Intended for healthcare professionals

Letters Covid-19 and pregnancy

Collateral damage of the covid-19 pandemic: a Dutch perinatal perspective

BMJ 2020; 369 doi: (Published 12 June 2020) Cite this as: BMJ 2020;369:m2326
  1. E Joanne Verweij, obstetrician1,
  2. H Ismaili M’hamdi, medical ethicist2,
  3. E A P Steegers, professor in obstetrics and gynaecology1,
  4. I K M Reiss, professor in neonatology3,
  5. S Schoenmakers, obstetrician1
  1. 1Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Postbus 2060, 3000 CB Rotterdam, Netherlands
  2. 2Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
  3. 3Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center Rotterdam, Erasmus MC, Netherlands
  1. e.verweij{at}

The Royal College of Obstetricians and Gynaecologists has rapidly prepared guidelines for covid-19, like other professional organisations, based on the available data.12 Yet, the covid-19 pandemic will have multifaceted effects.

We have noticed that pregnant women are now more hesitant to visit the hospital as they perceive an increased risk of infection. Depending on gestational age and medical and social status, we think this is detrimental. For many ultrasonography appointments, pregnant women are not allowed to bring company. The fetal anomaly scan is a key evaluation of the pregnancy, and cancellation is worrying. These scans are paramount for the reproductive autonomy of pregnant women. The informed choice of whether to continue or terminate a pregnancy depends heavily on the timely opportunity to have and interpret a fetal anomaly scan.

Despite birth being perceived as one of the most important life events, hospitals are not allowing partners to be present during labour.34 In many hospitals only one visitor per day can visit a child in the neonatal intensive care unit, which might lead to long term neonatal bonding problems as well as parental psychosocial complications and depression.

After discharge the new family is isolated from family and friends owing to social distancing rules. Women, especially those who are vulnerable, need monitoring for postpartum depression and domestic abuse.

Altogether, we are worried about the collateral damage caused by the covid-19 pandemic, not only in the Netherlands. The less obvious consequences, not described in guidelines, should be registered in a timely manner for further understanding of these adverse sequelae and to put secondary prevention programmes in place.


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