Dr. Natali Aziz, director of Perinatal Infectious Diseases at Lucile Packard Children’s Hospital Stanford, has cared for women who have diseases like H1N1 (Influenza A virus subtype) that may affect their pregnancy. She recently spoke with Bay Area Parent about what is known about the impact of the coronavirus on pregnancy, breastfeeding and conception.
Have you treated any pregnant women with coronavirus?
So far, we have not seen any pregnant women with the coronavirus at Stanford. The testing criteria prior to this was based on symptoms and risk factors of having COVID-19 exposure or having traveled to a coronavirus region. There’s now been a change where the criteria for testing has been reduced to populations at risk and that includes pregnant women. So now I think we’ll have more testing which may identify more women that have coronavirus.
Does pregnancy compromise a women’s health and make her more susceptible to disease?
Yes, it can. It depends on specific infections. Pregnancy causes an immunity change and physiology change. So it’s not unreasonable that we would potentially see pregnant women be more susceptible to diseases. At this time, we do not have that evidence for the coronavirus. But given our prior experience with pandemics, we are putting them in a higher risk category.
Can pregnant women get more ill from diseases than non-pregnant women?
H1NI seemed to cause more severe adverse effects in pregnant women. There were more of them in the ICU and a higher proportion of fatalities. We have not seen that with the coronavirus yet. … Healthy pregnant women, at this time, do not appear to have a more severe response or severe adverse outcomes than non-pregnant individuals.
But it’s so early on. But with H1N1, we had the vaccines that protected us. … At this time, coronavirus does not have a vaccine that has been developed yet, nor are there approved anti-viral medications for the coronavirus. There are studies going on, but nothing has technically been approved.
Should pregnant women self-quarantine?
I do think pregnant women and all adults should be decreasing their exposure to large group gatherings and places where there are a lot of individuals. I do think it’s important to minimize unnecessary and non-urgent gatherings to keep down the rapid spread of the virus.
Besides washing hands, are there other steps pregnant women should take to stay healthy?
I think the same general guidelines apply to pregnant women. Avoiding unnecessary travel or large group gatherings or appointments that can be deferred. You should be keeping in close communication with the obstetrician office and making sure you attend the needed appointments. Elective appointments can be deferred, but it’s important to monitor pregnant women. We certainly don’t want someone to go unrecognized if she is severely ill.
What about nursing moms? Are they more at risk and should they take extra steps to stay healthy?
We don’t have that data at this time. We have not seen it yet. Unfortunately, the limited studies we have are really just handfuls.
It looks like with infected pregnant women, the virus was not detected in the amniotic fluid or breast milk. That is a fortunate finding. However, if a mom is breastfeeding and she has COVID-19, she should definitely try to avoid direct contact with her infant if possible. Do things like wash hands, keep a mask on and perhaps pump milk and have the baby fed by a healthy family member or support person.
If someone is trying to conceive, should they hold off?
We do not have that data for coronavirus at this time. Coronavirus seems to primarily transmit through droplets and contact. There’s also potential that it’s airborne, but that still needs to be determined. But we do not have data to show that it’s sexually transmitted at this time.
I think that at this time, it’s a judgement decision and it should be discussed with the person’s OBGYN or primary care physician. … I don’t think there’s reason to recommend not conceiving. But if there is the luxury to see what happens in the next month or so, we can get a little bit more information to reassure patients. There are many unknowns. That’s the problem.
Teresa Mills-Faraudo is an associate editor at Bay Area Parent.
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