How COVID-19 Affects Pregnant People and Newborns

Speaker 1

Hi, everyone. Welcome to Big Fat Positive. We have another very special coronavirus pandemic special, our favorite kind of special for you today. And we're actually really excited because we have special guests, Joanna and Diana from the podcast Baby Doctor Mamas here to answer our burning questions about what's going on with this whole pandemic thing, especially regarding being pregnant and newborn babies and all that stuff. Joanna and Diana are podcasters, but they are also neonatologists. And they have an amazing podcast that you should definitely listen to, and we'll make sure to tell you exactly where to find that throughout this episode. But they are actual scientists, as opposed to Sean and I, who just read a lot of news and talk about things.

Speaker 2

Yeah, I can start the Citroen. I am a neonatologist. I am, I do mostly clinical neonatology. So I spend a lot of time in the hospital because neonatologists work in the neonatal intensive care unit. So we take care of babies who are sick basically from the time of birth. Sometimes we get transfers in from other hospitals of babies who are in their first few weeks of life. And so we take care of those babies and manage them while they're in the NICU. And then we don't, we are trained as pediatricians first. I, some neonatologists do clinic to follow up on their babies after NICU discharge, but I just work in the hospital.

Speaker 3

And this is Diana. I am also a neonatologist. So I also work in neonatal intensive care unit and actually the same one as Joanna. But I am also a health equity scientist and do a lot of research on health disparities among racial, ethnic, minority women and immigrant women. So I wear a couple of different hats in my role as both a doctor and a scientist.

Speaker 2

Diana is much more the scientist between the two of us.

Speaker 4

Great. All right. So one of our first questions, just broadly, what do we know about pregnant women and their risk for COVID-19 right now?

Speaker 3

So one of the things that I want to sort of preface this discussion with is that this is really an evolving area. We are starting to see a little bit more data being published. and so numbers and cases and we're trying to learn as much as we can. But I just want to say that everything we will talk about today is based on very little information. I really like to tell parents information about their babies and their health and things like that based on lots of information and data and studies that have really big numbers, probably my bias as a scientist. But everything we're going to say today is based on case reports, meaning these papers that talk about a few women, sometimes three women and their babies, sometimes seven.

Speaker 2

Right. Yeah. And to add to what Diana is saying, the Centers for Disease Control is saying that pregnant women are an at-risk group. And there are reasons for that because you have changes in immunity and cardiovascular health when you're pregnant and also lung kind of compliance and the ability to take deep breaths and things like that, which all pregnant women know, especially in their trimester. Oh God, I remember that.

Speaker 4

Yeah, that's what it seems like. So pregnant women, it sounds like, are considered more at risk. What about newborns? Are newborns more at risk for contracting this disease?

Speaker 3

So that's a great question, I think. One of the major tenets that we have seen play out in many countries right now is that children seem to be, in general, children seem to be at lower risk for both showing symptoms and becoming very ill with their symptoms. And so I just want to point out I didn't say getting it because we don't know whether a lot of kids are getting it or not. We're not doing a lot of widespread testing of children really anywhere in the world. So it's hard to know whether kids are actually getting it or not. But we do know that sort of as a rule of thumb, children do not seem to have as high a risk or we are not seeing as many high numbers of children getting sick from this disease and getting as sick as their adult counterparts. But there is a caveat. I don't know, Joanna, if you want to take it.

Speaker 2

And that's a little scary for us as neonatologists. I think we're kind of braced that we may see cases of it coming through our NICUs. That said, the data is sort of not strong for the idea of something called vertical transmission, which is transmission from mom to baby in utero. So when baby's still inside mom. So we don't know. I mean, there's some evidence that there may be vertical transmission to babies, and there's also some evidence that there may not. So I guess we're operating with the assumption that a lot is still unknown. And thinking that we may see cases, I can tell you right now I have not seen a bad neonatal case of COVID-19. But it's again that kind of like ask me in a week, you know. And where are you located again?

Speaker 1

In Philadelphia. So I feel like most of that, the East Coast is actually hit fairly hard, right? How is it in that area?

Speaker 2

So New York, yeah. New York's really bad. It's really sad to hear about our colleagues in New York.

