COVID-19 and Preeclampsia
I’m pregnant and being watched closely for preeclampsia, or I have preeclampsia that is being managed at home. How should I protect myself from COVID-19, and how will it affect my pregnancy? Because this is a new virus (SARS-CoV-2) that causes a new illness (COVID-19), we don’t have a lot of answers yet. Everyone in the general public, including pregnant women with or without preeclampsia, should lower the chance of infection by the virus that causes COVID-19 by:
- socially distancing from others
maintaining a 6’ distance from others in crowds
staying home as much as possible
avoiding people who are sick
staying home from work when sick
- washing hands frequently with soap and water for 20 seconds
- using hand sanitizer when you cannot wash your hands
- coughing and sneezing into your elbow or a tissue
We do not know if pregnant women or women with a history of preeclampsia are at greater or lesser risk from COVID-19. Pregnant women can have a weaker immune response to infection, but in women with preeclampsia this immune response is different from what is normal in pregnancy. We will learn more, quickly, as this pandemic continues.
The Centers for Disease Control is maintaining a page on pregnancy, breastfeeding, and COVID-19 here.
No cases of transmission from infected mother to baby are known yet. So far, no virus has been found in the breastmilk or the amniotic fluid of infected women. This probably means you will not be able to pass the virus to your baby through breastmilk and that it does not cross the placenta to the fetus while you are pregnant. There is no guidance yet for how long newborn babies should not be taken into public places after birth to protect them from exposure, but right now everyone has been asked to stay home as much as possible to lower the risk of community transmission. We suggest this means keeping the baby at home until further notice. Somewhat older children do not seem to develop severe cases, although they can be infected. Teenagers can be sicker than younger children. Your pediatrician will have more guidance shortly, and we will update our messages as we learn more. View the American College of Obstetrics and Gynecology’s Practice Bulletin for providers here
and their flow chart produced with the Society for Maternal-Fetal Medicine used for patient assessment here.
Does having a history of preeclampsia put you at higher risk of serious illness from COVID-19?
If you are not currently hypertensive or if your hypertension is well-controlled by medication, no, almost certainly not. If your postpartum hypertension is not well-controlled roughly two months after delivery, you may be at higher risk. Most everyone that does poorly from this infection has significant and active underlying heart disease or high blood pressure, or other health conditions that make you more vulnerable. Those who are at high risk of getting very sick from this illness include:
- older adults
- people who have serious chronic medical conditions like:
Although preeclampsia can put you at a greater risk of cardiovascular disease, you would have to already have this condition to be considered in the higher-risk category.
Is there any connection between a history of preeclampsia or HELLP, and how our bodies handle an infection by this coronavirus?
All viruses, including coronaviruses, find ways to duplicate themselves inside cells, and use proteins on the outside of those cells as “receptors” that help them attach to other cells. The particular receptors for COVID-19 are called angiotensin 1 converting enzyme 2, or ACE2, ones that we share in common with all mammals and also birds.
There is no known correlation between preeclampsia and COVID-19 at this stage of research, and the existence of this cell receptor as a target for the disease doesn’t suggest there will be one (anything with kidneys has this cell receptor.) We need to learn more about this illness and how this virus works to be able to say much more.
We don’t know exactly why people with various underlying conditions are at higher risk from viruses, but probably it is just that they are less resilient - they make fewer of the proteins that would protect them against a viral onslaught, or they make too many. But this is not a fact we know with any precision about any coronavirus, let alone this brand new one.
ASK AN EXPERT This article is a response to research questions submitted by Preeclampsia Registry participants. If you have a research idea or question, enroll in the registry or login and select "Submit a Research Question" from your registry home page.
About Caryn Rogers Senior Science Writer
Caryn Rogers is the Senior Science Writer at the Preeclampsia Foundation. As a community moderator, she has dedicated 15 years to creating clear, understandable explanations of the science underpinning preeclampsia so that women can use this knowledge to protect their own interests. Published in the Journal of Medicine and Philosophy and in Pregnancy Hypertension, Caryn uses her experience with philosophy of evolutionary medicine to support the Preeclampsia Foundation's mission. She developed preeclampsia with severe features at 33 weeks in 2002. After a week in the NICU, her son recovered well. Her daughter was born at 39 weeks after a normotensive pregnancy.