Should a patient who was in contact with COVID-19 (Coronavirus Disease 2019) avoid a pregnant woman at 20 weeks gestation?

COVID-19 Contact and Pregnancy: Precautions for 20 Weeks Gestation

Yes, a patient who was in contact with COVID-19 should stay away from a pregnant woman who is 20 weeks pregnant to minimize potential transmission risk. 1

Rationale for Recommendation

The Royal College of Obstetricians and Gynaecologists and American College of Obstetricians and Gynecologists recommend that pregnant women practice stringent social distancing, particularly after 28 weeks gestation 2, 1. While a 20-week pregnant woman hasn't yet reached this threshold for more stringent precautions, several factors warrant caution:

• Pregnancy creates physiological changes that may increase susceptibility to respiratory infections
• The pregnancy immune system shifts toward T-helper 2 (Th2) dominance, which may reduce viral defense mechanisms
• Avoiding potential exposure is a preventative measure that carries minimal risk but significant potential benefit

Risk Assessment Framework

For the COVID-19 Contact:

• Symptomatic contact: Should absolutely avoid contact with pregnant women
• Asymptomatic contact: Should self-isolate for 14 days from exposure and avoid contact with pregnant women during this period
• Testing status: If the contact tests negative but was exposed within the past 14 days, they should still maintain distance as false negatives can occur

For the Pregnant Woman:

• At 20 weeks gestation, routine antenatal care is essential and should not be delayed 2
• After 28 weeks, social distancing should be observed more stringently 2
• Mental health considerations should be balanced with physical health risks

Recommended Precautions

If interaction between the COVID-19 contact and pregnant woman is unavoidable:

1. Maintain physical distance (minimum 2 meters/6 feet)
2. Both individuals should wear masks
3. Practice thorough hand hygiene
4. Ensure good ventilation in shared spaces
5. Limit duration of contact
6. Consider virtual communication alternatives when possible

Special Considerations

• The pregnant woman should monitor for any COVID-19 symptoms and report them promptly to healthcare providers
• If the pregnant woman develops symptoms, she should be assessed for COVID-19 and other potential diagnoses like pulmonary embolism that may mimic or coexist with COVID-19 1
• For confirmed cases of COVID-19 in pregnant women, fetal growth surveillance should be arranged 14 days after symptom resolution 2

Conclusion

While there is limited direct evidence about COVID-19 exposure in pregnancy at exactly 20 weeks gestation, applying the precautionary principle is warranted. The potential risks of COVID-19 infection during pregnancy outweigh the inconvenience of temporary separation or distancing between a COVID-19 contact and a pregnant woman.