The epidemic caused by the coronavirus responsible for Covid-19 has now reached stage 3 in France, leading to exceptional measures, including reinforced restrictions and a national curfew, which is implemented from 19 p.m. Future mothers are invited to be vigilant. So what are the precautions to take if you are pregnant? What are the risks if you contract Covid-19 during your pregnancy? 

Update of March 25, 2021 – For the time being, pregnant women do not have access to vaccination against Covid-19. However, women during pregnancy and who present with comorbidities (diabetes, hypertension, pathologies, etc.) may be at risk of developing a severe form of Covid-19. This is why the vaccination of pregnant women is done on a case-by-case basis with the doctor, the gynecologist or the midwife.

Update of December 23, 2020 – The key and known information, following studies carried out on pregnant women infected with Covid-19 are that:

• most pregnant women who contracted Covid-19 did not develop severe forms of the disease;
• the risk of transmission from mother to baby during pregnancy exists, but remains exceptional;
• pregnancy monitoring, adapted to the epidemic context, must be ensured, in the interest of the mother and the unborn baby. Infected pregnant women should be closely monitored during pregnancy;
• breastfeeding is still possible, wearing a mask and disinfecting your hands;
• As a precaution, women in the third trimester of pregnancy are considered at risk, to protect them and their babies.   

In its press release dated November 9, the Ministry of Solidarity and Health indicates the new conditions childbirth during Covid-19. The purpose of these recommendations is to ensure the well-being and safety of women and the protection of caregivers. After consulting with the High Council for Public Health, in particular on wearing a mask during childbirth, the ministers recall that “the wearing of a mask in a woman who gives birth is desirable in the presence of caregivers but it can in no case be made compulsory. ” This advice is valid for women who do not have symptoms, but not for others. In addition, a visor can be offered to them. If the woman who gives birth is not wearing a protective tool on her face, then caregivers should wear an FFP2 mask. Indeed, “the birth must remain a privileged moment even in this context of epidemic knowing that everyone must be attentive to the respect of the safety instructions given by the staff of the maternity hospitals“, Recalls the National College of French Gynecologists and Obstetricians. Also, the presence of fathers is desirable during childbirth, And even a possible cesarean. They can also stay in a room, provided they meet the conditions imposed by the maternity ward.

As long as the virus is active, pregnant women must continue to protect themselves from the coronavirus. Washing your hands, wearing a mask outside the home, going out only if necessary (shopping, medical appointments or work) are the precautionary principles to be observed for future mothers. A person, the future dad for example, can now accompany pregnant women to pregnancy follow-up appointments and be present during and after childbirth. This was not the case during confinement, during which time the dad could stay during childbirth and only 2 hours after. Fortunately, however, these recommendations have evolved. The accompanying person can stay with the young mother. It is now possible that a systematic search for symptoms is carried out in future parents. In addition, they must wear a mask for the duration of childbirth. The postpartum stay is shorter than before. During this time in the hospital, the future dad agrees to remain confined, or to come back from the next day only. Visits from family and friends are not permitted. 

Breastfeeding continues to be recommended by health authorities. No transmission of Covid-19 through breast milk has yet been identified. If the new mother shows clinical signs, she should wear a mask and disinfect her hands before touching the newborn. It is quite normal, in this epidemic context, for pregnant women to ask questions. Unicef ​​tries to give appropriate answers, based on scientific data, if they exist.

In April, to go out beyond 10 km, a travel authorization must be completed. For trips within a radius of 10 kilometers, proof of address is required in the event of a check by the police.

Update March 25, 2021 – The curfew has been pushed back to 19 p.m. for all of mainland France since January 20. Sixteen departments are subject to reinforced restrictions (confinement): Aisne, Alpes-Maritimes, Essonne, Eure, Hauts-de-Seine, Nord, Oise, Paris, Pas-de-Calais, Seine-et-Marne, Seine-Saint- Denis, Seine-Maritime, Somme, Val-de-Marne, Val-d’Oise and Yvelines. To go out and get around, it is therefore necessary to complete an exceptional travel certificate, except within a radius of 10 km, where only proof of address is essential.

Strict containment measures have been lifted since December 15 and have been replaced by a curfew, from 20 p.m. to 6 a.m.

