- I am Mama Dr. Jones, a board certified OB GYN.
And today we're doing an update on COVID-19 in pregnancy.
Thank you for your patience as I've waited on more data
to come out so that I could give you more information.
This data is up to date to the best of my knowledge
as of July 6th, 2020.
This is still very developing.
We know a lot less about COVID and pregnancy
than we do about COVID in general.
And as you all know,
we know not even nearly everything about COVID in general.
I'm going to answer your questions to the best of my ability
and give you a general update on what we know.
(upbeat music)
As always, this video does not serve
as specific medical advice to you.
It just serves as empowering information,
a link of resources in the description,
so that you can take that to your doctor and ask questions
about your personal health.
So unless you've been living under a rock
since about February of this year,
you have heard the word
SARS-CoV-2 coronavirus or COVID-19.
Honestly, if you're living under a rock,
that's probably the best thing for you
because you're probably not around a bunch of other people,
and that's what we need to do right now.
However, if you don't know, SARS-CoV-2
is a virus that was discovered in late 2019
and has ended up causing a worldwide pandemic.
COVID-19 is the disease that this virus causes.
So the most common question I get is, what is the effect
of COVID-19 on pregnancy?
That kind of has twofold answers.
What is the effect on the person who is pregnant
and what is the effect on the pregnancy itself?
Let's start with the person who is pregnant.
We have had a few reports come out,
notably one from the CDC that says,
that maybe people who are pregnant are in an increased risk
of ICU admission or the need for ventilator support.
Avenell, a Scandinavian meta-analysis,
which is very high level data collection and review
as well as a recent publication in the Lancet,
a British medical journal and a U.S. study,
have failed to corroborate this greatly increased risk
of ICU admission or ventilation needs.
I think here, our take home point is,
we don't know for sure.
There is some evidence that says,
there may be an increased risk
if you are pregnant and get COVID-19
of needing ICU admission or of needing
and of needing ventilation support.
However, we're still working on gathering this data.
So potentially there, we need more information.
Think about how little data we have on COVID-19 in general.
And then think about the small percentage
of those people who are pregnant.
We're working with small numbers.
So when we get two or three years out,
we're going to look back at this data
and know a lot more than we know right now.
Importantly, it still does not look like people
who are pregnant are at an increased risk
of dying from COVID-19.
This is really good news
because a lot of respiratory illnesses,
preferentially kill people who are pregnant,
when they are infected with them.
And we just really haven't seen that.
Unfortunately, there have been some maternal deaths
from COVID-19.
Fortunately, they have been few and far between.
Now it doesn't matter what causes a maternal death,
it is always heartbreaking,
but it is reassuring that very least in the midst
of this pandemic, we can say, if are pregnant,
we don't think you're at an increased risk
of dying if you get COVID-19.
So what is the risk to pregnancy or to the fetus?
It does look like since I made my last video,
that we have elevating evidence
that there could be an increased risk of both miscarriage
and stillbirth related to COVID-19.
This is thought to be from either or both clotting increase,
which occurs as we know in pregnant people
and which we are finding occurs
also in people who have COVID-19.
So either a blood clot forms in the placenta,
or there's low perfusion and blood flow to the fetus,
and this can cause fetal death or stillbirth.
The other thing that we may find associated with this
is damage to the placenta.
So it looks like there's some inflammatory markers,
which we call cytokines,
which can affect the health of the placenta
and lead to pregnancy loss or fetal death.
So again, we don't have really great numbers.
I can't tell you if you get COVID-19,
your risk increases by X amount.
But what I can tell you is that,
it looks like there probably is an association.
So you need to be extra diligent with your hygiene measures,
lots of hand washing, lots of hand sanitizer
and avoiding crowds.
Let someone do your grocery shopping for you,
order and go pick it up in the parking lot.
Just do the best you can to stay away from people
as much as possible if you are pregnant.
What about the risk of other complications in the pregnancy?
We have seen an increase in preterm birth
in people who have COVID-19.
This is a little bit hard to tease out
because it likely is related to people who are really sick
are also just more likely to have a fetus
that shows signs of fetal distress.
