Pregnant woman in doctors office on table

How COVID-19 Affects Your Pregnancy and Delivery

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Being pregnant during the COVID-19 pandemic can be scary and with good reason. Some couples even have elected to wait to start a family until there is a vaccine. The COVID-19 virus has been around long enough for the medical system to have collected some data and made some adaptations. Here are some questions people are asking, and some answers.

Is COVID-19 Dangerous to Pregnant Women?

Aren’t pregnant women especially resistant to disease? Not entirely. 

During pregnancy, your immune system goes through changes designed to protect your baby. While sometimes your immune system seems supercharged, at certain stages a woman’s immune system is lowered so she doesn’t eject the child as a foreign body! These fluctuations increase the risk of your getting sick, so pregnant women are considered immuno-compromised. 

Also, because you have a larger body mass and you are supplying oxygen to your placenta for your baby, your respiratory system already has enough to deal with. The last thing you and your baby need is COVID 19. 

Medical treatment for pregnant women with COVID will differ because there are so many medications that are not safe for your baby. Some antiviral drugs should not be used in pregnancy because they are toxic to embryos or can cause deformities. 

Chloroquine, despite recent political taint, is considered a good antiviral alternative for pregnant women.

How Much Risk is There? 

The American Journal of Obstetrics and Gynecology says that 80% of COVID-19 cases are mild to asymptomatic, 15% are severe, and 5% are critical. Since pregnant women and fetuses are a vulnerable population, several studies are being done right now to address perinatal concerns. 

On the one hand, women contract COVID-19 at a lower rate than men, but on the other hand, pregnant women are more at risk for respiratory infection, since the body shifts immune response priorities to benefit the fetus. 

Because pregnant women do get colds and may suffer more from shortness of breath anyway, your doctor will test you if you have any symptoms. Gestational rhinitis can mask COVID, but testing will show the difference. 

You Need To Breathe! 

Respiratory impairment is the main danger with COVID-19 infection in pregnant women, because continued lowered oxygen in the mother, called hypoxia, is a danger to fetal growth and development. Pregnant women with respiratory impairment should receive a higher oxygen saturation to provide sufficient oxygen to the baby.

Hypoxia can also lead to a narrowed umbilical cord, similar to what is found in undernourished pregnant women. This may set your baby up with a tendency towards diabetes and obesity because the fetus develops with an expectation of scarcity. In other words, the baby may develop a propensity to store fat reserves and a lowered ability to deal with high sugar levels, as if you were pregnant during a famine.

Does Wearing a Mask Lower Your Oxygen Levels?

The answer is mostly not, but sometimes. Have you noticed shortness of breath when wearing a mask? Effective masks like N95 are associated with hypoventilation. In other words, you may start breathing more shallowly. The Elsevier Public Health Emergency Collection says pregnant healthcare workers should not wear an N95 mask, but instead use a motorized filter with supplemental oxygen such as a PAPR. 

However, other experts say that the mask only restricts water droplets; not oxygen or carbon dioxide. They say that the feeling of restriction is merely psychological. 

Experts do agree that people with lung issues may be adversely affected by mask use. Engineers working to build a better mask at Stanford University say that N95 masks can reduce blood oxygen levels from 5-20%. Since being pregnant gives you an increased oxygen requirement, and gynecologists and obstetricians are advising pregnant medical workers to use a PAPR, let’s say there is some concern. 

If your work requires you to wear a mask full time, take mask breaks. Some schools are now encouraging teachers to take students outdoors for mask breaks at least once a day. Kids space out to six feet and sit or stand quietly for 10-15 minutes. It’s a good idea. 

Taking a 15-minute break every 75 to 90 minutes makes sense for a pregnant woman, especially since it coincides with the adult human brain’s ability to maximize concentration on a task. A letter from your doctor might help that conversation. 

Delivery With COVID-19

When you go in for delivery, you will be triaged as to your level of risk based on travel and exposure history, and whether you have symptoms.

Low-risk mothers will be delivered with personal protective equipment such as masks and gowns. Medium to high-risk mothers will be tested and put into negative pressure rooms on the labor ward, where suction fans ensure that there is no airflow out of the room. High-risk mothers are delivered in a negative pressure operating room, with the ICU prepared to receive in case of need. 

If you do contract COVID-19 during pregnancy, you’re likely to have a preterm delivery. The primary reason is respiratory impairment. As maternal oxygen requirements get higher, your baby may start to suffer from lowered oxygen, and fetal growth restriction becomes a danger. You may have seen public health announcements about cigarette smoking, another cause of hypoxia, leading to low birth weight. Low birth weight can cause health and learning problems, but so can preterm delivery. Your OBGYN will discuss with you when he or she believes the risk of waiting outweighs the risk of delivering preterm. 

Can My Partner Be Present?

