COVID-19 | Fertility, Pregnancy & Postpartum

Exactly 3 years ago, I was home with a fresh newborn. As every birthday brings up nostalgic emotions, memories and feelings, this year is a bit different.

I can imagine, home with a newborn and a toddler with my older parents actively present in helping out at home, I would have felt increasingly cautious, fearful and have an immense amount of questions.  

This is my biggest driver, in these times, for providing all the information I have been digging deeply into, especially for those trying to conceive, who are pregnant or who are home with a newborn.

The overall consensus in the research is that there are no added risks associated with contracting the virus to pregnant people, newborns or on fertility efforts. Below, I will breakdown those categories for more insight. 

Please note that the majority of research articles are looking at past infections of similar coronavirus strains SARS + MERS. Research and numbers are very limited for this novel strain of coronavirus.

*Updated 3/16/2020

Trying to conceive

  • If you and your partner are trying to conceive naturally, there appears to be no added risk to conceiving at this time. One study of women who contracted SARS (not COVID, but similar virus) in the early 2000’s, had no placental abnormalities when ill during their first trimester. So, if you do conceive in the coming weeks, then do contract COVID-19, there is no data suggesting complications with pregnancy or fetal development. Contracting pneumonia (a possible complication of COVID) is a well known secondary illness that can cause complications in pregnancy. If you are newly pregnant and start to develop symptoms, contact your healthcare provider. 

  • There is no data to suggest becoming pregnant in the current state of infection should pose any greater risk to conception.. 

Assisted Fertility Technologies (ART, IVF, IUI) *Updated

  • American Society for Reproductive Medicine (ASRM) has officially recommended suspension of initiating new reproductive cycles, embryo transfers & egg retrievals as well as all elective diagnostic procedures. This recommendation is fueled mostly by limiting visits to the doctor in effort to slow the spread of COVID-19. The statement states there is still no data to suggest getting pregnant at this time holds any additional risks.

  • There have been very limited studies on this population, however there has been no evidence that COVID-19 or other coronavirus strains (that have had more time to be tested) cause impairment in fertility, sperm, egg, ovary or uterine health. 

  • If you do contract COVID or have close contact with someone who tests positive, it may be worth waiting until you are healthy to proceed, if that complies with your fertility timeline.

Pregnancy 

With the quick spread of the virus, it is likely many more pregnant people have been infected than we have data on. However, at present the effect in pregnancy is largely unknown. It appears the severity of infection is less in pregnancy and there haven’t been studies or case reports of significant complications. 

  • Fever risk for fetus

    1. Maternal fever may pose complications to fetal development and should be closely monitored if fever develops. There have been a few meta-analysis studies that observed the impact of fever on maternal health. Of those, some complications were found in fetal development where mothers had fever during pregnancy, namely neural tube defects.

    2. In general, studies concluded there was not enough evidence that fever alone caused complications. Some protection from taking 400 mcg folate was observed in preventing neural tube defects (in all populations) for fever in pregnancy. (5) 

    3. Of the possibility of risk, it seems to be greater for those in their first trimester whose fever exceeds 102.2° F. If you are pregnant and develop a fever, consult with your care provider for best management. 

  • Respiratory infection

    • Pneumonia due to any cause during pregnancy can increase complications. Bacterial pneumonia is a problem, but viral pneumonia has been found to have more risk of maternal morbidity. The most common complications of a pregnant person with pneumonia is premature rupture of membranes (PROM), preterm labor (PTL), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR). 

    • SARS & MERS demonstrated an increase in pathogenesis for pregnant people, however that risk has not yet been identified with the nCOV-2 infection. 

    • Currently the highest risk for pregnant people is a lung infection.

    • Unlike some viral infections, notably Ebola and Zika virus, the likelihood of intrauterine maternal-fetal transmission of coronaviruses is very low—there have been no documented cases of vertical transmission occurring with either SARS or MERS. 1

    • HOWEVER, it has been reported that pregnant people who do contract COVID-19 experience only mild or moderate cold/flu symptoms. Historically, the seasonal flu has more data contributing to developing pneumonia than COVID-19, suggesting with appropriate care, a healthy pregnant person is at no greater risk of developing COVID-19 complications such as pneumonia. 

  • Risk of fetal complications

    • Ten cases of neonates delivered from pregnant women in Wuhan, China with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative. There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups.