And thus indicates us delivering,
what we call, ayatransgenically
or the medical team makes a decision to deliver preterm
for the health of what we are seeing
as a concerning finding in the fetal monitoring.
Or because mom is so sick that we feel like removing
the pregnancy will help her improve and get better.
And we do see this in most respiratory viruses as well.
So probably an increased risk of preterm delivery
for that same reason,
probably an increased risk of cesarean delivery.
Although notably not the 80%
that we saw in the China studies,
the risk of vertical transmission,
which is where mom has SARS-CoV-2 or COVID-19
and passes the virus to the fetus,
and the fetus becomes infected and show signs in utero,
at one point was a theoretical,
but probably isn't happening thing,
but is now been proven to happen.
Although we have now found SARS-CoV-2 in amniotic fluid,
and then the fetus immediately
tested positive at delivery as well.
And additionally showed some signs of illness
in the neonatal intensive care unit.
We don't think this happens often, we think it's very rare.
So we know it can happen,
it doesn't seem like it's very likely,
but you should know that it's out there.
Of a note, that baby that I'm talking about
in the case report that I was reading,
did go home at about 19 days of life and did fine,
but did have some complications in the meantime.
We're not really seeing malformations
or babies who have developed abnormally,
that we think have been a result of COVID-19.
A lot of you have asked me about this headline
about a study that said there's been an overall decrease
in the incidence of preterm birth.
And I'd haven't read that study,
if it's true, I suspect that this is either
some con founding factor or circumstantial thing
that is contributing from lockdowns or decreased activity.
I don't know what it is,
but I don't think that that would mean COVID-19
decreases the risk of preterm labor.
I think that that would mean we need to look
at COVID-19 pregnancies by themselves
and their risk of preterm labor.
And then we can talk about worldwide incidents
and what's contributing to that
in kind of a separate discussion.
So should you be trying to make a baby right now?
I don't know, this is a personal decision.
I think you have to weigh the risk
to you of waiting to get pregnant
versus your perception of the risks
that I've just discussed about COVID-19
and the risk to pregnancy.
You have to talk to your doctor about it
because it's going to come into play
a lot of what is the risk to you of waiting.
Meaning, if you're 39, your doctor may say,
"I don't know that waiting a year or two years
until we're out of this mess makes sense."
So I think this is very personal,
you have to decide on your own risk benefit analysis
and you need to discuss it with your physician.
What about masks?
Should pregnant people be wearing mask?
It is safe and recommended for people who are pregnant
to follow the same guidelines as those who are not.
Please, please, please, to protect other people,
wear a face covering when you are out in public
or not able to socially distance.
It's important, it is not harmful to your pregnancy,
to you, to the fetus.
You should wear a mask just like everybody else.
I think this is one of the most important things
to talk about, and that is the increase in postpartum
and pregnancy associated, depression and anxiety.
If you were experiencing worse anxiety, worse depression,
and it is affecting your ability to enjoy your pregnancy
or look forward to birth or to enjoy your life in general,
this is absolutely something I want you
to bring up with your doctor.
I will link some resources below as well as some places
where you can get therapy appointments online.
But the most important thing you need to do with this
is talk to your doctor.
One of the biggest risks to pregnancy
is a risk of postpartum and antepartum,
which is before delivery, depression and anxiety.
So please, if you're feeling the weight
of what is going on in the world right now,
and it's affecting you,
a lot of other people feel that way
and you don't need to be ashamed
to bring it up with your doctor.
Please talk to your doctor, use the resources below,
get help if you need it.
And if not, if you're just feeling a little bit
of an increase in the anxiety and the depression,
know that a lot of people are too,
and this is a normal reaction
to a really abnormal situation.
Hang in there one day at a time.
I know this is a really crazy time to be pregnant,
but there's a lot of people with you
and we're here to listen, please, please, please talk to us.
If you follow me on Twitter or Instagram,
you know I have been talking about this
a lot in the past couple of weeks.
Most hospitals are testing you for coronavirus
or COVID-19 on admission.
And I think this is a good practice
because it helps us conserve personal protective equipment
for the nurses.
