FACULTY Q&A
Newswise — Nearly 4 million babies are born each year in the United States. In the wake of the coronavirus pandemic, pregnant women are concerned about their health and the health of their children.
University of Michigan maternal and child health expert Miatta Buxton, an assistant research scientist in the Department of Epidemiology at the School of Public Health, discusses the issue.
Is the coronavirus more dangerous for women who are pregnant?
Although data are limited and much remains unknown about the full extent of the impact of COVID-19 during pregnancy, recent information released by the Centers for Disease Control and Prevention indicate that pregnant women are at greater risk of severe outcomes such as hospitalization and admission to intensive care units, and require mechanical ventilation if they contract the coronavirus, compared to nonpregnant women. However, available data suggest that the risk of death between pregnant and nonpregnant women does not appear to be different.
Can the coronavirus be spread from mother to child? If so, how?
There's no conclusive evidence at this point of vertical transmission of COVID-19 from mother to child. Vertical transmission occurs when a virus passes from mother to baby during the period either just before birth or just after birth. Additionally, there's also no evidence of transmission through breast milk. But we need to be mindful that after birth, there is a potential for direct transmission from mother to child if a mother is diagnosed with COVID-19.
What advice do you have for expectant mothers who might be nervous right now?
The impact of being pregnant during this pandemic, wondering what is going to happen to me, wondering what's going happen to my baby—while at the same time dealing with potential job losses, financial challenges, lack of normal activities, and potentially not being able to see family and friends—all leads to increased stress and can make pregnancy a huge challenge for a mother.
So first, I would acknowledge that it's okay to be nervous. But there are things expecting mothers can do to empower themselves: Practice the public health measures that have been recommended and be mindful about who you're exposed to. It's OK to speak out and let people know that you need to take extra precautions because you need to be healthy for you and your child. Operate as if you already have COVID-19 when interacting with your child or act—within reason and without necessarily offending people—as if others may potentially be COVID-19 positive. What this does, it allows you to take the necessary precautions that you might otherwise relax if you felt comfortable.
Seek out reliable information for your concerns. Talk to your doctor and nurses at your doctor's office and see what they're recommending. Be proactive in seeking out support and the services that you need. If you're proactive, you'll be better prepared to respond to anything that could come up.
How have health care providers adjusted to providing care for pregnant women during the pandemic?
Hospitals and clinics have taken additional measures to protect their patients, such as screening patients for symptoms and not allowing visitors or limiting the number of visitors into hospitals. Providers are also utilizing telemedicine for prenatal care. This allows for easier access for patients to communicate and receive care from doctors and reduces the number of people in a hospital, health center or clinic during a given time.
In cases where patients do not need lab work or require a physical exam—and if they are considered low risk—they can use telehealth services in the form of a telephone call or video conference to meet with their provider. But for pregnant women who are considered to have a high-risk pregnancy or who are closer to their due date, it is generally encouraged to attend in-person visits so they can be closely monitored.
It's important to mention that although people may be concerned about going to hospitals or worried about policies restricting guests and visitors, hospitals are still the safest place to give birth. Even with healthy pregnancies, complications can occur without warning, so it's recommended that women still plan to give birth in a hospital rather than changing plans due to COVID-19.
Are there any learnings that we might use post-pandemic?
One of the things I potentially see going forward, even past the pandemic, is widespread use of face masks. This is something that could be used during breastfeeding outside of COVID-19. For example, during the flu season, that's another time when transmission of a virus between mother and child can occur, just from the fact that the baby is so close to its mother. It's a new way of thinking. Mothers could wear a face mask to reduce the chance of spreading flu or other illnesses to their babies.
Also, sometimes due to scheduling conflicts or lack of transportation, people don't make it to all of their recommended prenatal visits, which is associated with increased risks of adverse outcomes for mothers and babies. If insurance companies consider covering these types of telemedicine appointments for people with low-risk pregnancies going forward, it may increase the likelihood that pregnant women are able to attend all of their prenatal visits.
We've heard a lot about how coronavirus has affected different populations differently due in part to health disparities. Have we seen that in pregnant women as well?
Although data on COVID-19 among pregnant women are just becoming available, I think it is fair to say that pregnant African American women will be disproportionately affected by COVID-19 compared to pregnant non-Hispanic white women. Even before the pandemic, African American women were 3-4 times more likely to die from pregnancy-related complications than white women and are now disproportionately affected by COVID-19. This means that there is an increased probability for a pregnant African American woman to be exposed to someone who has COVID-19. This increases her risks of contracting COVID-19 and compounds the risks for an adverse pregnancy outcome.
Initial reports indicate that COVID-19 outcomes are worse among people with preexisting conditions such as hypertension and diabetes. According to the Centers for Disease Control and Prevention, the prevalence of hypertension among adult African American women is higher compared to women from any other race. With increased risks during pregnancy and increased risks associated with higher prevalence of existing chronic conditions, it is safe to be concerned about an increased burden of COVID-19 among pregnant African American women.
New measures implemented during the pandemic such as telemedicine are helpful in increasing the number of prenatal visit patients are able to attend, which is crucial for early identification and subsequent management of complications during pregnancy. However, access to technology, although common, may not be widespread across the population. Telephone use is widespread, but a person who has access to a computer for a video conference visit will have a more effective telemedicine appointment compared to a person who completes their visit by telephone. Other factors related to the use of telemedicine such as insurance coverage, availability of service in certain communities and the need for training related to medical equipment used for monitoring health indicators are potential points of concern that may lead to differences in the quality of care received across subgroups in the population.
Finally, other consequences of the pandemic, such as financial challenges associated with job losses, affect subgroups in the population differently. Hispanic and African Americans are reported to be greatly affected. These challenges can lead to increased and prolonged periods of stress and may contribute to adverse pregnancy outcomes. Existing health disparities are also leading to a disproportionate impact of COVID-19 within other population subgroups. For example, based on available data from the CDC, pregnant Hispanic or Latina women accounted for 48% of COVID-19 cases compared to 23% for pregnant non-Hispanic white women. Public health efforts aimed at mitigating the impact of COVID-19 will need to take existing disparities into account in order to be effective.
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