Coronavirus and Pregnancy: What You Need to Know

Life in 2020 is not turning out as we had expected. Just imagine what it’s like for women who are expecting! The novel coronavirus is causing increased anxiety and uncertainty for pregnant women and their loved ones.  What is known about how the virus affects mothers-to-be, their unborn children and newborn infants? Host, Dr. Jonathan Fialkow gets the latest information from Dr. Katia Magalie Apollon, a specialist in Obstetrics and Gynecology with Baptist Health South Florida on this episode of Baptist HealthTalk.

EDITOR'S NOTE: On June 24, 2020 the American College of Obstetricians and Gynecologists released this statement regarding COVID-19 and pregnancy:
ACOG Statement on COVID-19 and Pregnancy | ACOG

For more information about COVID-19 please visit BaptistHealth-coronavirus.com

Transcript

Announcer:

At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life. Life in 2020 is not turning out as we'd expected. Imagine what it's like for those who are expecting. We'll examine how the coronavirus is affecting pregnant women on this episode of Baptist Health Talk.

Dr. Jonathan Fialkow:

Hello, Baptist Health Talk podcast listeners. This is your host, Dr. Jonathan Fialkow, and I'd like to welcome you to another special edition of our show focused on the novel coronavirus. We've had lots of emails and requests for information regarding today's topic, which has to do with COVID and pregnancy, and we appreciate the requests, and I think we're going to have a great show to answer a lot of the questions that came in.

Dr. Jonathan Fialkow:

We do know that during pregnancy changes in a woman's immune system make them more prone to infections like the flu. So understandably, the coronavirus pandemic is causing particular anxiety and fear within this vulnerable population. Today, we'll explore the topic of coronavirus and pregnancy, what you need to know. And our guest today is Dr. Katia Magalie Apollon, who is a specialist of obstetrics and gynecology in Baptist Health South Florida. Welcome to the podcast, Maggie.

Dr. Katia Apollon:

Thank you.

Dr. Jonathan Fialkow:

As noted in the intro, again, this is a concern that's raised by many people, and we hope to be able to allay some of the concerns and answer a lot of questions, and specifically with facts. Starting out broadly, what have we learned regarding corona illness in pregnant women? We're still relatively early in the pandemic. There's still a lot of uncertainty regarding the coronavirus and COVID-19 and various organ systems. Can you bring us up to date about what's going on, specifically as related to pregnant women?

Dr. Katia Apollon:

Sure, thank you. I would say there's like two main things that we think we know about pregnancy and COVID-19, and one is, it doesn't appear that pregnant women are at increased risk for more severe manifestations of the disease. As you mentioned in your introduction, viruses like influenza are very concerning for us as obstetricians because there is evidence that pregnant women, when they get influenza, commonly known as the flu, they're at higher risk for hospitalizations and complications and superimposed pneumonia. So when COVID-19 came out, that was of great concern to us. But what the data that we're getting, first out of China and New York, and as the pandemic progresses, is that pregnant women do not appear to be at an increased risk for more severe disease, so that's reassuring.

Dr. Katia Apollon:

The other thing that we think we know is that it does not appear that there is what we call vertical transmission, which means transmission of the virus from mom to baby through the placenta. Again, the caveat is that we're still learning a lot. There are no what we call randomized control trials, but it does not appear so far that there is vertical transmission, and that's very reassuring. When you compare it to viruses like Zika, where there is really severe birth defects, we're not seeing that with COVID-19.

Dr. Jonathan Fialkow:

Well, that is very reassuring, and I appreciate those introductory comments. If you're taking care of a pregnant woman and they wind up having symptoms, cough, fever, what in particular might you be telling them to do if they called you? What options do they have, and how should they approach those symptoms?

Dr. Katia Apollon:

Well, pretty much it's the way the CDC gives guidelines for nonpregnant women. So we do the screening. Initially when the virus came out, we thought about fever, cough, shortness of breath. As an obstetrician, we try not to bring anyone who is actively sick into the office to protect our other patients and our staff.

Dr. Katia Apollon:

Baptist has its care programs, so often we'll ask our patients to go through the screening here on demand, and then we evaluate how sick they are because if they have what are mild symptoms, the recommendations are the same for nonpregnant women, to quarantine yourself, to watch out for more worrisome symptoms, which for me is shortness of breath. The way I gauge it is if you can't complete a full sentence at rest, that's a concerning thing, weakness. For our pregnant patients, if they're not feeling the baby, then we would have them go in.

