Pregnancy, Postpartum, and Covid-19 - What this means for all of us?

Updated: Aug 14

Good day intrepid Mamas.

These are scary times for parents and the rest of the world, and we hope that providing you information will help alleviate some of those fears. As a reminder please try and limit your exposure to others around you.




DISCLOSURE: This information is not meant to be ALL encompassing and should NOT replace seeking advice from your health care provider for specific, questions, solutions, and concerns about your health! The purpose is to spark curiosity and gain some insight into your health.


ADDITIONAL DISCLOSURE: This information is as up to date as we can give it to you, however as with many things involved with this virus it seems to change every single day. For the most accurate information (and FB/IG not my favorite resource), please go to the center for disease control website https://www.cdc.gov/coronavirus/2019-ncov/index.html or the world health organization website https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen


How is COVID-19 spread?


The theory is that this virus likely started from an animal source (like most other pandemics) but is now spreading from person to person. There are many different ways to spread this virus which is what makes it so scary 1. Airborne droplets (coughing/sneezing) 2. Close personal contact (shaking hands, touching the mouth, eyes, nose AKA mucus membranes. 3. UNKNOWN- sexual contact, semen, intercourse.


How to Prevent Spread?


STAY HOME! AVOID EXPOSURES


  • Avoid close contact 6 ft distance.

  • If you are sick with a cold, flu or other illness STAY HOME unless you believe you need acute medical care. Wear a facemask at home or if you go out.

  • Clean your hands often- this is a good time to teach your kiddos about germs and NOT touching your face. Wash hands with soap and water for at least 20 seconds.

  • If soap is not available carry hand sanitizer that contains >60% alcohol.

  • AVOID FACE TOUCHING- this is a hard one for me, but I am trying my best.

  • Avoid close contact with people who are sick.

  • Cover coughs and sneezes-google ELBOW SNEEZE!

  • IF YOU ARE NOT SICK- DO NOT WEAR A FACEMASK (unless you are a healthcare worker or caring for someone sick). We are going to run out of protective equipment if we overuse medical supplies unnecessarily.

  • Clean and disinfect. If you have to go to the stores, carry Clorox wipes with you or sanitizer and wipe down the carts.


Take care of yourself! Stay as healthy as possible. Get plenty of sleep, a well-balanced diet, Vitamin C and whatever other homeopathic remedies you can find to boost your immune system. https://www.healthline.com/health/food-nutrition/foods-that-boost-the-immune-system


Who is at risk?


  • Older patients

  • 8 out of 10 deaths reported in the U.S. have been in adults 65 years old and older

  • HIV patients

  • Chronic Medical Conditions: Heart Disease, Diabetes, Respiratory disease, immunocompromised patients.

  • Asthma and other respiratory diseases

  • Pregnant patients





What is currently known about Pregnancy and Covid- 19?


The data is limited but what has been published is reassuring. With that being said the CDC and obstetrical societies are still listing pregnancy as an increased risk factor because during pregnancy your body experiences many physiologic changes that can make you susceptible to ALL respiratory infections potentially including COVID-19. It is reasonable to assume that if you are pregnant you are in fact at an increased risk I in comparison to the general population for covid-19. This is true of all respiratory infections such as the flu (which is why healthcare providers work hard to encourage you to get your flu shot). The largest study out to date right now involves 18 women and only 1/18 of the women suffered a severe respiratory compromise and needed ICU care. Although it is reassuring to see that the majority of patients did not have severe symptoms the CDC is still recommending that all pregnant women take precautions.


IF YOU TEST POSITIVE FOR COVD-19 ARE YOU AT RISK FOR GIVING BIRTH EARLY?


Based on small studies, yes you would be at risk for preterm birth. It is unclear whether this is due to iatrogenic causes or because of an overall increase in early delivery with infections in general.  As with many other respiratory viral infections during pregnancy, Covid 19 may cause preterm birth, low birth weight, and small for age, and adverse neonatal outcomes. Often this is based on the severity of the disease. Reassuring in these studies is that all infants of small study are doing well, no deaths reported.


DOES COVID-19 CAUSE MISCARRIAGE OR CONGENITAL ANOMALIES?


No such data exists at the current time to give an answer on this one. There is a similar virus (SARS) that showed no increased risk of fetal loss or congenital anomalies with early pregnancy and infection. In general, severe infections early in pregnancy has been shown to cause poor obstetrical outcomes in some studies.


WHO SHOULD BE TESTED FOR COVID-19?


Because most cases of covid-19 are likely to be mild and testing resources are limited we encourage those who screen positive for the symptoms and risk factors below to get tested.


  • FEVER and OR cough + Shortness of breath

PLUS

  • Close contact with someone who has tested positive with Covid 19 within 14 days of symptoms

  • Traveled from the affected or geographic region within 14 days of onset of symptoms.


DISCLAIMER ON CLINICAL JUDGEMENT: Most of the healthcare providers are trying desperately to use the limited screening test to the best of their ability. It is currently cold and flu season and that makes it difficult to ascertain between some other MORE common conditions. The CDC recommendation for who to test is changing DAILY, so please visit the website for more information and call your healthcare provider if you have questions. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html


CAN AN INFECTED WOMAN BREASTFEED?


Small students done by Chen et al showed no evidence of Covid 19 in breast milk in 9 infected women. Breastfeeding is encouraged and is a VITAL IMPORTANT source of protection for your infant's immune system to provide antibodies directly to your baby. Although there is a recommendation for infected women to be separated from their newborns, these women are still encouraged to express and pump and to maintain breast milk supply. If you are infected please practice hand hygiene prior to pumping.


CAN COVID-19 BE TRANSMITTED TO YOUR BABY DURING PREGNANCY?


Based on the latest data from the CDC release, the same study as above found no evidence of Covid-19 in amniotic fluid or cord blood in 6 infants born to infected mothers. Although very small studies reassuring data from other respiratory illnesses such as flu have also never shown evidence to transmit through the placenta.


PREGNANT AND SELF-QUARANTINED? WHAT DO I DO NEXT?


Try and limit your exposure to the general public. Limit the amounts of trips to the hospital and office. Call your doctor if you have any symptoms, and if yes, do not come into the hospital or clinic. Stock up on supplies. Take everyday precautions: wash hands, limit close contact, avoid others who are sick.


ARE THERE TREATMENTS FOR COVID-19?


Currently, there is no treatment but there is the potential for a vaccine in the future. A vaccine will not likely help during this current pandemic as it takes more than 18 months for a vaccine to be approved and tested amongst a population.


PLEASE REMEMBER: THIS IS A RAPIDLY CHANGING CLIMATE. Continue to read legitimate sources.

ADDITIONAL RESOURCES:

Inpatient recommendations for those who are about to deliver: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html

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