COVID-19 & IBD: Pregnancy

We understand that, as a pregnant woman with IBD, one of the top things on your mind is your health and the health of your baby. During this time, the COVID-19 pandemic can add uncertainty and concern as you get ready to welcome your new baby into the world. We are here to help you sort through the information and misinformation, so you have the facts to discuss with your partner and healthcare team. As you read through this page, here are important points to keep in mind:

• A healthy mom is key to a healthy baby, therefore being in remission from IBD is important. 
• Most IBD therapies are safe in pregnancy and should be continued. Some exceptions to this include methotrexate and tofacitinib (Xeljanz®).
• It is important for your gastroenterologist (GI), and obstetrician (OB) or maternal fetal medicine specialist (MFM) to keep good lines of communication open and coordinate to help advise on all levels of health for you and your baby.

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Pregnancy and COVID-19 | Delivery | Your baby's health | Breastfeeding | Social distancing

What we know about pregnancy and COVID-19

According to the CDC, we do not yet know if pregnant women have a greater chance of getting sick with COVID-19. However, we do know that in general, pregnant women are more vulnerable to respiratory illness such as the flu and other coronaviruses including SARS. The American College of Obstetricians and Gynecologists (ACOG) suggests that pregnant women should be considered an at-risk population for COVID-19. 

In terms of transmission of the virus to the fetus, limited data from peer-reviewed literature has shown that infants who were born from mothers who had the infection did not test positive for COVID-19¹, but a recent single case identified antibodies to SARS-CoV-2 in a baby delivered by Caesarean section, suggesting the possibility of transmission. In this case, the baby did not develop symptoms or other manifestations of infection (see JAMA article here). 

All pregnant women are encouraged to protect themselves from illnesses, including respiratory infections including influenza and COVID-19.  Pregnant women with IBD and their partners should use general healthy practices. If you have concerns about your level of risk, talk to your maternal fetal medicine specialist (MFM), obstetrician (OB), and your gastroenterologist (GI).

Delivering your baby

Hospitals are taking extra precautions when delivering babies, and are restricting access to the delivery room to the mother and medical staff. Mothers-to-be are encouraged to talk to their partners and families about these recent changes so family and friends do not gather at the hospital. Virtual streaming of mother and child after delivery is a great way to engage loved ones who want to welcome your new arrival.

The decision to deliver at a hospital, or at a birthing center, is completely a personal decision. No matter what you choose, now is a good time to call ahead and ask any questions or concerns you may have related to your birthing plan.  

Questions to ask your healthcare team:

• What are their current recommendations to ensure a smooth process when you arrive at the hospital? 
• What precautions are being followed for those staff involved in labor and delivery? 
• How will your exposure to COVID-19 be minimized? 
• Are there enough supplies and equipment to protect you and your baby? 

It is important to follow recommendations of your MFM specialist, or OB/GYN, and your GI.

Reference: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html

Research on IBD and COVID-19

Currently there are not much data on the effects of COVID-19 on patients with IBD, including those who are pregnant. However, there are important steps being taken to understand the impact in the IBD population. One way this is being tracked is through registries like SECURE-IBD. This registry is meant for healthcare professionals to report information on IBD patients that have specifically tested positive for COVID-19. This is an important way we can learn about health outcomes and have a better sense of what can be expected within this patient group. If you are an IBD patient, or a pregnant IBD patient, make sure your healthcare team is aware of this registry. Ask them to provide information in the registry if they have any IBD patients who have COVID-19. (There may also be broader COVID-19 registries that address pregnancy, but these may not be specific to IBD patients.)

Your baby's health

You may also be wondering if COVID-19 can cause problems with your unborn baby. One study based in Singapore observed 55 pregnant women with COVID-19, and found that 39% of the cases resulted in preterm birth (early delivery), 2% of the women had fetal complications (including miscarriage), and 10% of the fetuses had delayed growth.² No fatalities were observed.² This is small study and more research is needed.

Resources for pregnant women with IBD: https://ibdparenthoodproject.gastro.org/toolkit/ 

Breastfeeding

There is no evidence that coronavirus is transmitted through breast milk. According to American College of Obstetricians and Gynecologists( ACOG), an important concern related to breastfeeding is transmitting the virus through contaminated surfaces or respiratory droplets (such as through a cough or sneeze). Mothers who have COVID-19, or who are suspected to have the infection, should follow careful handwashing before touching their baby, or items needed for feeding (including breast pump, bottles, cloths, etc.). Mothers should consider asking someone else who is feeling well in the household to feed the infant. 

Should I hold a baby shower?

Whether your tradition is a baby shower before the baby arrives or after, you should cancel social gatherings and consider hosting a virtual baby shower instead of an in-person gathering. You can also host a “meet and greet” once social distancing recommendations are lifted, and once there are fewer risks associated with larger gatherings, which may be determined by federal, and/or state governments, as well as the CDC.

Communication with your healthcare team about pregnancy and COVID-19

As a pregnant woman with IBD, it’s important to know that you are not alone in managing your care. Your healthcare team, including your gastroenterologist, obstetrician and/or maternal fetal medicine specialist, are there to help you. If you are taking an immunosuppressing medication during pregnancy, it is important to know that you should continue to follow the advice of your healthcare team and take medications as directed by your doctors.

Any changes to your treatment plan would require a coordinated discussion with the care team. Talk to them about your level of exposure to COVID-19, such as contact with anyone who has been ill, or participation in large gatherings. You should also talk to your doctor about any changes in your symptoms. Being pregnant can bring about many different types of changes to your body, but your healthcare team will help you understand what may be related to your IBD, versus pregnancy, or other potential causes. 

Know the symptoms of COVID-19 and contact your doctor right away if you are experiencing a fever, cough, or difficulty breathing. While the feeling of being winded or short of breath can be common in the later stage of pregnancy, be sure to call your healthcare team for their medical advice if these and other symptoms develop or change.

Last updated April 2, 2020