do not have a medical mask, they should still continue breastfeeding.
- When breastfeeding is not possible, mothers should be encouraged to express breastmilk with support from a well person.
Please refer to this document for compiled programmatic information for implementers and project managers.
Please refer to the following interim guidance for more information:
- WHO Academy COVID-19 Mobile Learning App — Available in six languages, the app delivers mobile access to a wealth of COVID-19 knowledge resources developed by WHO, including up-to-the-minute guidance, tools, training, and virtual workshops to support health workers in caring for patients infected by COVID-19 and protect themselves as they do their critical work.
- Frequently Asked Questions: Breastfeeding and COVID-19 for Health Care Workers (28 April 2020) — This FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected (13 March 2020) and provides clarifications regarding those recommendations.
- Q&A on COVID-19, pregnancy, childbirth and breastfeeding — This Q&A provides answers on pregnancy, childbirth and breastfeeding when COVID-19 infection is suspected or confirmed.
- Coronavirus disease (COVID-19) advice for the public: Healthy Parenting — This document brings to attention key health and human rights considerations with regards to the COVID-19 pandemic. It highlights the importance of integrating a human rights based approach and global cooperation in response to COVID-19. It provides key considerations in relation to addressing stigma and discrimination, prevention of violence against women, support for vulnerable populations, quarantine and restrictive measures and shortages of supplies and equipment.
- Operational considerations for case management of COVID-19 in health facility and community — This document is intended for health ministers, health system administrators, and other decision-makers. It is meant to guide the care of COVID-19 patients:
- As the response capacity of health systems is challenged; and
- To ensure that COVID-19 patients can access life-saving treatment, without compromising public health objectives and safety of health workers.
- Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected – Interim Guidance — This resource is intended for clinicians involved in the care of adult, pregnant, and pediatric patients with or at risk of severe acute respiratory infection (SARI), when infection with the COVID-19 virus is suspected.
- Guiding principles for immunization activities during the COVID-19 pandemic — This document provides guiding principles and considerations to support countries in their decision-making regarding provision of immunization services during the COVID-19 pandemic, which is endorsed by the WHO’s Strategic Advisory Group of Experts on Immunization.
- Advice on the use of masks in the context of COVID-19 — This document provides advice on the use of masks in communities, during home-care, and in health care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, public health and infection prevention and control professionals, health care managers/ administrators, health care workers, and community health workers.
- Advice for health workers — This document focuses on responsibilities of health workers during the COVID-19 pandemic. It outlines occupational and health guidelines, as well as symptom awareness and spread prevention.
- Advice for a safer workplace — This document points out that WHO and public health authorities around the world are taking action to contain the COVID-19 outbreak. However, long term success cannot be taken for granted. All sections of our society – including businesses and employers – must play a role if we are to stop the spread of this disease.
- Surveillance and case definition — This document summarizes WHO revised guidance for global surveillance of COVID-19 disease caused by infection with novel coronavirus (COVID-19). WHO will continue to update this guidance as new information about COVID-19 becomes available.
- Laboratory guidance — The purpose of this document is to provide interim guidance to laboratories and stakeholders involved in laboratory testing of patients who meet the definition of suspected case of pneumonia associated with a novel coronavirus identified in Wuhan, China.
- Patient management — This document is intended for clinicians taking care of hospitalized adult and pediatric patients with severe acute respiratory infection (SARI) when COVID-19 infection is suspected.
- Home care of patients with suspected infection or mild infection — This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018, and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, and based on current information regarding COVID-19 infection.
Other important resources:
- UNFPA: COVID-19 Technical Brief for Antenatal Care Services — This document explains how maternity care providers have the right to full access for all personal protective equipment, good sanitation and a safe and respectful working environment. Maintaining a healthy workforce will ensure ongoing quality care for women and their newborns.
- UNFPA: COVID-19 Technical Brief for Maternal Services — This document continues to explain how maternity care providers have the right to full access for all personal protective equipment, good sanitation and a safe and respectful working environment. Without healthy midwives and other maternity care providers there will be limited and perhaps lower quality of care for women and newborns.
