Dr. Arnold:
This is LiveWell Talk On COVID-19 in pregnancy. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health-St. Luke's Hospital. Being pregnant during an outbreak of a virus certainly can cause anxiety for the general public as well as pregnant women. This raises several questions. Is my unborn baby at risk? Am I at higher risk? Could a COVID-19 diagnosis increase the likelihood of an adverse pregnancy outcome? Joining me to answer these questions and more is Dr. Stephen Pedron, physician at UnityPoint Clinic Maternal Fetal Medicine. Welcome.
Dr. Pedron:
Hi Dustin. How are you?
Dr. Arnold:
I'm great. To start off, let's just give a little background about the virus. It's a novel meaning new coronavirus. There are seven coronaviruses. Four of them, cause the common cold and then three of them are pathologic to a certain degree and this is one of them and it certainly caused a concern. And in particular there's so many unknowns. So I know some of the answers today are just going to be, we think or maybe. But I think we want to at least throw it out there to start the discussion. And probably put some people's minds at ease. Do you know, does COVID have a higher risk in the pregnant patient?
Dr. Pedron:
I don't know anything about COVID and its risk in pregnancy other than to say that every viral infection causes risk in pregnancy and greater in pregnancy than the non-pregnant patient.
Dr. Arnold:
Are pregnant woman? That's redundant right there. Do a pregnant patient....
Dr. Pedron:
That's not redundant. There's some women who are not pregnant but we'd like them to be pregnant.
Dr. Arnold:
Yeah.
Dr. Pedron:
I didn't mean anything weird by that.
Dr. Arnold:
No. Are pregnant women at higher risk for infections in general?
Dr. Pedron:
Oh boy, that's a great question. Yeah, I would say that they are. They have some immune modification to tolerate having their little foreigner inside of them. And so yes, generally they are at higher risk for infection.
Dr. Arnold:
So there's just a concern just on that alone?
Dr. Pedron:
That's correct. And nowhere is that more true than for viral infections.
Dr. Arnold:
Now Zika, some of the other, rubella I believe.
Dr. Pedron:
CMV.
Dr. Arnold:
CMV, cytomegalovirus, those they caused birth defects, correct?
Dr. Pedron:
Yes.
Dr. Arnold:
Now, the March 3rd edition of or issue of the new England Journal of Medicine had the clinical spectrum of the coronavirus from China and it was up until about January 29th so they had end of December through January 29th in that article. And they did not believe vertical transmission is present with this virus at this time. Have you heard or read anything different than that?
Dr. Pedron:
I haven't heard anything to say that it is, but I haven't seen any data to say that it is or isn't. I would suspect that it isn't and I don't think that we need to look at this virus at all like we would something that is vertically transmitted such as cytomegalovirus or Zika or rubella for that matter.
Dr. Arnold:
For my own knowledge, is HIV vertical transmission or does it happen at the time of pregnancy, at the time of delivery?
Dr. Pedron:
HIV is transmitted vertically. In fact, it's one of the great success stories in our specialty is decreasing that transmission with medication.
Dr. Arnold:
What should, just in general, I mean we believe COVID-19 is most likely droplet transmitted. Contact and droplets. So sneezing, coughing and touching. It's unlikely it's airborne. So, you know, I'm not going to be driving around the community looking for some monkey somewhere to get antibodies from like in the movie Pandemic because it's probably not airborne. But what precautions should a pregnant patient take just in general for infections?
Dr. Pedron:
Since you asked me, let's talk about cytomegalovirus. Let's talk about CMV. No pregnant patients should ever share food with a toddler, should share food with anybody, should touch their face anywhere after having touched a doorknob or a railing. The same precautions for this virus for corona, obtain for any pregnant patient. Really just to avoid transmission of other more lethal infections such as influenza or CMV.
Dr. Arnold:
Makes sense. Refresh my memory on influenza. Can pregnant women receive the flu shot?
Dr. Pedron:
Absolutely.
Dr. Arnold:
Okay. That's what I thought. It's recommended I believe, isn't it?
Dr. Pedron:
It's recommended especially in pregnancy because influence can be so lethal in pregnancy.
