Covid-19 is likely to remain a problem for many months.
Very little is known for certain at this time about the risks associated with Covid-19 for pregnant women and their babies; evidence is still emerging and advice for pregnant women could change at any time. As a precaution, pregnant women have been categorised as a vulnerable group, meaning they should reduce social contact through social distancing measures. The following is a summary of some of the key points to consider when deciding if now is the right time for you to plan a pregnancy.

If you are using a LARC (long-acting reversible contraceptive method) such as a coil or implant and want to start trying for a pregnancy, then removal of the device will require direct contact with a trained healthcare professional who will need to be within 2 metres of you during the procedure. Services will adopt measures to minimise any risk of virus transmission eg wearing PPE, but cannot guarantee being completely risk free. It is important that you consider the possible risk of transmission of Covid-19 in this situation. During a lock-down scenario, provision of these routine procedures may not be possible.

Pregnant women do not appear to be more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune response to viral infections in general which can occasionally cause more severe symptoms. This may be the same for Covid-19 but there is currently no evidence that pregnant women are more likely to be severely unwell. Most will have mild symptoms.

However, pregnant women with the following risk factors may be more likely to develop severe symptoms requiring hospital admission if they become infected with Covid-19:-

• Black, Asian or minority ethnicity (BAME)
• Overweight or obesity
• Pre-existing medical conditions such as diabetes or high blood pressure
• Maternal age >35 years

Data has also shown that the risk of severe illness appears to be greater in the third trimester of pregnancy, so it’s important to pay particular attention to social distancing measures from 28 weeks of pregnancy.

You should also consider that routine antenatal care will result in frequent contact with healthcare professionals which carries a risk of transmission of the virus. The frequency of visits may increase if you develop any pregnancy complications. Furthermore, appointments may need to be delayed if you are self-isolating.

Therefore, if you fall into the above categories, have had complications during previous pregnancies or have a long-term health condition that means you will need extra care during pregnancy, then you may feel that now is not the right time for you to get pregnant.

If you have any queries about the Covid vaccine or feel you have additional risk factors for becoming acutely unwell during pregnancy, please contact your midwife or obstetrician.

There is currently no evidence suggesting an increased risk of miscarriage in relation to Covid-19.

There is also no evidence to suggest the virus affects the baby’s development in the womb. However, a similar viral infection (SARS) has been associated with foetal growth restriction and so this is considered possible with Covid-19 but there is currently no evidence of an association.

It is unclear at present if severe illness resulting from Covid-19 can lead to premature birth.

Transmission of the virus from a woman to her baby during pregnancy or at the time of birth might be possible but appears to be uncommon and the babies tend to be well. The evidence regarding this is very limited and more data is needed before any conclusions can be reached.

If your birth partner has symptoms of Covid-19 or is in self-isolation for confirmed Covid-19, then they will not be able to accompany you to the labour ward.

Current advice is that birthing pools should be avoided in women who have suspected or confirmed Covid-19 at the time of delivery. This is because there is a potential risk of virus transmission (to the baby or staff) from faeces.

If you are scheduled to have an elective caesarean birth or planned induction then you may be asked to follow a period of self-isolation and offered a test for Covid-19 prior to admission.

If an emergency caesarean section has to be performed, then staff will need to put on personal protective equipment which is time-consuming but essential. The time taken to do this could have an adverse impact on the birth outcome.

The pandemic may cause an increased level of anxiety and mental health problems in the general population. This is likely to be even greater for pregnant women due to the additional uncertainty resulting from pregnancy. Anxiety may result from:-

• Concerns about Covid-19 itself
• The impact of social isolation resulting in less support from wider family and friends
• The potential of reduced household finances
• Major changes in antenatal and other NHS care including some appointments being changed from face-to-face to telephone contact. You may also have to attend appointments on your own.

If you are feeling particularly anxious at present due to the pandemic, then you may feel that now is not the right time for a pregnancy.

In summary, the key points to think about when deciding if this is the right time for you to try for a pregnancy are:-

1. Your general health and whether you have any risk factors for severe Covid-19 in pregnancy.
2. Your mental health and how a pregnancy could affect this during the pandemic.
3. The current uncertainties about the impact of Covid-19 on pregnancy and a developing baby.
4. The risk of transmission of Covid-19 during antenatal appointments.
5. The potential impact of Covid-19 on childbirth and antenatal care.

Ultimately the decision to try for a pregnancy is a very personal choice and is down to you and your partner. If you decide that you want to proceed with a pregnancy at present, it remains important (as always) that you address the following issues before you stop contraception. This will optimise your health and the chance of having a healthy pregnancy and baby.

• Stop smoking and drinking alcohol
• Start taking folic acid and vitamin D (ensure these supplements are formulated for pregnancy)
• Eat a healthy, balanced diet
• Cut down on caffeine
• Maintain a healthy weight and stay active (if you are overweight, consider trying to lose weight before becoming pregnant)
• If you have underlying health conditions or are taking medication then speak to your GP for advice before you start trying for a pregnancy