Speaker 3

This is also a kind of day-to-day changing thing, but we have seen what we're calling endemic areas where there's widespread virus and widespread illness from virus. And New York is definitely, I think, I would say one of the hardest hit in this country right now in terms of number of cases overall that have been identified and how sick people are and how overrun our hospitals are. New York City is sort of, in my opinion, one of the worst right now. That being said, we don't know what's going to happen. We do know that things are changing in some, for instance, two weeks ago, if we were reporting this, New York didn't look like this three weeks ago, two, three weeks ago. And so I don't know where the next hotspot's going to be, and it's a little scary to think about, but there is concern that some of these Northeast cities may be the next on the list, so to speak, to get hard hit.

Speaker 1

And I should mention that we're recording on April 10th, 2020. So everything changes very quickly. So this is all the information we have as of Friday, April 10th, 2020.

Speaker 3

It's so true. We've been recording our own episodes and we're like, it is this day at this hour because it might change tomorrow morning.

Speaker 4

Tomorrow morning. It's so true. What can a pregnant mom expect if she has coronavirus or Should I call it coronavirus or COVID-19 or COVID? I'm never sure.

Speaker 2

No, no, this is a good question. There are lots of coronaviruses. So the coronavirus also causes the common cold. So there's many different. So if you wanted to be like accurate, this is the novel coronavirus because it's the new one in town. And you could call it COVID-19. You could call it SARS-CoV-2. There's another name for it. And those are all synonymous for the virus. Okay.

Speaker 4

So if a pregnant mom has COVID-19, what can she expect going in to deliver? Will she be completely isolated? Will her baby be tested immediately upon birth? Will they be separated? What might that experience be like?

Speaker 2

So it'll probably be a little different everywhere because, again, guidelines and policies are changing. very rapidly and hospitals are not all following the same policies. But what did come out, at least in our pediatric world, to help us with management of the babies is the American Academy of Pediatrics put out guidelines for newborn care for after-mom delivers. Essentially, what I've seen happen with moms is if they have symptoms and get tested, and are positive. It kind of matters when they're positive, right? Because if they're positive and then they get better and then they deliver and they're not symptomatic, they might not be treated like a mom who has active COVID-19. So kind of when you get the infection matters for how you're going to be treated in the hospital. For moms that we think have active infections,

Speaker 1

Oh my gosh, no way.

Speaker 2

Yeah, totally. So to all moms, gosh, I can't imagine how anxious they must be. I don't know if you guys have friends that are pregnant.

Speaker 1

I don't have any close friends right now, but I do have a lot of sort of acquaintances on Facebook who are ever friends who had to have her C-section all by herself. Well, obviously, the doctor was there. She didn't have to give it to herself. That would be really hard. No, her husband stayed home with their three-year-old because the plan to have the grandparents come and take care of the toddler went out the window. And she said it was actually not as bad as you would think. Oh, good. Yeah. But I know that this sort of leads into another question, which I actually know your answer to this because I listened to your podcast. But I think there's a lot of pregnant women who are now considering birthing centers or home births because of this. And I was wondering if you could talk about why you think that's probably not the best idea, spoiler.

Speaker 3

Yeah, and I think the first thing I'll say is I totally understand. Like I totally understand why moms, parents, families in general are having these discussions. I can absolutely understand why someone might say, might look at a hospital policy at the hospital that they plan to deliver at, which is now saying, you know, if your support partner during labor has to leave the hospital in between when the baby is born and has to go home, then they can't come back and say, you know what? I don't want to be in the hospital by myself. Or God forbid they can't even be next to me as I'm pushing the baby or as I'm getting my C-section. I can totally understand why that might make them want to say, you know what? Maybe I don't want to deliver there. I get it. There's a lot of anxiety about delivering a baby or unknown questions, anticipation, fear, even in the best of circumstances.

Speaker 2

Yeah, when babies need help when they deliver, babies need help right away.

Speaker 3

Like right away. We need to respond to babies in minutes. And moms too, but the data is really showing that the risk is there for babies. And so when you set up, when you tell me now there's going to be moms who are delivering at home, and I think about babies who the minority of babies, but that sizable chunk of babies who are going to need help breathing after birth, who are going to need something from a very advanced practitioner to help them get through that transition into life. And they won't have access to that because now they're not in the hospital. So then it becomes an emergency situation where you're calling for an ambulance and we're in the middle of a pandemic. Ambulance services are already strained. So now you have an emergency situation And you're waiting and waiting for ambulance transfer.

