Pregnancy During COVID
Authored by:
Anna Glezer, M.D.
The pandemic has changed our world. It also has led to many questions from my patients about how, when, and if to make any changes in their conception plans, and for those already pregnant, concerns about pregnancy.
Should I Postpone My Plan for Pregnancy?
This is a common question. For some, the concern is about the potential for risk of infection during pregnancy for mom and baby and outcomes for the pregnancy. For others, there are logistical worries when pregnancy requires interventions from fertility clinics that may not be running to full capacity or may not be open at all. For even others, there are fears about resources being diminished that they had counted upon to ensure a smooth pregnancy, delivery, and postpartum period, such as the help and support of family and friends.
Reproductive Risks of COVID-19
As time continues with the pandemic ongoing, more data is released to answer the question of safety and risks infection during pregnancy. This data is early; much of what is published to data is for women who were infected in their third trimester.
It is important to remember that pregnancy, at baseline, is an immunocompromised state. This means that all women who are pregnant are vulnerable to infections. This is why, for example, pregnant women are encouraged to get the flu shot. Because of this vulnerability, taking precautions is particularly important. This means physical distancing, frequent handwashing, and masking. Those that work in highly exposed fields, such as healthcare, can consider accommodations to decrease exposure. However, the available data does not suggest that there is any heightened risk specifically for infection with this virus.
One trend that is emerging in the literature suggests there may be a higher risk of preterm birth when a pregnant woman is infected with COVID-19. To date, it does not appear that the severity of the illness is significantly different for pregnant women than those who are not pregnant; meaning, the ratios of women who have mild, moderate, or severe illness are the same and the risks for more severe illness are similar (such as underlying medical problems). The researchers are still out on the question of whether or not a baby can be infected by transmission from the mom.
Support in Pregnancy during Coronavirus Times
From a mental health perspective, pregnancy is a time when support is paramount. Because of the infection precautions, this becomes more challenging these days. Often, OB appointments are limited to just the pregnant patient, and the number of family allowed during labor is usually 1-2. Postpartum, the challenge may be having fewer family able to travel to help with the baby or less comfort in hiring support staff like doulas. I encourage thinking about creative ways around this. For example, more and more online mothers and parent groups are forming that can provide social support, including those that focus on pregnancy during Coronavirus. There’s also good data emphasizing the importance of physical activity and being in nature for decreasing risks of depression and anxiety, and those remain available during COVID times.
Postpartum, because the combination of physical isolation due to Coronavirus and the limitations imposed by having a newborn, depression risks may be elevated. Therefore, it’s important to be aware of the signs and symptoms of postpartum depression (See: Article)
In the end, however, it is a personal decision weighing these risks and benefits and discussing them with your doctors and your partner. The question is whether the additional challenges imposed by Corona Virus are surmountable for you, rather than whether you should wait for the pandemic to resolve. Many of the women who ask me this question – whether to postpone conception or an IVF cycle – are concerned about the timeline and I rarely advise doing so because we do not know how long the pandemic will last. Instead, I advise considering the added challenges and deciding from there. Working with a psychotherapist to help navigate the emotional ups and downs of making this difficult decision is often my strong recommendation. I also advise against spending too much time researching, reading the news, and on social media, as these often perpetuate fears and anxieties.
References:
Di Mascio, D. et. al. (2020) Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM.
