A Quick Guide to COVID-19 and Reproductive Health
Have questions about COVID-19 and reproductive health? Dr. Naz explains everything you need to know if you’re TTC, thinking about TTC, or pregnant.
By Dr. Nazaneen Homaifar, Medical Advisor, Natalist
**Please realize answers to these questions may change as we learn more about COVID-19.
Where to get up-to-date information on COVID-19:
- American College of Obstetrics and Gynecology
- Centers for Disease Control
- Society of Maternal Fetal Medicine (SMFM):
- FAQ on Coronovirus in pregnancy
- OBG Project: COVID-19 updates
Can I get pregnant during the COVID-19 pandemic?
- YES. At this time, there are no recommendations around delaying spontaneous conception (trying to get pregnant on your own). However, the American Society of Reproductive Medicine states that if you’re at risk (suspected symptoms or exposure to a COVID-19 positive patient within 14 days) or have confirmed COVID-19, avoid pregnancy, but there is no cause for alarm if you’re already pregnant.
- There is very limited data on the risk of congenital malformations in the setting of fever in early pregnancy. Data from the SARS epidemic in 2003 and the MERS epidemic in 2012–2013 are reassuring, suggesting that there was no increased risk of fetal loss or congenital anomalies associated with infection early in pregnancy. Currently, there are inadequate data on COVID-19 and the risk of miscarriage or congenital anomalies.
Can I get an abortion during the COVID-19 pandemic?
- YES. As hospitals make difficult decisions about cancelling elective surgeries to reduce potential exposures and limit use of personal protective equipment, it’s important to highlight that abortions are not elective procedures. Abortions are time-sensitive and a delay in care can increase risks associated with the procedure. Certain states have tried to push legislation limiting access to abortion care in this time period. The Obstetrics and Gynecologic professional organizations issued a joint statement on 3/18/20.
- In brief, the joint statement states the following: “The American College of Obstetricians and Gynecologists and the American Board of Obstetrics & Gynecology, together with the American Association of Gynecologic Laparoscopists, the American Gynecological & Obstetrical Society, the American Society for Reproductive Medicine, the Society for Academic Specialists in General Obstetrics and Gynecology, the Society of Family Planning, and the Society for Maternal-Fetal Medicine, do not support COVID-19 responses that cancel or delay abortion procedures. Community-based and hospital-based clinicians should consider collaboration to ensure abortion access is not compromised during this time.”
- If you need help getting access to abortion services, consider visiting: https://ineedana.com/
- You can also learn about participating in a research study that allows for medical abortions here: https://telabortion.org/
Can I get birth control during the COVID-19 pandemic?
- YES. Talk to your OBGYN or Primary Care Provider about their availability to see you for birth control counseling via a telehealth visit. There are many types of birth control that can be prescribed without an in-person physical examination: hormonal contraception pills, the Nuvaring, or hormonal patch.
- Long-acting reversible contraception like a Nexplanon or Intrauterine Device requires an in-person visit. Talk to your doctor to see what circumstances may merit an office visit for one of these options. At times, you may want to think about the risks and benefits of going into the office (and possible exposure to COVID-19) for a visit; if you decide to hold off, consider trying another option or continuing what you’re on and coming in at a safer time.
- Check out the Planned Parenthood website to make appointments for contraception counseling. When last checked on 3/23/20, their centers continue to be open across the country and in-person visits require a screening process.
Can I get prenatal care during the COVID-19 pandemic?
- YES. As we think critically about how we can protect patients and health care workers from COVID-19 exposure, health care providers are rethinking how we can best provide care to our patients. Many places have converted some of the traditional prenatal visits to telehealth visits. This doesn’t mean that you won’t see a provider in person, but the number of in-person visits may be limited. Ultrasounds, routine blood work (genetic testing and third trimester labs), and non-stress testing will continue.
- Your healthcare provider will teach you how to do kick-counts as a good proxy for fetal well-being. It will be helpful if you have a blood pressure cuff (arm cuff, not a wrist cuff) and weight scale at home so you can provide some vitals on potential telehealth visits.
- I encourage my patients to think of this as an opportunity that has allowed us to innovate (and hopefully improve) the quality and delivery of our care.
I have heard of people delivering in hospitals without a support person. What will happen to me?
- Talk to your OBGYN, midwife, or nurse practitioner about the policies at your hospital.
- The medical literature is unwavering that support during the birthing process is key to advocacy, patient trust, and experience. However, the state of the current pandemic in certain areas, like NYC, has forced the hospitals to make some very tough, heartbreaking decisions in the interest of preserving the health of patients, health care workers, and everyone they may be exposed to. While it may feel extreme, it’s important to acknowledge that in the face of limited personal protective equipment, resources for the critically ill, and risks of exposure to patients, especially immunocompromised ones (including pregnant patients), hospitals have had to make some tough decisions for the protection of all.
- Many hospitals are trying to take enough preventative measures so that they can continue guaranteeing one healthy support person can stay by the side of a pregnant patient through the labor and postpartum period.
I am pregnant and work in health care. Should I continue working?
- Talk to your boss and come up with a plan.
- The American College of OB/Gyn (ACOG) and Society for Maternal-Fetal Medicine both look to the CDC for guidance on this question.
- Per the CDC: Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.
- Interestingly, the Royal College of Obstetrics and Gynecology in the United Kingdom (RCOG) has made following recommendations for pregnant health care works:
- Women <28 weeks should practice social distancing, but continue to work in patient-facing roles, provided necessary precautions taken.
- Women >28 weeks or those have underlying health conditions should avoid direct patient contact.
Can I pass COVID-19 on to my baby if I’m pregnant and haven’t yet delivered?
- The passage of an infectious pathogen from mother to child is called vertical transmission.
- Previously reported data showed no evidence for congenital COVID-19. However, two articles published in JAMA on March 27, 2020 suggest vertical transmission might occur. A total of three infants born to women with mild COVID-19 disease were found to have elevated immunoglobulins that usually indicate recent infection (SARS-CoV-2 IgM) at birth. Because IgM molecules are generally too large to cross the placenta (in contrast to IgG and cytokines), these results provide serologic evidence of in utero transmission. These infants remained asymptomatic and had negative RT-PCR virologic testing. Limitations of these reports include their small number and the potential false positivity of IgM. So, as of today, we can say the answer to this question is “Maybe.”
- Speaking of which, if you or someone you know is pregnant and tests positive for COVID-19 or is suspected of it, please consider encouraging them to sign up for the UCSF PRIORITY Study: Pregnancy Coronavirus Outcomes Registry. We need a way to track down and measure outcomes for pregnant women with COVID-19.
Can I breastfeed if there is a concern that I may have COVID-19 (person under investigation) or if I test positive for COVID-19?
- There is no evidence that COVID-19 passes through breast milk. However, given the risks of a viral infection in an infant, the CDC recommends separation of mother and baby if there is concern that mother may be positive for COVID-19.
- This doesn’t mean that your baby can’t get your breast milk. Pumping is perfectly acceptable, as long as you take appropriate hand/skin hygiene precautions.
- If you decline separation from your baby, the CDC recommends that breastfeeding mothers wear a face mask and practice hand hygiene before each feeding.
Interested in learning more about COVID-19, TTC, and pregnancy? We hosted an insightful discussion about motherhood in the uncertain times of the coronavirus pandemic.
To learn more about Natalist, head to natalist.com now.