Should Couples Postpone Pregnancy Until We Have a COVID-19 Vaccine?
Categories: Clinical Insights
For many of us across the nation, the shelter-in-place orders around COVID-19 has put so much of our day-to-day lives on pause. In many instances, the sacrifices are relatively small considering the potential lives we are saving. But for couples who were considering pregnancy this year, COVID-19 is potentially changing how they think about growing their family.
Grand Rounds has received many calls from our members with questions about pregnancy. Here are a few concerns I have heard over the past month.
Should couples reconsider plans to get pregnant (naturally) this year?
This is an extremely personal decision and one that couples should make upon consulting their physicians and OB-GYN. At any time, but now more than ever, it’s important for people to make an informed decision on whether or not to try to conceive. The most important point to realize is that there are still a lot of unknowns on how COVID-19 affects pregnancy, fetal development and newborn babies. COVID-19 has only been around for several months. There is no way to have good information on how this diagnosis impacts an entire 10-month pregnancy.
Mental health also plays an important role throughout this process. The stressors associated with COVID-19 — whether it’s social distancing or economic insecurity — can be difficult to handle over a long period of time. Since it’s hard to predict how long these safety measures will be needed, consider that social distancing may be in place through part or all of pregnancy, including after delivery. This would mean that you, your partner and your baby may not be able to celebrate this new beginning with your immediate and extended family. Likewise, many employers and small businesses are facing uncertainty, so financial changes through this time may be a serious consideration when deciding whether or not to conceive.
How can I talk to my OB-GYN if I can’t go into their office?
Most offices are likely offering virtual consultation options; this is a great medium for pre-conception counseling. They can get more specific information on your medical history and circumstances to better guide you and potentially provide lifestyle change recommendations to optimize your health before conception. It would be beneficial to discuss all of these things before making a decision on whether or not you are ready to try and conceive.
Are pregnant women at higher risk of catching COVID-19?
Current reports do NOT indicate that pregnant women are at increased risk of catching COVID-19. Although data is limited, the same reports also show that pregnant women do NOT have more severe symptoms than the general public. However, pregnancy is associated with a weakened immune system and other respiratory infections (such as influenza) do seem to have higher complication rates in pregnant women. As such, pregnant women should be considered an at-risk population for COVID-19.
That said, there are a few reports of preterm birth in pregnant women with COVID-19. However, numbers are too small to confirm a true association. It is also too early to know if COVID-19 has any effect on a developing fetus, or if the infection can be passed from a COVID-19 positive mother to the baby during delivery.
Can COVID-19 be transmitted through breastfeeding?
COVID-19 has NOT been found to pass through breast milk so it is safe to breastfeed even if you tested positive for COVID-19. Just wash your hands with soap prior to handling the baby or any breast pump parts (pumping and having someone else feed the baby will minimize risk of transmission the most). If you do feed from the breast, use a facemask during feeding to reduce the risk of exposure to your baby.
Are there particular couples who are more at risk of catching COVID-19?
Couples where one or both members have chronic and pre-existing conditions may want to be particularly cautious about moving forward with trying to conceive. Any immunocompromising conditions place an individual at higher risk for conditions that I would be most concerned about. Additionally, for those who are undergoing fertility treatment, The American Society for Reproductive Medicine (ASRM) has officially recommended to “Suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation”.
Would you change your recommendations based on a particular new development?
I don’t think there is any single event or piece of research that will change the recommendation for whether or not to conceive. Unfortunately, COVID-19 will likely be impacting us for at least the next year or two. Over time, we will learn more about this condition and how it affects pregnancy. We will also be learning more about how to treat this infection and how to better manage the complications associated with COVID-19. As our knowledge grows, we can refine our recommendations in order to help people make the best decision for their family.
Once more time has passed and more information on pregnant women, developing fetuses, and newborn infants is available, I imagine the American College of Obstetricians and Gynecologists (ACOG) can be clearer about the safety of pregnancy during this time.
Again, pregnancy at any moment in time is an extremely personal decision. The clinical uncertainty around COVID-19 certainly warrants a moment of pause and careful consideration. I strongly urge any couples considering conceiving a child this year to consult with their OB-GYN to make an informed choice.