OBGYN Q&A with Dr. Naz on Coronavirus and Pregnancy

What is known about COVID-19 in pregnancy?

Currently, there is limited information from published scientific reports about the susceptibility of pregnant women to COVID-19 and the severity of infection. The available data are reassuring, but limited to small case series. In general, pregnant women experience immunologic and physiologic changes that make them more susceptible to viral respiratory infections, including potentially COVID-19.

Data from MERS-CoV and SARS-CoV, although limited, suggest that infection in pregnancy may be associated with severe infection and adverse neonatal outcomes, including increased risk of miscarriage, fetal growth restriction, and preterm birth. But again, data specific to COVID-19 are not yet available.

The currently published data on COVID-19 infection in pregnancy include two case series, totaling 18 women, only one of whom suffered severe respiratory morbidity requiring intensive care unit admission and mechanical ventilation (lower than the reported general population risk).

Does getting pregnant have risks?

In terms of risks for pregnancy including miscarriage or congenital anomalies, there is very limited data regarding risks associated with infection in the first and second trimesters. There is mixed data regarding the risk of congenital malformations in the setting of maternal fever in general. Additionally, there is an inadequate amount of data on COVID-19 and the risk of miscarriage or congenital anomalies. However, data from the SARS epidemic are reassuring, suggesting no increased risk of fetal loss or congenital anomalies associated with infection early in pregnancy.

Should obstetric care appointments be altered?

Alternate prenatal care schedules have been proposed as a strategy in the effort to control the spread of COVID-19. Community mitigation efforts are important; however, the implementation of such strategies will depend on local practice and population factors and resources. Where available, telehealth (including telephonic and other remote services) can be a tool leveraged to allow access to care for these patients while implementing community mitigation efforts.

Has anyone heard whether OB practices are loosening their video/facetime policies if they are not permitting a spouse/partner attend appointments with you?

I think most health care providers would welcome use of FaceTime to include a support person for office visits and counseling. At my institution, we’ve been encouraging it! Four ears are better than two with these difficult conversations!

What do you think about home birth during these times?

I read a really great open letter from the New York Homebirth Collectiveto the birth community to address the number of questions people had regarding the option of home birth

Is there evidence of vertical transmission of COVID-19?

Researchers found no evidence of COVID-19 in the amniotic fluid or cord blood of 6 infants of infected women. While this report includes only a small number of cases, the lack of vertical transmission is consistent with what is seen with other common respiratory viral illnesses in pregnancy, such as influenza.

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