From Friday, October 30, the President of the Republic, Emmanuel Macron, imposes once again confinement to citizens of the French metropolis. The goal is to curb the spread of the Covid-19 disease and to protect the population, especially the most vulnerable. As in March, each person must bring the exceptional travel certificate for each outing, with the exception of permanent supporting documents for professional or educational reasons. Authorized trips are:

• travel between home and place of professional activity or universities;
• travel to purchase supplies;
• consultations and care that cannot be provided remotely and cannot be postponed and the purchase of medicines;
• travel for compelling family reasons, for assistance to vulnerable and insecure people or childcare;
• short trips, within the limit of one hour per day and within a maximum radius of one kilometer around the home.

Monday March 16, French President Emmanuel Macron confirmed the confinement during his speech. Thus, all unnecessary travel is prohibited. To travel, you will then need to bring the travel certificate, only for the following reasons:

• Travel between home and the place of exercise of professional activity when teleworking is not possible;
• Travel for essential purchases (medical, food);
• Travel for health reasons;
• Travel for compelling family reasons, for assistance to vulnerable people or childcare;
• Short trips, close to home, linked to the individual physical activity of people, to the exclusion of any collective sporting activity, and to the needs of pets.

This measure comes after the same decision by China, Italy or Spain and Belgium to limit the spread of the Coronavirus Covid-19. Pregnancy monitoring continues to be provided by doctors and midwives during confinement, but under certain conditions. 

Since May 11, France has implemented its strategy of progressive deconfinement. A pregnant woman must be particularly vigilant to protect herself and her baby from the new coronavirus. She can wear a mask every time she has to go out, in addition to hygiene measures.

An exceptional case of mother-child coronavirus contamination

To date, there are no studies to confirm or deny the transmission of the coronavirus from mother to child during pregnancy. However, recently Chinese public television CCTV communicated the case of a possible mother-to-child transmission during pregnancy of the Covid-19 coronavirus. Thus, the coronavirus could cross the placental barrier and affect the fetus when the mother is affected.

The infected baby from birth suffered from shortness of breath: these signs of the presence of Covid-19 in the baby were confirmed during a chest x-ray. It is still impossible to say when the child was infected: during pregnancy or at birth.

On May 17, 2020, a baby was born infected with the novel coronavirus, in Russia. Her mother was infected herself. They returned home, “in satisfactory condition”. This is the third case in the world that has been reported. A baby with Covid-19 was also born in Peru. 

A reassuring study on the transmission of the mother-to-fetus coronavirus

Apart from these 3 cases of the Covid-19 coronavirus in babies around the world, no other has been reported to date. Also, doctors do not know if the transmission was through the placenta or during childbirth. 

Even if a study, dating from March 16, 2020, published in the journal “frontiers in pediatrics”, indicates that it does not appear that the viral infection with the Covid-19 coronavirus can be transmitted from the mother to the fetus, these 3 babies prove the contrary. However, this remains extremely rare. 

Precautions to limit the risk of transmission for pregnant women

To protect themselves from the coronavirus, pregnant women are advised to respect barrier gestures to avoid any contamination. Finally, as with all other risks of disease transmission (seasonal flu, gastroenteritis), women during pregnancy must stay away from sick people.

Reminder of barrier gestures

The care of pregnant women is maintained by health professionals as indicated by SYNGOF, the Syndicate of Obstetrician Gynecologists of France, in a recent press release. However, teleconsultation remains strongly recommended as long as possible.

Note that the three mandatory ultrasounds are maintained with the kindness to respect the hygienic precautionary measures:

• Spacing of patients in the waiting room, with at least one seat apart;
• Regular disinfection of the room;
• Respect for barrier gestures.

In addition, patients must go to the office alone: ​​without the future father and without children. Finally, the National College of Midwives concluded to postpone collective childbirth preparation sessions and pelvic floor rehabilitation sessions. Only individual consultations are maintained.

No study has shown that the coronavirus passes into the breast milk of women with coronavirus and who are breastfeeding.

In comparison with the 2002-2003 SARS-Cov epidemic, for which antibodies to the virus had been detected in the breast milk of infected mothers, but not the virus. It is therefore recommended to breastfeed as indicated by Unicef ​​” Given the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, the mother can continue to breastfeed, while observing the necessary precautions ».

However, a nursing mother is strongly advised to consult her doctor quickly if she declares symptoms (cough, fever, breathing difficulties) and to strictly follow the hygiene rules communicated with the wearing of a mask and washing of the clothes. hands before and after any contact with their baby. It is also important to regularly disinfect contaminated surfaces using a suitable disinfectant solution.