  • Transmission to baby in utero

    • SARS pregnant patients found no transmission of infection to baby via placenta. 

    • From Wuhan, 18 cases reported, infected in their 3rd trimester - no additional complications found compared to those non-pregnant patients. All but 2 of those pregnancies, babies tested for SARS-COV-2 were negative. (so, 16 or 18 of those reported cases, babies were negative for COVID-19. The 2 positive cases were most likely due to respiratory transmission rather than in utero).

Labor/Delivery

  • Data from Wuhan, nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. None of the patients developed severe COVID-19 pneumonia or died, Nine livebirths were recorded with healthy development in all parameters.

  • Current reports suggest no need to change birth plans for healthy pregnant people.

Breastfeeding

  • Breastmilk tested in 6 COVID-19 patients, all were negative. This is pertinent to patients who have been diagnosed with COVID. If mother has been healthy, there is no reason to discourage breastfeeding and the potent immune support it provides will be preferred with this time.

Infancy

  • Of infants born to COVID-19 positive mothers, there were 2 infants that tested positive for the virus. This has been directly associated with respiratory transmission of viral particles and there has been no association of vertical transmission (maternal-fetal in utero).

Attending medical visits 

  • This is a question for your provider directly. Many clinics in the Portland, OR area are rescheduling non-essential visits. If you are high-risk or have an essential appointment scheduled, you may choose to keep your appointment.

If you start to develop symptoms? 

  • Contact your Midwife, OB or PCP via phone or patient portal. They will be able to give you recommendations pertinent to your case best. 

Best places for up to date information? 

Questions to ask your provider: 

  • Should we check my vitamin D levels to see if I should be supplementing & keep my levels healthy for viral protection? 

  • What are the best immune protecting measures I can take right now? 

  • What is the best support for my family? 

What can I start doing at home? 

  • Wash your hands! ( I had to include that ) 

  • There are currently NO known treatments for COVID-19 

  • Basic immune supportive therapies seem to be harmless at this time and, if cleared with your provider, could be safe for you. Those include: 

    • Zinc 30mg

    • VItamin C 2,000 mg

    • Maintaining adequate levels of vitamin D 

    • Prenatal

    • Probiotic

    • Fish oil

  • Stay home. This is the best way to avoid exposure. While home, consider this an extra invitation to nest, prepare for baby mentally with some guided meditations, journal about all your thoughts, feelings, dreams, etc. 

  • If you’re needing more support, reach out. Many providers (myself included) are offering telehealth options to have a touch point. Be in close contact with your therapist, especially if you’ve been experiencing an uptick in mood symptoms, including anxiety, depression, irritability.

  • Move your body, go for a walk or hike. There are abundant options for live streaming yoga or movement classes. Commit to moving your body 30 minutes a day (unless you’ve been told to limit movement). 

In summary

Take care of yourself and your family. There is a lot we don’t know yet and are still putting together.

What seems to be clear is that a period of avoiding social spaces can decrease viral acquisition.

There seems to be no complications for pregnant people, those trying to conceive or breastfeeding.

There seems to be an immense amount of fear and circulating fear based statements - check your facts before committing an idea to truth. 

Be gentle with yourself and reach out for support as you need it. The more we can unite in support, the better off we all will be.

Virtual hugs to you & your growing family,

Dr. Stang

References:

  1. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):E194. Published 2020 Feb 10. doi:10.3390/v12020194

  2. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know [published online ahead of print, 2020 Feb 24]. Am J Obstet Gynecol. 2020;S0002-9378(20)30197-6. doi:10.1016/j.ajog.2020.02.017

  3. Zhang L, Jiang Y, Wei M, et al. Zhonghua Fu Chan Ke Za Zhi. 2020;55(0):E009. doi:10.3760/cma.j.cn112141-20200218-00111

  4. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–815. doi:10.1016/S0140-6736(20)30360-3

  5. Sass L, Urhoj SK, Kjærgaard J, Dreier JW, Strandberg-Larsen K, Nybo Andersen AM. Fever in pregnancy and the risk of congenital malformations: a cohort study. BMC Pregnancy Childbirth. 2017;17(1):413. Published 2017 Dec 8. doi:10.1186/s12884-017-1585-0

  6. https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/asrm-issues-new-guidance-on-fertility-care-during-covid-19-pandemiccalls-for-suspension-of-most-treatments/

Kelsey Stang