Dr. Arnold:
But they probably can't take the nasal live virus. That has to be the shot? Or do you recall?
Dr. Pedron:
It has to be the shot. Live viruses are discouraged in pregnancy.
Dr. Arnold:
Well we probably don't know this next question. But are viruses, cytomegalovirus, is that transmitted via breast milk?
Dr. Pedron:
Oh man, you got me on CMV. I think it is, but I would have to go do my homework on this.
Dr. Arnold:
I think we'd have to assume at this juncture that COVID is, until proven otherwise in my opinion.
Dr. Pedron:
Could be. I just don't know the answer to that Dustin. I'm not going to speculate. I'm going to have to do homework on that.
Dr. Arnold:
Fair enough. Travel in general is not being encouraged if you don't have to travel at this time. Because we're in the mitigation phase. We're trying to slow down the spread, reduce transmission. What is your general recommendations for pregnant patients and travel? Is there a certain time you say, okay, no travel, no more?
Dr. Pedron:
No, there really isn't. I don't discourage travel at any point in pregnancy as long as they've thought it through. For example, you don't want to be laboring at 30,000 feet and having your pilot have to put down in a city and have to inconvenience the rest of the passengers. For that matter, if you're a high risk patient you don't want to be delivering a 28 weeker in a city and have to stay there for another eight weeks to watch your baby in the intensive care unit. But generally speaking no, I don't discourage travel at all and there are no restrictions as long as they're thoughtful about it.
Dr. Arnold:
Okay, that's good to know. If a pregnant patient should develop a fever, cough, what should they do? Should they follow the same precautions that a normal patient has taken at this time or a non-pregnant patient?
Dr. Pedron:
Absolutely. They should follow all the recommendations for the non-pregnant patient and just make sure that they're in touch with their provider.
Dr. Arnold:
That's great advice. A lot of unanswered questions at this time and I think we'll probably need to have you back to answer some of these questions that we brought up today.
Dr. Pedron:
Yeah, I want to say a couple of other things in case you're fixing to wrap up. One of the really cool things about corona that differentiates it from influenza is that if I'm hearing my infectious disease colleagues correctly, there is treatment for this virus.
Dr. Arnold:
Remdesivir which was actually developed for Ebola by Gilead Company. It has been shown to have some efficacy against this virus in China as well as in South Korea. They're also in vitro, so in the lab, hydroxychloroquine has been shown, so Plaquinel, has been shown to be effective as well, which is really cheap. Chloroquine, that we use to treat malaria is very treat, very available. Also an HIV medication, Kaletra, has been shown to be effective in patients in China and I think they're using in Korea. So there is some options for those, the minority of patients that end up in the intensive care unit.
Dr. Pedron:
Well just to break this down, if a pregnant patient contracts influenza and gets pneumonia from influenza, we don't have many options. We've got oseltamivir and supportive therapy. And the risk of a viral pneumonia in pregnancy, the mortality for that can be up to 50%.
Dr. Arnold:
Wow!
Dr. Pedron:
For this virus, for corona, if a pregnant patient gets sick, get in touch with their provider. See somebody who knows what they're talking about. And get treated early because none of these medications that have been suggested to be efficacious for Corona, none of them are contraindicated in pregnancy. They all have a good track record. And so I would really put in a plug, since a viral pneumonia can be so lethal in pregnancy, get in, be evaluated for it. And if you need to be treated for it, for gosh sakes, get treated and save some lives.
Dr. Arnold:
That's great advice. Well, that's really great information. We have a lot of unanswered questions. I think we'll have you back in the near future. This is a dynamic situation to to update on this topic as well as other topics related maternal fetal medicine. Again that was Dr. Stephen Pedron, physician at UnityPoint Clinic Maternal Fetal Medicine. For the latest on COVID-19 visit our website at unitypoint.orgo or go to coronavirus.gov. If you have a topic you'd like to suggest for our TalkOn podcast, shoot us an email at stlukescr@unitypoint.org. We encourage you, tell your family, friends, neighbors, strangers about our podcast. Until next time, be well.