Recently, pregnant after loss parents have been circulating articles about COVID-19 and pregnancy, specifically the severity of illness for the pregnant mom, and an increased risk for adverse outcomes. It goes without saying that any studies showing any increased risk for stillbirth or data indicating an increase in stillbirths during the pandemic raises huge fears and anxieties in the pregnancy after loss community. That’s why Pregnancy After Loss Support (PALS) reached out once again to Dr. Kristen Sharp, an OB specializing in pregnancy after loss and director of the Hope After Loss Clinic in Madison, WI, to discuss these developments and help you understand what they mean and what you can do to keep you and your rainbow baby safe.

pregnant woman wearing mask - Pregnancy After Loss and COVID-19: March 2021 Research Update

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The American Journal for Obstetrics and Gynecology recently published a study of the pandemic and pregnancy in Washington state, which showed patients infected with COVID-19 have a greater risk for hospitalization or death.

The Seattle Times summarized the findings, “..a new study from Washington state …  finds a much higher risk of death than previously reported, suggesting the peril to pregnant patients continues to be underestimated across the country. The analysis found the COVID-19 mortality rate among them was more than 13 times higher than among those of similar ages who were not pregnant. Those pregnant women with COVID-19 were also 3.5 times more likely to be hospitalized due to the disease and had higher rates of preterm birth.”

Since our first discussion, Dr. Sharp has been cautioning that pregnant women were at higher risk for severe illness and death. I wasn’t sure if this study said anything different than what she’d been saying since the beginning. So that’s what I wanted to ask her: “Is there anything alarming in this study? Is there cause for greater concern? Based on this study, do your recommendations on quarantining change at all (previously you said, cocoon as much as possible, try to limit exposure as much as possible)?”

She responded, “Despite being over a year into this pandemic, we are still working to fully understand the effect of COVID infection on a pregnant woman and her baby. What we do know is that pregnant women are at higher risk of severe infection (which the Seattle Times article summarizes well). Given this, I would still recommend minimizing the risk of contracting COVID as much as possible. And, as the vaccine becomes more widely available, to consider getting vaccinated. While there are now vaccine trials started in pregnant women, we likely won’t have the data from these trials for some time. However, extrapolating safety data from other non-live vaccines in pregnancy, there isn’t anticipated adverse outcomes to mom or baby with the COVID vaccine. Organizations such as ACOG, SMFM, CDC have been supportive of offering pregnant women these vaccines. But, ultimately, it is a personal decision.”

Another study being discussed in the PALS community is a case report (published in a Women’s Health journal’s April 2021 issue) of an otherwise healthy woman who had a stillbirth after being infected with COVID.

I wrote to Dr. Sharp, “This of course is terrifying for women expecting right now especially our PAL mamas. What are your initial impressions? The case suggests stillbirth is a potential outcome of COVID-19 infections. Is this outcome something the medical community agrees on? The authors mention that this case demonstrates a need for greater monitoring for expectant moms during this time. Do you agree? What would that extra care look like?”

She responded, “We are definitely still learning more about how COVID infection affects an unborn baby and the placenta. The case report that you sent me suggests that there can be an adverse effect of COVID on how the placenta functions, and I imagine over these next few months, more information will become available. Our organization has started recommending monthly growth ultrasounds starting at 24 weeks for women who are diagnosed with COVID at any point in their pregnancy. Additionally, for women who have had more severe respiratory symptoms and low oxygen saturations due to COVID in pregnancy, our organization has recommended antenatal testing (NST/AFI) if they are 28 weeks and beyond. I haven’t yet seen any national recommendations for how to monitor the baby in the setting of a COVID infection, but I imagine that at some point within the next few months, there will be more national/international guidelines and recommendations in place. In the meantime, I would strongly recommend doing what you can do avoid infection. If you do contract COVID in pregnancy, I would recommend discussing your fears and concerns over your baby’s well-being with your obstetric provider and discussing what options are available to you to assess how baby is doing.”

I also shared another article with Dr. Sharp reporting a stillborn baby tested positive for COVID-19.

This was her response to that article: “Also, thank you for sending the Al Jazeera article. The disruption of care nationally and internationally, especially in the early months of the pandemic, made me concerned as an OB/GYN. I would recommend to advocate for minimal disruptions in routine prenatal care and reduce barriers to receiving care in as much as pregnant women can control in their healthcare systems.”

As more and more studies become available, PALS will continue to keep you informed.

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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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