This is a very good question and one that everybody is asking. The answer is probably yes, but make sure. The WHO is saying that one birth partner can be present, but some hospitals currently disagree. The situation is fluid; these policies are constantly changing, so let your OBGYN or midwife know to keep you in the loop. 

Could I Give My Baby the Corona Virus? 

Studies show that the risk for vertical transmission of COVID infection; spreading the virus from mother to baby, is minimal. Also, because pediatric COVID is usually mild, doctors are not as worried about it. Vaginal delivery is fine if you can make it to term. 

Yes, you can breastfeed your baby even if you have COVID-19. The Center for Disease Control and the World Health Organization both say that the benefits of breast milk and breastfeeding outweigh the risks, with handwashing, hand sanitizer, and mask precautions. If you are on oxygen, wear your mask over the nasal cannula. 

Do not put a mask on your baby unless absolutely necessary for a few minutes. It is a SIDS risk, and the cord is a strangulation risk. 

Does COVID-19 Affect How I See My Doctor? 

Doctors are now using telemedicine appointments to reduce contact except when tests are required. Smartphones make it easy for your doctor to see you, talk to you, and get a sense of how you are. If anything seems off, your doctor can schedule an in-person visit for tests or a more in-depth checkup. 

How Much Should I Quarantine?

How much you should self-isolate is probably the most important question you can ask about COVID-19 and pregnancy. 

Knowing how dangerous COVID-19 is to you and your unborn child, you should avoid contact and be hypervigilant about COVID protocol: wash your hands, use hand sanitizer, wear a mask when in close contact, and socially distance. Is that enough to keep you safe? Maybe. Being furloughed or sent home to telework could be the best thing for you.

If you can stay home during your pregnancy, consider it seriously. You may feel imprisoned, but remember it’s only 9 months. You can avoid contact in the safety of your home, without a mask, without risk to your baby. With a good internet connection, you can work remotely, take distance learning courses, order groceries through a delivery service, and paint the nursery!

If you can’t stay home, talk to your job about changing your duties so that you aren’t on the front line. Ask your doctor for a written explanation of the accommodations you need to help your employers understand.

The Takeaway

Prenatal Care and Delivery Will Change:

• Your prenatal appointments will mainly shift to televisits. 

• If you contract the coronavirus you will use different medications 

• You will be triaged at the hospital to determine your level of risk and appropriate care.

• Hospitals may have different policies as to whether a birth partner can be present 

COVID-19 is Dangerous in Pregnancy: 

• Your pregnancy doesn’t protect you. 

• Pregnancy makes you especially vulnerable to respiratory distress from COVID-19.

• Respiratory distress gives you and your baby hypoxia, or lowered blood oxygen.

 • Low oxygen causes low birth weight in babies, which can cause long-term health and learning problems.

• After delivery, you can worry less: your baby is unlikely to catch the coronavirus from you, and pediatric cases tend to be mild. 

Use Common Sense:

• Avoid contact as much as possible. 

• Work and study remotely if you can. 

• Ask for special considerations from your employer. 

• Be vigilant about handwashing and the use of PPE. 

• Breathe. Take mask breaks.

References:

Contributor, W. (2020, November 26). Intrauterine growth restriction. Retrieved December 02, 2020, from https://en.wikipedia.org/wiki/Intrauterine_growth_restriction

Dashraath, P., Wong, J., Lim, M., Lim, L., Li, S., Biswas, A., . . . Su, L. (2020, June). Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Retrieved December 02, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270569/

Desfosse, B. (2017, November 27). The Immune System and Pregnancy: A Step-by-Step Guide. Retrieved December 02, 2020, from https://www.familyeducation.com/immune-system-pregnancy-step-step-guide

Ghebreyesus, T. A., MD. (2020, June 13). WHO says COVID-positive mothers should breastfeed. Retrieved December 02, 2020, from https://youtu.be/S8yXe6iMlZg

Ibrahim, N. (2020, May 8). Is It Dangerous to Wear a COVID-19 Protective Mask for Too Long? Retrieved December 02, 2020, from https://www.snopes.com/fact-check/masks-dangerous-health/

If You Are Pregnant, Breastfeeding, or Caring for Young Children. (2020, November 3). Retrieved December 02, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html

Kaur, R. (2020, March 21). Doctor says pregnant women should take precautions as COVID-19 concerns grow. Retrieved December 02, 2020, from https://www.wave3.com/2020/03/21/pregnant-women-advised-self-quarantine/

Miller, M. J. (2020, November 23). Patient Experience After Modifying Visit Delivery During the COVID-19 Pandemic. Retrieved December 02, 2020, from https://www.ajmc.com/view/patient-experience-after-modifying-visit-delivery-during-the-covid-19-pandemic

Vozza, S. (2017, November 01). This Is How Many Minutes Of Breaks You Need Each Day. Retrieved December 02, 2020, from https://www.fastcompany.com/40487419/this-is-how-many-minutes-of-breaks-you-need-each-day

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