Pregnancy COVID-19 Updates

Not surprisingly, as the epidemic has evolved we have been learning more about COVID and pregnancy. Last week, the British Journal of Obstetrics and Gynecology published two papers and a mini-commentary on this. The commentary abstract said it best, I think: Two papers in this issue, on births to Covid‐19 infected mothers, are important additions to this rapidly evolving literature. They are both broadly reassuring. The newest and probably most informative of these reports on labor and delivery outcomes for 42 women with COVID-19 in Lombardy, Italy. About half of them (19 of 42) have pneumonia, and 8 required oxygen (note that we should not take this to mean that half of pregnant women with COVID-19 develop pneumonia; this is a cohort with more serious disease). Only 3 infants tested positive for the virus among this cohort, which is reassuring, and there were no maternal or infant deaths. The second report is on a smaller cohort of infants in China, reports that of 5 infants born to infected mothers none of them developed COVID-19. Also within the last week or so a systematic review of 18 studies, covering 114 pregnant women with COVID-19, concluded that the clinical characteristics were similar to non-pregnant adults, and fetal outcomes were similar to babies born to uninfected women in the same cohorts. This all adds to a growing sense that pregnancy itself is not a significant risk factor for COVID-19 (this is different from the original SARS and MERS which were both much more serious in pregnant women). Pregnant women can get sick, just as non-pregnant women can, but they do so at similar rates. Moreover, transmission to infants is relatively rare. I also wanted to touch on this article , a case report of a second trimester miscarriage in Switzerland. Many, many people sent this to me. The bottom line: the mother in this case had COVID-19, and analysis of the placenta suggested it carried the SARS-COV-2 virus (this is the virus that causes COVID-19). The authors of the article suggest that the infection may have been responsible for the miscarriage. It is very important to say, however, that this is a single report and it is very difficult to say for sure even in this case whether the miscarriage and COVID-19 are related. Some people have COVID-19 and some women miscarry in their second trimester. The placental involvement suggests it is plausible these are linked in this patient, but much more research would need to be done, with much larger samples, to be conclusive. The media coverage of this has been tremendously unhelpful, most notably this piece which reports on a very scary set of facts from a survey run by an OB. But the piece doesn’t provide enough detail for us to know how this information was collected; without that, it is hard to know how to take this. The fact is, most of what we know about COVID and pregnancy is reassuring. When to Conceive Many weeks ago, back before I bought a 50 pound bag of flour and took on a job as my husband’s barber, I wrote about conception. I suggested that if people were flexible, there might be a reason to put off trying to conceive for a few months but if there were other compelling reasons to try to conceive now, that could well outweigh. A lot of you have written to see if I now have re-thought that analysis in either direction. On the second, I think the answer is no. As I discuss above, there isn’t strong evidence for COVID-19 having an outsize effect on pregnant women. If this is the time for you, I would do it. On the first, I think my thinking has evolved along with many other people. It was easy, early on, to think about this as a short-term thing — as if a month in, things would be different. And while things are evolving every day, it now seems clear that in some form we’ll be dealing with this through the next year and beyond. I see less value in waiting now that I did before. I guess I’m struggling to answer the question: What would you be waiting for? Small Samples, Media Coverage, and Fear A final word. There is an enormous amount of, frankly, very scary media coverage about COVID-19. Many of us are extremely focused on the epidemic. And a lot of this coverage focuses on small samples, on examples, on cases where something terrible happened that may have been COVID-19 linked. The miscarriage piece above is one example; the small number of deaths among children in NY which may be linked to COVID-19 is another. These losses are horrific — so much of the epidemic is horrific — and they’re something we should recognize both to mourn the loss and for medical professionals to be aware of what could happen. But I worry that these cases can engender fear beyond what they should. In the case of children, serious complications from COVID-19 remain extremely rare. Much rarer than, say, the seasonal flu. I worry that there are many parents who may think nothing of sending their child out into the world during flu season — perhaps even without a vaccine — who will react to these examples in a way driven by fear. I hesitated to write this because I know there will be those who react and say if even one death could be prevented by us all staying home it is worth it. But this ignores the costs on the other side of the ledger. And it also isn’t consistent with choices that we make in the non-COVID era, such as driving cars or owning swimming pools. None of this is not to say that the choice to stay home indefinitely or keep kids out of day care is wrong — it may well be the right choice for some families — but we want to make sure to be making these choices out of a realistic assessment of the facts, not out of fear or the salience of the latest coverage.

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