On Sunday — as cases of covid-19 skyrocketed in the United States — Meghan McCain announced she is pregnant. In a statement, she wrote that she is self-isolating per her doctor’s advice. She’ll be spending a lot more time online now, as a virtual co-host of “The View.” She’s also joining millions of American women who have no idea what to expect now that they’re expecting in the middle of a pandemic.
“The fear is real,” says Michelle Dinh, a 29-year-old realtor and yoga instructor in Raleigh, N.C., who is 15 weeks pregnant.
“I lost a pregnancy in July of last year, and to say that losing this baby is not on my mind would be a lie,” she says.
Dinh’s fears are not uncommon these days; there is still a lot we don’t know about the coronavirus and its effect on pregnancy. The current Centers for Disease Control and Prevention guidelines for pregnant women are similar to those for everyone else: Wash your hands, avoid people with symptoms, cover your cough. But some doctors are advising women to go a step further and follow what McCain and Dinh have opted to do: stay at home and minimize contact with the outside world.
“It’s very difficult, because pregnancy is a very fragile time in life, not just for the pregnant mother, but for the whole family,” says David Schwartz, a pathologist with Augusta University specializing in global maternal health who is currently researching the effects of coronavirus on pregnancy. Adding to that stress, he says, is the fact that “we don’t know a lot about this virus or how it behaves during pregnancy.”
For women with high-risk pregnancies, these fears may be ratcheted up.
“So much about pregnancy feels scary and unknown. When you add a pandemic on top of it, things just feel more complicated,” says Corinne Richards, a music therapist in El Paso, Texas, whose daughter passed away shortly after she was born in 2016 due to a birth defect. This makes Richards’s current pregnancy, which is 13 weeks along, high risk. She and her family decided to start “sheltering in place” last week.
The speed at which the pandemic is progressing only escalates the urgency of these unknowns. With 462,684 cases of covid-19 from almost every country in the world confirmed by the World Health Organization (WHO) at the time of writing, the deadly virus is moving with breathtaking velocity. Its spread is only hastening: It took 67 days to hit the first 100,000 cases, 11 days for the second 100,000, and just two days for the next 100,000.
Meanwhile, in the next three months, nearly 1 million American women will be giving birth in a health-care system that experts predict could be stretched to a breaking point.
What we do know
There are a lot of reasons for expecting mothers to be hopeful. According to the most recent research, based on 38 pregnant women with covid-19 and their newborn infants in China, there’s no evidence that infected mothers will pass the virus on to their fetus. This is big news and, importantly, makes it very different from viruses like Zika or Ebola, where that is possible.
Journey Roberts, an editor for a health-care company who lives in Sanford, N.C., and is 17 weeks pregnant, says she’s been following the CDC guidance and reducing her time out in public; she only grabs groceries when it’s absolutely necessary.
The 27-year-old says there are disappointments: the prospect of canceling her baby shower, for example. She also worries about friends who have struggled to find baby wipes or diapers on depleted grocery store shelves. For now, though, her priority is staying calm.
“It’s definitely an uncertain time, but being stressed right now isn’t good for me or the baby, so I’m just trying to take it a day at a time,” she says.
Researchers are keeping an eye on one area of concern: Even young and healthy patients are at risk of severe respiratory complications from the coronavirus, which could affect pregnant women.
A recent study by Schwartz, the pathologist, and PhD candidate Ashley Graham, analyzed previous outbreaks of two different coronaviruses (SARS and MERS). They found the risk of complications, including pregnancy loss and pneumonia, was increased. With respiratory viral infections that can cause severe pneumonia — covid-19 falls into this category — both the mother and the fetus risk not getting enough oxygen, with potentially dire consequences.
In addition to the research based on 38 women in China, Schwartz is currently reviewing about 40 additional cases of pregnant women in China with confirmed or suspected covid-19. So far, there seem to be a significant number of preterm deliveries in pregnant women with the virus, which can lead to health problems for the baby. Still, these are tough to definitively classify as related to covid-19.
“It can be difficult when you’re dealing with small numbers of patients like this ... to be able to determine what’s coincidence and what is actually a direct or indirect result of mom being infected with [the novel coronavirus],” says Schwartz.
