The Democratic Republic of Congo is currently experiencing the second largest Ebola outbreak in history, following a 2014-2016 outbreak in western Africa that had an estimated 28,000 cases. Investigational treatment and vaccination trials are ongoing, but data in the context of pregnancy and breastfeeding are limited. A paucity of scientific evidence exists on how to best treat pregnant or breastfeeding women with suspected or confirmed Ebola virus disease (EVD). Historical reports suggest that, among women who acquire EVD during pregnancy, there is increased mortality and morbidity, and a near 100% rate of adverse pregnancy outcomes. To save the lives of mothers and their babies, mitigate complications, and limit the spread of disease, it is critical that recommendations are made on the prevention, treatment, and surveillance of women who are exposed to EVD, acquire EVD during pregnancy or breastfeeding, or survive EVD with ongoing pregnancies. These guidelines are the first to provide such recommendations. They also cover the surveillance and management of ongoing pregnancies and adverse pregnancy-related events, the handling of bodily and pregnancy-related fluids during acute maternal infection and following recovery, and the management of subsequent pregnancies in Ebola survivors. These guidelines will be of interest to health policy-makers, emergency preparedness and response teams, and healthcare providers who work with pregnant or breastfeeding women in the context of Ebola. The guidelines are relevant to the WHO goal of ensuring one billion people are better protected from health emergencies by impacting maternal mortality, neonatal survival, and the transmission Ebola virus in the context of an Ebola epidemic. Specific recommendations cover 6 topics.

These are:

(i) the management of acute EVD in pregnant women, (ii) the management of pregnancies in women who develop EVD during pregnancy and those who survive EVD with an ongoing pregnancy, (iii) infection prevention and control (IPC) measures for pregnant women with acute EVD or who have recovered from EVD with ongoing pregnancies (with conception prior to EVD), (iv) IPC for women who become pregnant after recovering from EVD (with conception after EVD), (v) breastfeeding women with acute EVD or who have recovered from EVD, and (vi) vaccination recommendations for pregnant women who are at risk of acquiring EVD. Of note, some recommendations apply to both specific situations and in the context of rigorous research, such as the use of investigational therapeutics in pregnant women. Guidelines were developed in accordance with the WHO Handbook for Guideline Development, supported by a special WHO Guideline Steering Committee and a Guideline Development Group of international experts to formulate the recommendations. Scoping thematic discussions determined focus areas and key questions that were addressed in a systematic review. The quality of the evidence for key outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, followed by the use of an evidence-to-decision framework to analyse the available evidence relating to specific questions. An expert technical consultation of the Guideline Development Group took place on 4–5 June 2019 in Geneva, Switzerland. Prior to the technical consultation, WHO Declaration of Interest forms were reviewed and approved. The Guideline Development Group evaluated the draft guidelines and external reviewers’ reports prior to the WHO Guideline Review Committee approval of the final version.