Speaker 1

Yeah. I'm the daughter of a geneticist. So she, my mom taught me from the time I was very little, she was like, you're never giving birth at home. You have to be in an hospital. I will be there with you. And it turned out to be true. She was there. Oh, inspecting my baby the minute he came out. Oh, yeah, as a geneticist. Oh, and filming. Yeah, she also filmed it. She was better at inspecting him than filming it, to be honest.

Speaker 2

Did she do any measurements on the baby?

Speaker 1

No, she did check his hips for clicks, because he was for each.

Speaker 3

So my husband is a orthopedic surgeon, and that was one of the first things when both of my boys were born. He was sitting there examining their hips. They were like 10 minutes old. I was like, I don't think we really need to do that right now, but that's fine.

Speaker 1

Yeah, no, no. I mean, I really think it was immediately. Like she left my side, went over and started messing with this.

Speaker 2

She started her exam. I like that.

Speaker 1

Yeah, yeah, absolutely.

Speaker 4

So I was gonna ask a follow-up to that. What can we tell pregnant women to reassure them at this time that going to the hospital for birth is okay and safe? Like what are maternity wards doing that you're aware of to help prevent the spread of this disease and so forth?

Speaker 2

So to the best that they can, they're trying to have separate rooms for moms who are what we call PUIs, that means person under investigation for COVID-19, or women that have COVID-19. So they're trying to kind of make special places in labor and delivery where they all deliver those moms to try to minimize exposure of the virus to other delivery rooms. And I would also say the staff is now very mindful of when moms deliver, things go well, baby looks good, trying to get moms out of the hospital as safely and as quickly as possible. We really like as pediatricians for parents to stay for 24 hours. after they deliver the reason is that and because your mom's a geneticist you might like this. We like to send a newborn screen at 24 hours and it's mandated by the state and so if we don't send it on your baby then the state comes after us and we have to come after you to send it.

Speaker 3

And I would say that I would even add that 24 hours is sort of the minimum that we all feel pretty comfortable with because there's so many things that can happen even in that second day. I mean, breastfeeding is so tough. Right? And so being in the hospital gives you access often to people who have more knowledge about helping you get that breastfeeding started. And we know sometimes that if we don't get that initial help in the hospital, it's going to be even harder to breastfeed at home. And so I really worry about what leaving the hospital early is going to do to breastfeeding rates after this pandemic. And then we're not even talking about mom's issues. Moms who get seat sections, they really need their wounds checked. We need to make sure that they're not having postpartum bleeding that's really concerning.

Speaker 2

Because you want to be able to leave the hospital and then go to your pediatrician and yeah, be home otherwise and not bouncing back and forth for issues like Billy Rubin or jaundice or poor feeding, you know, because then you're going to have to maybe access hospitals again when it could have maybe been identified and taken care of during that one admission.

Speaker 1

It seems like the more times you pass through the waiting room, the worse, right?

Speaker 2

Yeah, but to kind of talk to mom's fears a little, I mean we are trying to identify the virus in pregnant women, isolate pregnant women that have it so they're not going to spread it through labor and delivery floors. And all providers are just being very mindful of when they enter and exit rooms and hospitals are taking on extra precautions. So for example, we do universal masking in our hospitals. So we're not wearing the heavy duty N95s into every room, but we are wearing surgical masks, which will help, you know, stop us from spreading the virus to others if we're to be exposed. And, you know, there's such an emphasis now on hand hygiene and disinfecting. And so, I mean, hospitals are taking this very, very seriously and wanting to protect moms.

Speaker 1

Good. I was going to ask, are premature babies or babies born with birth defects more like at a higher risk for COVID? Have you seen any information about that?

Speaker 3

So that's a really interesting question. And we are actually starting here nationally a registry of babies who test positive for COVID to try to understand this a little bit better. That's another effort by the sort of neonatal subsection of the American Academy of Pediatrics. So there should be more information now. know that we think, I don't know that we know whether or not COVID affects a preterm baby more likely, but we are starting to see in some case series that maybe pregnancies are ending earlier. So there is some preterm labor or preterm deliveries in COVID positive mothers. Now it's still unclear to me looking at the data whether that's because The COVID infection in mom is causing mom to go into preterm contractions and delivering early.

