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March 27, 2020
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OB-GYNs: Despite low risk, take steps to protect pregnant women from COVID-19

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Sean Blackwell
Sean Blackwell

WHO, CDC and the American College of Obstetricians and Gynecologists have all issued recommendations to health care professionals for the treatment of pregnant women during the COVID-19 pandemic.

Healio Primary Care spoke with OB-GYNs on the frontlines about the risks the disease poses to mothers and their offspring and how to manage this patient population during the pandemic.

Limited data show low risk

Sean C. Blackwell, MD, chair of the department of obstetrics, gynecology and reproductive sciences at McGovern Medical School at The University of Texas Health Science Center at Houston, said that based on the information available, the chances of developing complications during pregnancy as a result of COVID-19 are low.

The data that we're getting is that most pregnant women are not at higher risk for complications. There also doesn’t seem to be any direct danger to fetuses if they do contract [COVID-19],” he said. “These risks are not zero, and we don’t have a robust amount of information, but everything that we have suggests that those risks are low.”

 

The Society for Maternal Fetal Medicine (SMFM) has reported that are inadequate data on COVID-19 and the risk for miscarriage or congenital anomalies, according to Richard L. Fischer, MD, FACOG, head of the maternal-fetal division at Cooper University Health Care in Camden, New Jersey. He added that the SMFM said that data from the SARS epidemic “are reassuring, suggesting no increased risk of fetal loss or congenital anomalies associated with infection early in pregnancy."

According to Fischer, SMFM has also said that "preterm delivery has been reported among infants born to women positive for COVID-19 during pregnancy. However, it appears that some cases were iatrogenic and not due to spontaneous preterm labor. It is not clear that these outcomes were related to maternal infection. All of the
infants in this single report were clinically well, and no neonatal deaths were reported."

Richard Fischer
Richard L. Fischer

Manny Alvarez, MD, chairman of obstetrics and gynecology and professor at Hackensack University Medical Center in New Jersey, said there is “absolutely no evidence” of placental transmission of SARS-CoV-2 into the fetus.

“And there’s overwhelming scientific evidence that because of the cellular functions of the placenta and the fetus, there is some natural protection for the baby,” he told Healio Primary Care.

Protecting patients

Despite the relatively low risk for pregnant women, Fischer said he is encouraging his patients to stay home unless they have high fevers or shortness of breath.

Both Fischer and Alvarez said OB-GYNs should consider conducting prenatal visits via telemedicine as much as possible.

Aparna Sridhar
Aparna Sridhar

Another strategy to protect expecting mothers and their offspring is to increase the time between appointments, Aparna Sridhar, MD, an obstetrician and gynecologist at the University of California at Los Angeles Medical Center, said in an interview.

“Modify patient schedules by spacing out some of these office visits,” she said. “Center these office visits around the time when some key essential tests are being done.”

Alvarez said he expects to see an uptick in COVID-19 cases among pregnant women in the next few weeks.

“We’re not seeing a lot of exposure of COVID-19 right now in the pregnant population, but we expect those numbers to continue to increase,” he said. – by Janel Miller

For more information:

ACOG. Novel coronavirus 2019 clinical guidance practice advisory. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019.

ACOG and Society for Maternal-Fetal Medicine. Outpatient assessment and management for pregnant women with suspected or confirmed novel coronavirus (COVID-19). https://s3.amazonaws.com/cdn.smfm.org/media/2263/COVID-19_Algorithm5.pdf.

CDC. Pregnancy & Breastfeeding. Information about Coronavirus Disease 2019. https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html#anchor_1584169714.

Favre G, et al. Lancet Infect Dis. 2020;doi:10.1016/S1473-3099(20)30157-2.

WHO. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.

Disclosures: Healio Primary Care could not confirm relevant financial disclosures at the time of publication.