This is part of what makes it so difficult to develop guidance to protect pregnant women amid a raging pandemic: Experts are wary of drawing conclusions from such nascent research. (Researchers at the University of California at San Francisco are currently building a nationwide database of women with confirmed or suspected coronavirus to increase this evidence base.)
Of all the cases Schwartz has reviewed so far — the initial 38 women and the 40 more in China — there have been no maternal deaths. There was one woman with severe pneumonia who almost died in childbirth, he says, and she delivered a stillborn infant.
In other words, severe pregnancy complications still seem rare — although the sheer number of Americans who are likely to be infected means that “rare” could still affect a lot of pregnant women.
There’s still a lot we don’t know
In an unprecedented pandemic, the direct effects of the virus itself only represent one set of concerns. As the number of cases increases, the health-care system will struggle to accommodate patients. It is unlikely that hospitals will continue to be able to carry out prenatal appointments and births as planned.
Experts are worried about the impact of these disruptions in maternal health care. In the 2014 Ebola outbreak in West Africa, fewer women used maternal health services for fear of going to hospitals packed with infected patients. As a result, maternal mortality increased even for women who weren’t infected.
“Unfortunately, we know that past epidemics have taken a great toll on pregnant women and newborns, with large spikes in maternal and neonatal deaths due to disrupted access to labor and delivery care,” says Carleigh Krubiner, a policy fellow at the Center for Global Development and faculty member at Johns Hopkins Berman Institute of Bioethics.
This will be particularly difficult in the United States, which has the highest maternal mortality rate in the developed world, and where many women do not receive the prenatal care they need in the best of times. Nationwide, the maternal mortality rate is 2.5 times higher for black women than their white counterparts. In some states, 16 percent of women of childbearing age do not have health insurance. Moreover, a third of the poorest Americans do not have paid sick leave, meaning that for many women pregnant right now, self-isolating is a pipe dream.
“As resources are rapidly deployed to meet the needs of patients severely affected by covid-19, we cannot forget that other patient groups also have critical and urgent health needs during this time,” Krubiner says. “This includes pregnant women, who will continue to need essential obstetrical services in the coming months to safely carry and deliver their babies.”
An evolving experience
For now, the American College of Obstetricians and Gynecologists is warning women to be prepared for potentially limited access to routine prenatal care and encouraging the use of telehealth, such as video appointments, when possible. For many women, this means adjusting to a pregnancy, and potentially a childbirth, that was nothing like they imagined.
Roberts, the associate editor, had her 16-week appointment by telephone on Tuesday. She received a screening call in the morning to check her travel history and to see if she had any symptoms of covid-19. In the afternoon, her provider checked on her weight and asked if she was experiencing symptoms like bleeding. She panicked at the prospect of lab work and scans being delayed, but she was assured that wouldn’t be the case.
Richards, the music therapist, was supposed to have an ultrasound appointment Tuesday: It would’ve looked for the birth defect her daughter passed away from. That appointment has been pushed to next week, and she’s bracing herself for further delays. She’s hoping that life is largely back to normal by her September due date, but says she’s “ready to roll with the punches” if they aren’t. That may include her 2-year-old son not meeting his brother until he comes home from the hospital.
Already, some hospitals have banned partners from being present at births; on Monday, the New York City hospital network New York-Presbyterian, as well as the Mt. Sinai Health System, made headlines for barring spouses or doulas from the delivery room. And although national guidelines have not been put in place, many hospitals are moving to limit visitors in the delivery room to one or two people. They’re also weighing whether to separate mothers and babies at birth. Currently, the CDC recommends that women with confirmed covid-19 should be separated from their baby to reduce the risk of transmission.
For now, Dinh feels lucky to have supportive neighbors and co-workers that do grocery store runs and errands for her, but she’s worried about what certain milestones will look like now — finding out whether she’ll be having a boy or a girl, for example. Still, Dinh says she knows she’s lucky to have a roof over her head and food in her fridge — something many U.S. women cannot count on.
Her main focus is keeping “my stress in check for me and my little one,” she says: “I pray that I get to meet this baby, that we will all make it out stronger and unscathed.”
