A Short One

NY Hospital Policy As of Saturday, NY State issued an executive order requiring hospitals to allow one support person in labor, and the relevant hospitals in NY which were restricting partners have said they will comply. The rules allow support people only in triage, labor and delivery and immediate post-partum, they allow only one support person, and everyone must be gloved and masked. Partners with symptoms of COVID-19 will not be permitted. Still, this is probably a sigh of relief for many women near delivery. New Pregnancy and Infancy Data There are a few new studies that have come out about pregnant women, infants and COVID-19. The largest of these is a study of 33 infants born to women with COVID-19 in China. In this sample, 3 of the 33 infants contracted COVID-19. Two of the three had very mild symptoms which resolved within a few days. The third had more severe symptoms, although this infant was born at 31 weeks of gestation so the symptoms may have reflected pre-maturity as much as infection. This is overall quite encouraging. There were also two papers (here, here) published which suggested possible vertical (i.e. in utero) transmission of the virus. This transmission was suspected due to antibody detection in the infants. The total sample size between the two studies is 7 infants, so this is a small group and it is difficult to know when the transmission occurred. It remains possible that even in these limited cases the transmission was outside the womb. In addition, it is important to note that none of these infants showed any symptoms of COVID-19. Fever A lot of women in early pregnancy have written to me to say they are worried about COVID-19 because of links between fever and neural tube defects (same reason you do not go into a hot tub). It is true that some data has seen links between early pregnancy fever and neural tube defects, but my read is the most reliable data doesn’t see this. I think the best study here — it’s large and followed women over time — focused on a cohort of 100,000 women in Denmark. The data includes about 8,000 women who had a fever during early pregnancy. They see no link with birth defects. This is not a reason to be cavalier about the virus (or other illnesses like flu), but should be reassuring. Cases in Kids The data continues to suggest COVID-19 is mild in children, and they also seem to be less commonly infected (although this may reflect more asymptomatic cases). Tragically, there has been one infant death and one teenage death in the US thus far, but put in context these numbers are small (far less than child deaths from the seasonal flu). Nicholas Christakis has a thoughtful (and long) Twitter thread on this topic, both some details on what we know and some speculation as to why.

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