Scientists at UC San Francisco, UCLA look at COVID-19’s impact on pregnant women and their babies.
Women are asked to share information on symptoms, pregnancies, births, babies’ health
“There’s an urgent need right now for good, reliable information that providers can share with their patients on how the virus might affect their health.” — Vanessa Jacoby, vice chair of research at UCSF’s Department of Obstetrics, Gynecology and Reproductive Sciences
If a pregnant woman gets COVID-19, is she at increased risk for a miscarriage, for passing the virus on to her baby or becoming seriously ill? To protect her baby, does she need to be separated from her infant after birth?
These are among the wrenching questions pregnant women face as the novel coronavirus spreads around the world, infecting more than 1 million people and killing tens of thousands. Unfortunately,
the data is too limited to answer these questions with any certainty. So scientists at UC San Francisco and UCLA have launched a comprehensive study that looks at COVID-19’s impact on the health of pregnant women and their babies.
“Unfortunately, we don’t have a lot of definitive answers right now on questions such as: If you’re pregnant are you at a higher risk of getting the virus?” said Vanessa Jacoby, a co-lead investigator on the “Priority” study and the vice chair of research at UCSF’s Department of Obstetrics, Gynecology and Reproductive Sciences.
“We don’t want to increase fear and anxiety at all for pregnant women,” Jacoby said. “But we also don’t feel
there is data yet to fully reassure them. We just don’t know the answers to really critical questions.”
Researchers are asking women from around the country to register for the study if they have been diagnosed with or suspected of having COVID-19, and if they are pregnant or were pregnant within the past six weeks.
A questionnaire asks women about their coronavirus symptoms, and asks them to share information about their pregnancies, births and newborns’ health. The study includes women who recently gave birth, had a miscarriage or terminated a pregnancy.
Researchers also would like to hear from pregnant doctors and nurses, given concerns that their work puts them at increased risk of contracting the coronavirus, Jacoby said.
Women’s immune systems change when they become pregnant, she said, which makes them more susceptible to severe illness from flu or a respiratory sickness.
During the 2002 and 2003 SARS coronavirus outbreak, the small number of infected pregnant women had a high incidence of miscarriage and babies born with birth defects. During the 2009 H1N1 flu outbreak, pregnant women were more likely than others to need hospitalization and intensive care.
“Even with the seasonal flu, women can have more severe infections,” Jacoby said. “That’s why during flu season, we recommend pregnant women get vaccinated to prevent complications.”
A recent study of seven pregnant women with COVID-19, who were admitted to a New York City hospital, raises concerns about severe illness. Four of the patients were admitted to the hospital, and two wound up in the intensive care unit. The two ICU patients were asymptomatic when they arrived at the hospital to have their labor induced.
Dr. Katarina LannerCusin, administrative medical director for Women’s Services at Sutter’s Alta Bates Medical Center, agrees that there are a lot of “unknowns” in perinatal care.
So far, the limited data on COVID-19’s impact on pregnancy has offered some reassuring news. There’s no evidence yet that pregnant women are any more vulnerable to contracting the coronavirus than average healthy adults.
Until recently, there also was no evidence of “vertical transmission” — a woman passing the virus to her fetus during pregnancy or immediately after delivery, Lanner-Cusin said.
However, several smallscale studies show that the question of vertical transmission needs further study. A study published in JAMA Pediatrics found that three of 33 babies born to women with COVID-19 in China were infected.
However, the babies were not tested until two days after birth, so it’s possible that the infections did not happen inside the womb.
None of the babies had severe symptoms, and all recovered.
Other reassuring news is that COVID-19 has not been detected in breast milk, and it appears to cause, at most, mild symptoms in babies and young children.
But this information hasn’t settled the debate over whether babies born to women with confirmed or suspected coronavirus should be separated from their babies for a period of time due to the possibility that the virus could be transmitted from the mother’s respiratory secretions.
Bay Area hospitals, including UCSF and Alta Bates, follow U.S. Centers for Disease Control and Prevention guidelines that say newborns should be moved to a separate isolation room, but they may stay in their mothers’ rooms as long as they are separated by 6 feet and a curtain. The American Academy of Pediatrics has issued similar recommendations.
The World Health Organization, on the other hand, offers a more nuanced approach that acknowledges the documented health benefits for mothers and babies of immediate and sustained skin-to-skin cuddling. Such contact is known to release hormones that regulate a baby’s temperature, heart rate, breathing and blood sugar and hormones that lower a mother’s stress. WHO said women should carefully wash their hands before and after touching their baby.
Overall, the COVID-19 pandemic is forcing hospitals to remake decades of prenatal, labor and delivery and postpartum care in real time. Concerns about spreading the disease have prompted UCSF, Alta Bates, Kaiser, Stanford and other hospitals to limit women in labor to having just one support person with them.
Meanwhile, doctors, nurses, doulas, midwives and other providers have moved some of their routine in-person checkups and birth classes online.
“Much of what we do during prenatal visits is educational, and can easily be done using tools such as Zoom,” according to a joint statement by Mary Norton, division chief for maternalfetal medicine at UCSF; Roxanna Irani, executive medical director at UCSF; and Erica Rajabi, vice president for Women’s Health Services.
Jacoby hopes the “Priority” study will arm practitioners with better information to provide patients during the prenatal visits.
“There’s an urgent need right now for good, reliable information that providers can share with their patients on how the virus might affect their health,” she said.
Women interested in joining the study can register at https://priority.ucsf. edu and answer questions by phone, online or mail.
They will need to give researchers permission to review medical records related to their COVID-19 diagnosis and treatment. It’s also likely they will be contacted up to seven times over the course of a year to check on their health status.