Dr. Jonathan Fialkow:

I think that's also reassuring, that again, the lack of vertical transmission is again, important to know. If someone feels ill, they do have resources, whether it's to call care on demand, to call the physician offices. If someone does have that shortness of breath, what confidence can they feel about whether it's going to a doctor's office or an emergency room in terms of their exposure? How have practices changed to whether it's isolate patients who may not even have symptoms? What will they see differently if they're coming into the practice or to an emergency room?

Dr. Katia Apollon:

Like I said, we don't bring in anyone with symptoms. We were doing that even with flu symptoms. If a patient is just coming in for a routine prenatal visit, first, always call your doctors. But as the pandemic progressed, we still have to see our obstetric patients, right? So we stopped seeing our routine patients. What we're doing in practice is we're spacing out our appointments. We're trying to concentrate our appointments. We introduced telehealth, so you actually can do telehealth visits with obstetrics at certain stages.

Dr. Katia Apollon:

In regards to when you're symptomatic, again, the hospitals or urgent cares, they're all taking great precautions. You should go with a mask. If you don't have a mask, I'm sure they will provide one to you. They'll go through the screening questions and determine whether or not you should be tested for it. I try to reassure, and I think you may have had a podcast on this, that when the pandemic came out, there was this big panic. Don't go to the emergency room no matter what. But people still have heart attacks. People still have babies. And so we are doing our best as healthcare providers to make this environment safe for you, so I try to tell patients, yes, if you need to go, go.

Dr. Jonathan Fialkow:

We have all seen and we have all discussed the fact that we are seeing people who are staying home with medical problems, which are advancing because they're delaying care, and we do want to avoid that, so I thank you for the reassurance of the safety and the lack of exposure if you need to be seen, where they're in an emergency room.

Dr. Jonathan Fialkow:

You mentioned something interesting, as well, which we've talked about in the past is so the prenatal experience, if you will, is changing a little bit. Televisits, not every time a woman has to come in and take off of work and park, et cetera, et cetera. Do you think that will persist? Do you think it'll change a little bit about how prenatal care may be delivered after the pandemic? Or do you think it's a short term solution?

Dr. Katia Apollon:

I think this has caused us as providers to reflect on what's really necessary and what's not. I've been to conferences. Our organization is called the American College of Obstetricians and Gynecologists, and I've heard from people in New York that they have found that some of the changes that they're making, they will keep. A lot of them have had ... We, in my practice, have asked our patients to try to get blood pressure cuffs, and there are some health systems where they actually get grants to give their patients blood pressure cuffs. There are some people who do the home Doptones, the heart monitors. Although, I caution, I usually tell my patients not to buy them, but with proper instruction in front of the doctor, they can do that.

Dr. Katia Apollon:

I have friends in New York, where a lot of their patients left the city, and they're still able to give good care. So I think this has really given us a boost for telehealth, and it's caused us to really be creative in how we provide care. So I think some of the changes are probably going to stick around.

Dr. Jonathan Fialkow:

Let's talk a little bit about what the experience is during a delivery. A woman goes into labor, comes to the hospital, again, comfortable that they will be not exposed to patients who might have COVID or being suspected for COVID. Anything being done differently during the delivery process? And also let's address the issue with visitors coming in, either during or post-delivery. What's been done to accommodate that situation?

Dr. Katia Apollon:

Having a baby is a really extraordinary experience, and we want our patients to have a positive experience. And we know, data has shown, that when women have a companion, whether it's a partner or a doula, that they actually may have a more likely chance of having a vaginal birth. But in the pandemic, we also have to take precaution. In our hospital system, we are allowing one visitor. In the old days of having like grandma and cousins and nieces waiting in the waiting room, we can't do that now because it really isn't safe. It's not part of social distancing. But what we assure our patients is that yes, you can have one companion. When the patient arrives to the hospital, in our hospital system, we have decided to do universal testing, so every pregnant patient will get the swab to check for COVID-19, and we have the ability to do rapid testing, so we'll have the information within an hour.