- UNICEF: Coronavirus disease (COVID-19) – What parents should know — This resource provides guidance on COVID-19 and answers frequently asked questions regarding the pandemic with regards to children.
- UNICEF: Navigating pregnancy during the COVID-19 pandemic – An expert midwife on how to best protect yourself and your baby — Pregnancy is a special time full of excitement and anticipation. But for expectant mothers facing the outbreak of the coronavirus disease (COVID-19), fear, anxiety and uncertainty are clouding this otherwise happy time. Read this resource to learn more about how women can protect themselves and their little ones.
- USAID, UNICEF & IFE: Infant and Young Child Feeding Recommendations When COVID-19 is Suspected or Confirmed — UNICEF and USAID Advancing Nutrition, with the support of the Infant Feeding in Emergencies (IFE) Core Group represented by Save the Children and Safely Fed Canada, developed a counselling package, Infant and Young Child Feeding Recommendations when COVID-19 is Suspected or Confirmed. The set includes 10 Counselling Cards and a Recommended Practices Booklet. These materials reflect the global recommendations from WHO and UNICEF (March 2020) on IYCF in the context of COVID-19 and may be periodically updated to reflect new or emerging evidence. The package provides both easy-to-understand recommended practices for counsellors and user-friendly graphics that can be used with low-literacy communities in different contexts.
- Save the Children: Infant and Young Child Feeding Tools in the Context of COVID-19 — Infant and young child feeding in emergencies (IYCF-E) in the context of COVID-19 has particular nuances with some programmatic adaptations needed. Contents on IYCF are rapidly revolving and are designed for a global audience. This page will be updated with the most up-to-date information possible.
- Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE — This resource provides up-to-date statistics on COVID-19 cases, death tolls and recovery efforts.
- Guideline for pregnant women with suspected SARS-CoV-2 infection — This document proposes a detailed management algorithm for healthcare providers to use for pregnant women with suspected or confirmed COVID-19 infection.
- IAWG: Programmatic Guidance for Sexual and Reproductive Health in Humanitarian and Fragile Settings during COVID-19 Pandemic — This guidance was current as of late March 2020, but is subject to change as we gain more knowledge and experience in addressing COVID-19 and ensuring continuity of essential health services during this pandemic. Please check for updates and continue to share relevant experience.
- Interim Guidance on Scaling-up COVID-19 Outbreak in Readiness and Response Operations in Camps and Camp-like Settings (IFRC, IOM, UNHCR and WHO) — This document discusses people affected by humanitarian crises, particularly those displaced and/or living in camps and camp-like settings, are often faced with specific challenges and vulnerabilities that must be taken into consideration when planning for readiness and response operations for the COVID-19 outbreak.
- Continuing essential Sexual Reproductive, Maternal, Neonatal, Child and Adolescent Health services during COVID-19 pandemic – Operational guidance for South and South-East Asia and Pacific Regions (WHO, UNICEF and UNFPA) — In view of the possible risk of disruption of SRMNCAH services owing to the increased demands on the health system in the South and South-East Asia and Pacific countries following the COVID-19 pandemic, there was discussion in the H6 Regional Working Group to prepare a generic guidance for countries to plan for continuity of essential SRMNCAH services in the regions. WHO-SEARO, UNFPA and UNICEF collaborated to develop a joint Regional Operative Guidance on SRMNCAH Service Provision during COVID-19.
- The Lancet Coronavirus Resource Center — To assist health workers and researchers working under challenging conditions to bring this outbreak to a close, The Lancet has created a Coronavirus Resource Centre. This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All of our COVID-19 content is free to access.
- Considerations for Inpatient Obstetric Healthcare Settings — These infection prevention and control considerations are for healthcare facilities providing obstetric care for pregnant patients with confirmed coronavirus disease (COVID-19) or pregnant persons under investigation (PUI) in inpatient obstetric healthcare settings including obstetrical triage, labor and delivery, recovery and inpatient postpartum settings.
