Ask Your OB-GYN: Should We Postpone Pregnancy during COVID?

Sleeping Newborn with 2020 on diaperThe decision to have your first child or add to your family is deeply personal. You and your partner may have begun planning your family years ago as you discussed education, career, and financial goals.  For some couples, their ages or other factors make the “ideal” time to have a baby a very narrow window.

Come now the year 2020, and suddenly parents are overwhelmed with confusion. The COVID-19 pandemic is not the first public health emergency where women have asked, “Will a pregnancy right now be safe for me and my baby? The HIV epidemic in the 80s, swine flu (H1N1) a decade ago, and the Zika virus more recently all carried unique and serious childbearing risks. Perhaps more than other women, I have appreciated the risk that pregnant women face from contagious illnesses. I grew up in Botswana, a child and grandchild of a missionary family. In Africa, HIV and malaria are still a devastating infectious diseases, especially for pregnant women and babies. According to the World Health Organization, malaria kills over 10,000 mothers and perhaps 200,000 newborns each year.

As I said, childbearing decisions are sensitive and private. But over the past few months, couples have come in asking for my medical advice. Almost a year into the pandemic, we have a much better understanding of the risks. In July, you may have read a statement from the CDC that, according to available data, pregnant women were more likely to require hospital care, ICU care, or mechanical ventilation more than others with COVID-19. At that time, the American College of Obstetricians and Gynecologists (ACOG) cautioned that the data was too incomplete to make such a conclusion. For example, in many cases, the data did not separate women who were in the hospital because of severe COVID illness from those who were just there to deliver the baby. In early November, the CDC presented more complete information.

What We Know Now about COVID-19

The most current information from our professional organization (ACOG) is something in the middle:

  • Updated research does seem to show that pregnant women are a higher risk group for serious COVID illness. Nonetheless, overall increased risk of a serious outcome for pregnant women with COVID compared to nonpregnant women is small. To give you a better understanding, the absolute risk from COVID during pregnancy is still substantially lower than it was during the H1N1 (swine flu) pandemic. And higher risk during pregnancy applies to other infectious diseases as well (regular flu, food-borne illness, etc.). Please do get your flu shot!
  • Research tells us that there may be cases where the virus has passed to the baby before birth, but this would be rare. Because it is unlikely, virus-caused birth defects are also unlikely. A mother who develops a high fever during her first trimester (when the embryo is developing rapidly) faces some risk of injury to the baby. This would be a concern with fever from any causeone more reason to get your season flu shot. A normal dose of Tylenol is considered safe throughout pregnancy and should be used to control fever. Data is inconclusive about whether the risk of preterm birth or stillbirth is higher for women with COVID.
  • COVID can be contagious to the newborn after birth, but babies generally do well. Your pediatrician will recommend guidelines to protect your baby.

Making Your Pregnancy Decision

  • Like before COVID, a planned pregnancy is likely to be a safer pregnancy. Talk to us about birth control if you decide to wait.
  • If, because of your age or past difficulty getting pregnant, you have concerns about future fertility, we want to help you consider that risk. We can refer you for consultation with a fertility specialist.
  • Take the recommended steps to avoid COVID as you prepare for and during your pregnancy.
  • You should not delay preconception and prenatal care appointments because of anxiety about COVID exposure. Your regular immunizations (flu, whooping cough) are still very important.
  • Plan with your partner and your pediatrician what steps you would take to care for your baby if you were sick at the time of your delivery.
  • Plan your feeding decision. Advice from ACOG:

Researchers are still learning if COVID-19 can pass through breast milk and cause infection in the baby. Most information shows that it is safe to feed breast milk to your baby when you have COVID-19. Remember that breast milk is the best source of nutrition for most babies. Breast milk also helps protect babies from infections, including infections of the ears, lungs, and digestive system. For these reasons, having COVID-19 should not stop you from giving your baby breast milk.

 Sometimes a patient faces a health risk so serious that ethical medical advice has to be one-sided. For example, in 1986 nuclear accident at Chernobyl, Ukraine was such a situation. Near the accident zone, the potential risk to pregnant women and their babies was so great and avoiding exposure so impossible that doctors had the duty to strongly discourage pregnancy. But COVID during pregnancy does not carry that level of risk, and precautions can minimize your chance of exposure. So, I do not feel that COVID-related concerns need to control your decision. I encourage you to do what is best for your family. Whatever you and your partner decide, I am here to support and guide you.

Best wishes.

Sarah Whitehead MD