“What’s the risk to pregnant women?”

“What is the potential effect on the baby?”

“How will my prenatal care change during COVID?”

These questions are ones that have been at the forefront of our minds since the COVID-19 pandemic started to rage across the globe.

Pregnancy after Loss and COVID-19: November Research Update

Almost two weeks ago, the Centers for Disease Control and Prevention (CDC) announced the results of two studies relating to pregnancy and COVID-19. Also, this month, Women and Birth published a paper discussing pregnancy after loss and COVID-19.  Throughout this pandemic, we’ve been publishing articles about the effects this disease could have on you, and the precautions you can take, and how you can better advocate for yourself. Since these studies are newly released, I checked back in with Dr. Sharp, an OB specializing in pregnancy after loss and director of the Hope After Loss Clinic in Madison, WI, for an update on what pregnant after loss moms need to know.

The first CDC study seems to confirm what Dr. Sharp told us already back in August: pregnant women are at risk for more severe illness with COVID-19 than nonpregnant women.

The study, which included 409,462 women aged 15-44 who were infected with the virus, of which 23,434 were pregnant, showed that “…pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit (ICU), receive invasive ventilation, receive extracorporeal membrane oxygenation, and die.”

In reacting to this study, Dr. Sharp reminded me that “Most women overall are doing ok if they contract COVID in pregnancy and have a mild course or even no symptoms. However, pregnant women do have a higher likelihood of developing a severe infection (which can include the need for hospitalization, ICU care, ventilation, or even death) versus when they are not pregnant. This is similar to other infections women can get in pregnancy, such as the flu.”

The second CDC study showed pregnant women with COVID-19 might be at risk for preterm delivery.

This study included 3,912 pregnant women who were infected with COVID-19, and showed that of those women, 12.9% delivered prematurely. Here, it is important to note that preterm delivery occurred mostly in weeks 34-37, when most babies do extremely well. Dr. Sharp added, “Most women who contract COVID will not have a preterm delivery.” She further explained, “But, there is a slight increase risk of experiencing a preterm delivery above the baseline risk (12.9% versus 10.2%). We aren’t sure what is the exact cause of this increased preterm delivery rate. With these preterm deliveries, most of them were “late” preterm deliveries occurring from 34-37 weeks. Again, given these findings, I would recommend doing what you can to minimize the risk of contracting this virus.”

Dr. Sharp reminds PALS moms to “socially distance, wear masks, and take extra precautions to minimize the likelihood of contracting COVID. I also recommend calling your OB provider’s office if you are developing any symptoms consistent with COVID. And, GET YOUR FLU SHOT!!!!!!!!!! As a provider, I am seriously worried about people contracting flu and COVID at the same time.”

Pregnancy during the pandemic is hard for everyone but is particularly challenging for the mom pregnant after loss.

In addition to these studies, whose titles sound scary, prenatal care has been altered or could be limited when there are regional surges in coronavirus cases. Tele-med visits have been encouraged and have in some places become the norm. Support persons have been and could be restricted again when community spread is high and hospitals are overrun with COVID patients.

The unique experience and concerns of the PAL parent could be overlooked while medical teams are trying to control the spread and keep the public safe. In April, when Dr. Sharp and I first discussed the pandemic and pregnancy after loss, she encouraged us to have an open dialogue with our provider about our needs. She encouraged us to call our doctors to ask about having support persons present at ultrasounds if not in person, virtually.

When we talked again in August, Dr. Sharp told me there are no guidelines for handling prenatal care during COVID, and there certainly are no overarching guidelines for the pregnancy after loss (PAL) experience during a pandemic. It’s an unfortunate part of being a loss mom: having to educate about our experience and needing to advocate for ourselves in a subsequent pregnancy. It’s exhausting!

Fortunately, however, the burden is not just ours anymore. This month, a paper was published encouraging the medical community “to remember the unique and challenging circumstances of these PAL families.”

The paper, “Pregnancy after loss during the COVID19 pandemic,” published in the November 2020 issue of Women and Birth lays out recommendations for providers caring for our families.

Reading this short paper, it seems that the concerns of the PAL moms have been heard, and are trying to be addressed. The overall theme of the paper is that the level of care for a PAL mom should not change because of COVID. The authors encourage providers to maintain a “high risk” status for these patients. (Many thanks to our friends at Star Legacy Foundation for their part in this research study.)

Specifically, the paper outlines five recommendations for health care providers handling a PAL case:

  1. Antenatal care guidelines developed for general low-risk population use during COVID-10 should be regularly reviewed with consideration given to their implications to PAL families.
  2. Appointments with psychological services should remain open and available in an appropriate format.
  3. Ensuring mothers experiencing PAL can include their support person during antenatal appointment, if not in person then at least through telephone or Facetime.
  4. Where the partner is not allowed to attend scanning facilities, recognize the importance of scans as a vehicle for attachment and provide a disk/USB of the recording to be shared with the support person and family to connect with the unborn baby.
  5. Health care providers encourage PAL women and families to access local peer-support support.

It’s incredibly heartening to see the medical community taking our experiences seriously and using them to better the experience of the next PAL family. As research related to pregnancy and COVID-19 continues to develop, and papers continue to be published on prenatal care during the pandemic, PALS will strive to update our community. Stay safe and healthy, courageous mamas!

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Please note that the information in this article is not a substitute for medical advice from your own obstetrician or midwife. Your care provider is most familiar with your personal situation, your region’s response to COVID-19, and is best equipped to answer your specific questions and address your concerns. These questions and answers are intended for informational purposes only. Please do not use this article as a substitute for medical advice, diagnosis, or treatment.

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