- CDC: Frequently Asked Questions and Answers – Coronavirus Disease 2019 (COVID-19) and Pregnancy —This resource explains current knowledge on COVID-19 effects on pregnant women and possible mother-to-child transmission.
- CDC: Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19 — This guidance provides information on breastfeeding for mothers suspected or confirmed to be infected with COVID-19.
- RCOG: Coronavirus infection and pregnancy — These Q&As relate to the Coronavirus (COVID-19) infection and pregnancy – guidance for healthcare professionals: Version 8 – 17 April 2020 and Occupational health advice for employers and pregnant women during the COVID-19 pandemic: Version 3 – 21 April 2020 published by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and Royal College of Paediatrics and Child Health, with input from the Royal College of Anaesthetists, the Obstetric Anaesthetists’ Association, Public Health England and Health Protection Scotland.
- RCOG: Updated advice for pregnant women who are working in the NHS and other work settings during the coronavirus outbreak — This guidance, first published on 21 March 2020, is based on evidence from other respiratory infections, such as influenza and SARS, that pregnant woman who contract significant respiratory infections in the third trimester are more likely to become seriously unwell. This may also lead to preterm birth of the baby, intended to enable the mother to recover through improving the efficiency of her breathing or ventilation.
- JHPIEGO: Initial Assessment of Clients Presenting for Intrapartum Care – Summary of Key Considerations in the Context of COVID-19 — This guidance was current as of 23 March 2020, but is subject to change at any time. Consult WHO frequently for updated and additional guidance.
- JHBSPH: Synthesized guidance for COVID-19 message development — The purpose of this document is to provide a synthesized, indexed reference of accurate, standardized COVID-19 information from trustworthy sources. Information is presented in a simple, clear language to support the development of messages and materials needed for social and behavior change interventions.
- JHCHH: COVID-19, Maternal and Child Health, Nutrition – Literature Repository May 2020 — These resources were compiled by the Johns Hopkins Center for Humanitarian Health and provides an overview of what peer-reviewed journal articles currently state on COVID-19, maternal and child health (including infants), and nutrition.
- NEST: COVID-19 Resources compiled for use in Hospital-based Newborn Care — This guidance aims to aid clinicians and hospital staff to manage COVID-19 response efforts in newborn care units in sub-Saharan Africa. The guidance material includes a combination of NEST developed and compiled documents from various organizations and institutions.
News and articles:
- Coronavirus: Health system overload threatens pregnant women and newborns
- Hospitals are separating mothers and newborns during the coronavirus pandemic with little evidence it will help slow the disease
- Findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing COVID-19
- COVID-19 review of national clinical practice guidelines for key questions relating to the care of pregnant women and their babies
- Characteristics and outcomes of pregnant women hospitalized with confirmed SARS-CoV-2 infection in the UK
- Bereavement Care in the Time of Corona
- Avoiding indirect effects of COVID-19 on maternal and child health
- Should infants be separated from mothers with COVID-19? First, do no harm.
- COVID-19 and MNCH: Beyond the models, what are we hearing from countries?
- New virus, new life: Will this pandemic affect pregnancy?
- How do you keep your family healthy and happy in the coronavirus lockdown?
- Early estimates of the indirect effects of the coronavirus pandemic on maternal and child mortality in low- and middle-income countries
- Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries
- Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China
- Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis
- Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women
- Maternal Coronavirus Infections and Pregnancy Outcomes
- Covid-19 and reproductive health: What can we learn from previous epidemics?
- Estimates of the Potential Impact of the COVID-19 Pandemic on SRH in Low- and Middle-Income Countries
- What are the risks of COVID-19 infection in pregnant women?
- Coronavirus (COVID 19) Infection in pregnancy – information for healthcare professionals
- Lancet correspondence: Guidelines for pregnant women with suspected SARS-CoV-2 infection
- Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 in Inpatient Obstetric Healthcare Settings
- COVID-19 in pregnant women- author’s reply
- Appendix case management flowchart Obstetric COVID-19
- The species Severe acute respiratory syndrome related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2