COVID-19 and pregnancy.

Most importantly. Time stamp. July 11, 2020. 8am.

Why is that so important?

Our knowledge and treatments for COVID-19 are constantly evolving.

So what is true today. May not be true tomorrow.

Or maybe it will.

SARS-CoV-2 is a strange virus. During casual conversations with my doctor friends, I hear remarks such as:

So basically you can have no symptoms or be deathly ill.  Have fever or not.  Cough or not. Diarrhea or not. Sore throat or not. Congestion or not. Lack of smell or not.  Shortness of breath or not.”

And so on.

You can potentially spread it before you are even ill and have a positive test well beyond your contagious period. A diagnostic nightmare.

No wonder this virus has left our healthcare teams changing recommendations and running in circles.

So, what DO we know about COVID-19 and pregnancy? How does the disease affect pregnancy? How does the pregnancy affect the disease?

AND

How do we achieve our goals in this pandemic?  –> Happy, healthy mom. Happy, healthy baby.

Let’s start with mom…

Most pregnant women infected with COVID-19 will have a mild form of the disease and recover without complication.

But pregnant women are more likely to be hospitalized, admitted to the ICU, and placed on a ventilator than women that are not pregnant.

The hospital admissions portion of this data may be a little exaggerated due to non-COVID related admissions, such as labor, delivery, and pregnancy complications.

Most obstetricians are not surprised by the ICU findings, as we have long understood that pregnant women are at higher risk for complications due to respiratory infections such as influenza.

Fortunately, pregnant women do not appear to have a higher mortality rate compared to non-pregnant women.

COVID-19 also increases the risk of blood clots, or thrombotic events, in some patients.  We are still investigating exactly why this happens. Pregnancy itself is also a risk factor for thrombotic events so this could be a potentially concerning combination of risks.

What about the psychological issues?

Depression. Anxiety. Financial and psychological stressors. For example… “Will my partner be allowed with me at the hospital?” Now that is a question I never imagined I would field in my career.

Let’s just pause and let that one sink in for a moment.

And let me relieve your anxiety. Currently at our hospital, we have always allowed a support person with you. I really don’t anticipate that changing.

That rumor stems from a very short timeframe in New York when the system was being overwhelmed. That being said, your partner needs to pass a basic screen and wear a mask for the safety of everyone in the hospital.

And we will all do the same.

We are screening all of our laboring patients for COVID-19. This helps us provide you even better care by further stratifying your risk.

But what if I am positive? Will you separate me from my baby?

This question is challenging. But the answer is, not necessarily. We will talk to you about the risks/benefits, breastfeeding effects, mitigation measures. All with the aim to keep you and your family as safe and happy as possible.

Now to baby…

Can COVID-19 pass to babies during pregnancy?

Maybe. I say this tentatively because there have been reports of the virus being isolated from the umbilical cord, the placenta, and breastmilk.

But… that doesn’t necessarily mean that the virus is still infectious.

In one study, two infants tested positive shortly after birth with findings suggesting vertical transmission in the womb.

Prior to this, a review of 310 pregnancies saw no evidence of vertical transmission. So transmission appears rare. And more importantly, neither of the infants became ill. Current evidence suggests children under 3 rarely become seriously ill from COVID-19.

Does COVID-19 cause birth defects?

We have not yet noted any specific birth defect associations.  But high fever has been associated with an increase in certain birth defects historically.

Does COVID-19 cause miscarriage?

There is not enough information yet to answer this question.

Can I still breastfeed if I have COVID-19?

Data suggests that breastfeeding mothers do not seem to pass the virus to their infants.  Currently, we believe the benefits of breastfeeding outweigh the risks.  Your healthcare team will discuss risks, benefits, and mitigation measures based on your particular situation.

The best plan is to avoid the virus if possible.

What you should do…

• Wear a mask when you leave your home.
• Wash your hands and use hand sanitizer.
• Maintain a distance of 6 feet from others.
• Avoid unnecessary travel.
• Avoid large gatherings of people, especially indoors.
• Contact your physician if you are concerned about symptoms or exposure.

I know these times are trying. But, we are here for you. And we are all in this together.