And it helps us risk analyze
what's going on in the hospital.
One of the most common worries that I see
is what about if I am pregnant and go into labor
and I'm found to be COVID positive at the hospital,
are they going to take my baby away?
Some hospitals, thankfully,
a lot less than were two months ago,
but still some, are using a positive COVID-19 test
to force a parent to separate from their newborn.
And they're not allowed to do skin to skin or breastfeed
or anything like that.
I think this is the wrong decision.
The World Health Organization,
and the CDC have said all along,
this should be shared decision-making,
meaning we should talk to the parent
who tested positive and discuss what they want to do.
And nobody should be forced into this.
The American Academy of Pediatrics,
initially was recommending separation,
I never agreed with this policy.
And let me tell you why,
because what was happening is that
we weren't removing newborns from the care
of their mother or their parent
in those first two days after delivery,
key days for bonding, breastfeeding,
for preventing postpartum depression and anxiety.
And what we were theoretically hoping that would do,
is decrease the neonates risk of catching COVID-19
from its family member.
That never made sense to me,
because at the time we were also telling patients
who tested positive to quarantine for 14 days.
However, we were taking babies away for two days
and then sending them all home together.
So how does that decrease their risk?
So in my opinion all along,
I thought this increases the risk to the parents
of having PPD or postpartum anxiety,
as well as low milk supply and trouble breastfeeding.
Like we have research that says that,
that if you're separated and you don't get to participate
in skin to skin, especially if you wanted to,
then those things increase in likelihood.
But we don't have any data
to say that two days of separation
definitely decreases the risk to the newborn.
We actually now have data that says those patients
who separated for those two days
and then were discharged home together,
were at equal risk of giving COVID-19 to their baby.
Shocking, I know.
I mean, I feel like that's a very logical thing to decide,
not to mention the fact that we were putting these babies
in the care of a nurse, who had not been tested at all
and was just as likely to be an asymptomatic carrier
or maybe even more likely than the person
that delivered the baby.
So it never made sense to me.
Now that being said,
I definitely understood people who were sick
and didn't want their baby at the bedside
because they felt so bad they couldn't take care of it,
or people who were just worried
and would prefer not to do that.
But in my opinion now and all along,
we should use those two days
to teach our COVID-19 positive patients,
how to wear a mask properly,
how to wear gloves properly,
how to breastfeed and then put the baby
back in the bassinet, six feet away,
so that we can decrease the risk
both in the hospital and when they go home,
because they're going to be caring for their baby at home,
unless they decide to quarantine for 14 days.
But my point, and this was very long winded,
has always just been,
we need to support our patients in making these decisions
and their autonomy to choose this.
I am editing and I just felt like I needed to add in here,
that I got a little bit off on tangent
of what was being done more frequently,
and now seems to be relatively uncommon with the,
for separation, is just that it's not supported by CDC,
World Health Organization,
or now the American Academy of Pediatrics.
And to be clear,
the American Academy of Pediatrics
never recommended forcing separation.
They only said they recommend separation,
but now they have taken a very patient autonomous stance
of shared decision making.
So, all of that to say,
you should make sure that your hospital
is following these guidelines
from the World Health Organization,
from the CDC and from the AAP,
that this is a decision that you
and your healthcare team get to make together.
Sorry for the introduction.
Also my audio is about to get real bad in the videos,
so I apologize for that, hang in there.
I can definitively say, if it were me,
I would not choose that.
And I think patients should be empowered
to make that choice as well.
As with all of these things, that is my personal opinion.
It is an agreement with the CDC, World Health Organization,
and finally American Academy of Pediatrics.
But please talk to your doctor
and find out where they stand.
Sorry for getting a little heated,
I get very frustrated when I hear about
patients not truly being given,
what I see as informed consent to make a decision.
As far as hospital policies on visitors
who can be there at birth,
that is going to vary by hospital.
You can check with your hospital on that.
All right guys, I hope that helps.
I'm sorry that there's still so much that is not known.
If you have questions,
please leave them in the comments below.
I will see you next Monday for another video.
Be kind to yourself, to each other, to me,
in the comments be kind and I will see you next time.