Speaker 4

When would a newborn baby be tested for COVID-19? Is this happening with every new baby or only if there's some criteria that needs to be met before they receive a test?

Speaker 2

So currently it's not every baby receiving a test. Again, you remember earlier I mentioned the timing of mom's infection. So if mom was infected during her pregnancy, we think she cleared the virus. Then at this point, we're not testing the babies for the virus because we think if mom's cleared it and question if there's even vertical transmission, we're not going to test baby. If mom is positive when she delivers, we do test the baby. And currently, the timing on testing is something that the American Academy of Pediatrics has commented on.

Speaker 3

Yeah. So the first test should be done around 24 hours of age and then repeat testing is done at about 48 hours of age. And so, and so basically those are, those are the tests that we're going to see again to in a baby that's born to a COVID positive mother, Or to a mom who's currently under investigation, so say she comes in and the test hasn't come back yet, so we don't know the answer yet, so then we'll do the testing on the babies. So even if a baby tests negative at 24 hours, we're still recommending that you do the 48 hour test because there have been some cases of babies who sort of turn positive at the 48 hour mark, which is why that's being done. But once you have those two be negative, then that baby at this point, we wouldn't do any further testing.

Speaker 2

That baby would be cleared and then we would stop using protective gear. But while we're worried about the baby having the virus, we would use protective gear to take care of the baby.

Speaker 3

I will say though that if a mom delivers somewhere where they're doing active research, because this might come up, where a lot of people are trying to study this, then moms might experience other testing under a research protocol. What we just talked about was the guidelines for all babies born to COVID-positive moms or moms under investigation, and I hate how that sounds. It makes them sound like they are under investigation for a crime. But some people are trying to test amniotic fluid, cord blood, stool, just to try to understand whether we can find virus in other places. So I wouldn't be surprised if some moms are talking like they tested my baby in many different places. And hopefully they'll have been told that that was for research purposes. But some women might start to see some of that. Good to know. Thank you.

Speaker 1

Okay, so we actually got this question from a lot of listeners, which is they're wondering if they should delay trying to conceive right now. They, you know, have been trying and then they stopped because of this pandemic and like, should they, should they have stopped? Should they keep trying? Like, what do you do?

Speaker 3

This is a tough, tough question, and we totally empathize with these women and families because, oh my goodness, these are such decisions that seem to have such ramifications. And we definitely talked about this on one of our episodes, but we can sort of tackle it again. And I'll say my opinion, and I'm sure Joanna will have an opinion, so you'll hear two separate doctors. Some of this is opinion-based and not research-based. I actually think it's almost all opinion based right now. And what I've been telling friends, because I'm getting asked this question and I'm not an obstetrician. So I only take care of babies. I just read a lot about the whole perinatal period. But what I've been telling people is that we just don't know a lot about what happens with when a mom gets COVID in her pregnancy early on in the pregnancy. We have no information about that right now.

Speaker 2

But I also think it's hard, you know, the other side of that is it's not like when the day you decide to get pregnant, you're going to get pregnant, right? Right. So sometimes that takes some time. I think it's a really personal decision for those moms because it's sort of like, well, if I do get pregnant, do I have the type of job where I can still socially distance if I need to because I'm concerned about the virus because the virus is still in heavy circulation. And I think that that's part of it is we just also don't know what the There's a ton of projections and mathematical models going into how long the pandemic will last and when surges will be and what it'll look like when we stop officially recommending social distancing. There's still a lot of unknown.

Speaker 3

I'll tell your listeners what I've been telling some of my friends and I think it's with many things in medicine, we sort of have to make the decision that we can sleep with at night. You know, in terms of all the risks and benefits, it can take so long to get pregnant. It could be just another cold and early pregnancy and nothing, there's nothing wrong and we're making these big life changing decisions. You know, we are, like I said, we are seeing that for the most part, children are doing much better than adults. So why make these big decisions to delay your family for something where the baby might have little to no risk. And I totally understand that. So I think the best thing that we can do is tell women to sort of weigh the risks and benefits of getting pregnant and getting COVID while pregnant.