Dr. Katia Apollon:

The patient and her partner will be given a mask. They're brought to the labor floor. Everyone in the hospital is wearing a mask, so they'll see that the nurses, everyone is wearing a mask. And then the labor itself is pretty much the same, except that we're using PPE, the protective equipment. And this is for patients who test negative. For those patients who want to have their grandma or whatever available, we're being accommodating and trying to have the patients FaceTime and things like that. But I think the main difference is not having the visitors and having to wear a mask and pushing with the mask can sometimes be challenging, but we really try to support our patients. And we're still doing, again, especially for our negative patients, we're still doing skin-to-skin, delayed cord clamping. The baby stays with mom. So for people who test negative, those are the main differences.

Dr. Jonathan Fialkow:

And I think you mentioned it a few times, I just want to emphasize it. The reason we have this visitor limitation is to protect the patients. It's, you may know the person with you, but you don't want a whole hospital filled with other people coming from the outside who might be bringing in infection, so as difficult as it may be, it's to protect the patients in the hospital. And it is constantly being reviewed, and hopefully as we have levels of control might be liberalized to some degree. Now that we know that it's safe to come to the hospital, certainly have your baby, what about after the baby's born? What are we recommending about breastfeeding and the mother holding the baby after delivery?

Dr. Katia Apollon:

Again, so the good news is that to date, there's not been any evidence that COVID-19 is spread through breast milk. The CDC, the World Health Organization, all encourage breastfeeding, that we know that there's tremendous benefits to the infants and to mom to breastfeeding. Yes, you can still breastfeed, even if you have COVID-19. I think the question is, in terms of how you breastfeed, there's different recommendations. The CDC says to make it a shared decision model. So initially some organizations were saying that when mom is positive for COVID-19 to separate mom and baby, which can be challenging, but I think that was out of concerns of the baby getting the disease. So although we don't think there's vertical transmission, there is concern that respiratory droplets from mom could drop on the baby and the baby could get it.

Dr. Katia Apollon:

Again, it's a shared decision, so sometimes they may separate the baby. That's what we've been doing at Baptist. And then we encourage mom to pump and have someone who doesn't have COVID-19 give the baby the breast milk. But the moms still do have the option to breastfeed themselves, but they just have to take good precautions. They have to wash their hands. We recommend wearing a mask. When you're not nursing, they ask to separate the baby by six feet. But the bottom line is yes, you can still breastfeed.

Dr. Jonathan Fialkow:

People are still getting pregnant during the pandemic. People are delivering babies. Mothers are meeting and being able to care for their babies and life continues to go on, which is very encouraging. What advice are you giving regarding family planning? If someone says to you, is it safe to start a family or get pregnant, how does that conversation go?

Dr. Katia Apollon:

I individualize it. Like I said, we're still in the learning process to learn what happens with pregnancy and COVID-19. I think it depends on where you are in your family planning. As I've mentioned in other conversations, if I have a patient who's 40 and is trying to have her first baby, we have to take into other concerns about, well, as we get older, our eggs get older, and I don't want that patient to delay, so I encourage her to still try to get pregnant. You also have to think about other conditions. Does the patient have uncontrolled high blood pressure, uncontrolled diabetes? What we know from COVID-19 is that people who have what they call comorbid conditions are at higher risk of complications from the infection. So yes, I would want that patient to be in her best possible health before she gets pregnant. But I wouldn't say that I'm discouraging. I think we just have a discussion about their plans, and I say it's okay.

Dr. Jonathan Fialkow:

An individualized discussion, not an absolute yes or no, and the individual or the couple or whomever should feel comfortable speaking with their doctor and have a group decision, which is also encouraging. I really appreciate the information. Again, many of these questions have been asked through our email or other sources to us, and I think you've given great answers to those questions. Hopefully we assured the listening public. Any final comments that you'd like to make, or any particular information that you might want to provide that we haven't addressed?

Dr. Katia Apollon:

I think in this time of uncertainty, people can get very stressed. I would always encourage my patients to talk to their providers about any concerns that you have so that we can filter through any misinformation or misconceived notions. We are here to support you. And what we didn't talk about are things like depression, anxiety. There are ways that we can support you to help you through this, and we want you to have a good experience.

Dr. Jonathan Fialkow:

Thank you. Thank you very much. And to all our listeners, feel free to continue to send us any comments or emails through email or any topic requests. Send it to BaptistHealthTalk@baptisthealth.net. Thanks again, Doctor Appolon for your time and your passion towards the care of our community and our patients. And to all our listeners stay safe and stay home. Thank you.

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