Speaker 1

That's really good to know either way. You know, it's just nice to know that I don't know what I'm going to say. Gosh, being home for four straight weeks is just ruining my brain. I've lost all wit. OK.

Speaker 2

I know we're all like talking into screens now.

Speaker 1

I know. I know. I'm like in my closet trying to be funny and not working. This is not.

Speaker 2

an easy topic to be funny with either. I feel that Diana and I are lighthearted people, but it's hard to talk about COVID-19.

Speaker 1

Yes, it definitely is. But we really appreciate you both coming to answer our questions. We could talk to you probably for another three hours if we were really masochistic and you were really generous. But we're not going to do that. But what we are going to do is ask you if you could share a BFP as our listeners know. We usually do BFPs and BFNs, big fat positives or big fat negatives, but we are just doing positives for our COVID specials. And we've asked Joanna and Diana, the baby doctor, mamas, if they would share their BFPs with us. Do you have something to share with us?

Speaker 2

First, I just want to say I love the acronym BFP because we love acronyms in medicine and it just sounds like some fancy lab test.

Speaker 1

Mom, if you're listening, send me candy. Yeah. No one's sending me a candy. No one. No one.

Speaker 2

It's such a lot of candy, though. That's also a positive. But now I'm taking control of my candy eating. And I'm really proud of myself for that. So that's my big positive. Yeah.

Speaker 3

Yeah, I am not avoiding sweets right now.

Speaker 1

No, me neither.

Speaker 3

I'm having the opposite approach. I'm drinking all the delivered wine and eating all the chocolate. I'm budgeting the wine in. Yeah, there you go. The day of reckoning will come, the day of reckoning will come, but not today. But no, I really love that you guys do this because I think it's so easy to get fixated on all the negative and all the scary and I really love that you do this and that you end on it. So my BFP is that my son is going on seven days since we started potty training, my oldest. Ooh, wow. Yeah, we decided to do the crazy thing and since I have to be in here in this house all the time now, I decided to finally potty train him. It was a long time coming. He's old but he's a boy and so I wanted to take my time and wait until he was old enough and he's three and a half and he is killing it. Yay!

Speaker 4

That's so great.

Speaker 3

He's had like four accidents in a week and I am just so proud of him and so grateful.

Speaker 1

Oh, that's so cute. Yeah, why not take advantage? Just for you. Potty training is no joke. Yeah, I'm not there yet. I have a 15-month-old, so I've got a boy, so I've got a ways to go.

Speaker 3

Take that piece of advice. Don't force it early. Once they're ready, it is so much easier. Oh, good. It's been my experience.

Speaker 4

Yeah, that's what I've heard. Awesome. Well, thank you so much for sharing those with us and thank you so much for being on our show. Where can our listeners find you guys and what you do? I am sure they all want to know.

Speaker 2

So we are on Instagram as Baby Doctor Mamas and Facebook and Twitter as well. We post all the episodes on Twitter. We have a website, babydoctormamas.com, and we're also on all the platforms where you can find podcasts, iTunes, Stitcher. There's a few others that I'm not gonna remember, but basically find us anywhere. If you're having trouble finding us, let us know. But all our contact info is on the website and on Instagram as well.

Speaker 1

Fantastic. And we'll make sure to post a link to the shows we discussed and their website and everything on our website, which is bigpappositivepodcast.com. And you all can find us at BFG Podcasts on Instagram, Twitter, and Facebook. You can also join our community group, just search for Big Fat Positive Community on Facebook, request to join, and I will add you. And Joanne and Diana, thank you so much. I cannot express how awesome this interview was and how it's making me feel better. It's so nice to hear smart women talk about

Speaker 2

My brain is just being on smart women talking about things.

Speaker 1

Smart women talking about things. Woo. Yeah. There you go. Period. End of story. I'm changing. I'm changing the subtitle of our podcast. Smart women talking about things. It's, oh god. I like it. I like it. Thank you so much. It's so nice to hear, you know, smart women doctors talk about this stuff and it just, it makes me feel better. I don't know about you, Shanna.

Speaker 4

Oh my gosh. Absolutely. This has been awesome and so appreciate your time. Thank you so much.

Speaker 3

Absolutely. It's our pleasure.

Speaker 4

All right.

Speaker 1

We'll see y'all on our next episode. Bye.