UPDATED: July 28, 2020
Women who were trying to get pregnant in the days, weeks, and months before the Covid-19 pandemic find themselves facing a difficult question. Should they continue to try to get pregnant in the era of Covid-19? What do the experts say? The American College of Obstetricians and Gynecologists doesn’t offer specific guidance at this time. Ultimately, “individuals should make their own decisions based on their unique needs, desires, and values.” This means that each woman needs to evaluate, for herself, whether she wants to continue trying to have a baby at this time. It is important to note that the Covid-19 pandemic is an evolving situation, and we gain new knowledge as the days and weeks go by. In recent weeks, we have gained new knowledge about the transmission patterns of the virus and have learned more about the risks Covid-19 poses to pregnant women.
For many older women who may have limited fertile months and years left, the prospect of waiting another year to try to conceive can be devastating. Some women don’t feel they have the luxury to put off having a baby until a vaccine is developed. As many cities and states have reopened, leading to both a regained sense of a “new normal” and also increased infections, some couples might be revisiting whether now is a time to start a family or grow their families.
In recent weeks the American Society for Reproductive Medicine recently released new recommendations regarding resuming fertility treatments (and the most recent update: July 10, 2020 – August 10, 2020, reaffirms earlier guidelines). During the early days of the pandemic, the ASRM called for the suspension of I.V.F. and I.U.I. treatments. Currently, the new guidelines “support the measured resumption of care with appropriate and prudent measures for disease prevention.” Fertility doctors have been instructed to follow local guidance regarding providing essential and non-essential medical services. The ASRM considers fertility treatment essential medical care, but each region will have its own limitations regarding hospital and medical resources. Ultimately, access to fertility treatment will depend on your regional Covid-19 caseload, your local medical resources, and your doctor’s ability to formally mitigate risk to patients and staff. If you would like to resume fertility treatment at this time, your best option is to reach out to your fertility doctor today to learn more about your options.
It is important to understand that ASRM’s guidelines are region-specific, and if you live in an area of the country with a higher number of Covid-19 cases, or where Covid-19 cases are on the rise, guidelines may call again for the temporary suspension of I.V.F. and I.U.I. treatment in your region until case numbers go down. As Covid-19 cases increase in some regions of the country, the ASRM notes that “there is more mounting concern that more restrictive recommendations similar to those presented in March 17, 2020 may need to be enacted in specific regions because of significant flares in the incidence of Covid-19, which are now affecting increasing numbers of individuals of reproductive age.” The ASRM further notes that couples undergoing I.V.F. or I.U.I. treatments may want to consider self-quarantining through early assisted reproductive technology treatments and in early pregnancy.
With most of us at home practicing social distancing, there has been some talk that we might see a baby boom in the next nine months. But research doesn’t support this. Disasters that result in high death rates result in fewer births nine months down the line. Stress can reduce fertility, resulting in changed menstrual cycles and reduced libido. Cosmopolitan magazine reported that a popular birth control app saw 2% fewer people using the application, with 3% switching their birth control plan from “plan” a pregnancy to “prevent.” High fevers have also been known to reduce male sperm counts.
If you are struggling with the idea of whether you should try to get pregnant during the Covid-19 pandemic, we’ve put together a checklist of things to consider. The American College of Obstetricians and Gynecologists notes some key considerations couples might want to take into account. These considerations include:
- Covid-19’s risk to the fetus and mother
- Limited access to prenatal care
- Financial uncertainty
- Social and Psychological effects of Covid-19
Let’s explore each of these in more depth:
Covid-19’s Risk to the Fetus and mother
Unfortunately, there’s still not much data on the risks that Covid-19 might pose to the fetus, but there is some encouraging news. Let’s take a look at some myths and misinformation that has been circulating and clarify what we know and don’t know:
- Does getting Covid-19 while pregnant increase my risk of death or serious illness? The Centers for Disease Control recently published a paper indicating that pregnant women who get sick with Covid-19 may be at greater risk of hospitalization and ICU admission and they may be more likely than the general population to get put on a ventilator. When compared to women of reproductive age who were not pregnant, one third of pregnant women were hospitalized compared to only 5% of nonpregnant women. Pregnant women were more likely to be admitted to the ICU and require mechanical ventilation than the general population of women among reproductive age. The good news is that pregnant women were no more likely to die of Covid-19 than the general population of women of reproductive age, based on the study. These findings are still preliminary, and the data could be affected by the fact that pregnant women are more likely to be closely monitored for Covid-19. There was also missing data for a large number of the cases reviewed, specifically, pregnancy status of one-third of cases was missing in the total cases reviewed. It also isn’t clear whether women were admitted to the hospital for their pregnancy or due to Covid-19 symptoms. Finally, the study doesn’t account for whether Covid-19 increases the risk of adverse pregnancy outcomes, preterm birth, or pregnancy loss.
- Does pregnancy increase your risk of COVID-19? Ellen Schwartzbard, M.D., an obstetrician and gynecologist at Baptist Health Medical Group notes that pregnancy can weaken your immune system. But this doesn’t necessarily mean that pregnant women are at higher risk of getting the coronavirus. The American Journal of Obstetrics and Gynecology notes that there is no reason to believe pregnant women are more “susceptible to infection with coronavirus.” Pregnant women contract the coronavirus just like anyone else would contract the disease: by being exposed to droplets expelled (coughed or sneezed) by someone who is infected by the virus (whether or not the infected person is symptomatic). So this means that, like everyone else, you won’t get sick unless you get exposed to the virus. If you are pregnant, take social distancing recommendations seriously, wash your hands regularly, avoid touching your face and eyes, and avoid people who are sick. Women who become pregnant will not be able to practice as robust social distancing measures because of their need for prenatal care, something which women need to take into consideration when planning a pregnancy.
- Do pregnant women get sicker from COVID-19? A study published in the American Journal of Roentgenology noted that pregnancy and childbirth didn’t seem to worsen the course of the disease in pregnant women. All women in the study achieved full recoveries and either delivered their babies or were still pregnant at the end of the study. But do take into account that these studies were preliminary, and more recent research suggests that pregnant women might be more likely to end up in the ICU, which suggests that pregnant women may get more severe illness.
- If I get the coronavirus while pregnant, will my baby be born with the virus? While early data suggested that transmission of Covid-19 from the mother to fetus wasn’t likely, a more recent study indicates that the coronavirus can be transmitted from mother to fetus in the womb. The New York Times reported on several cases where Covid-19 was found in the placenta, where the infant was born with the virus, and where placental inflammation was detected. Doctors believe that when the virus infiltrates the placenta, it can replicate there and affect the infant. Because Covid-19 affects patients in different ways, some patients might experience this outcome, but doctors believe that in utero transmission may still be fairly rare. Just as some rare cases of Covid-19 affect the brain and heart, some rare cases affect the placenta. In the case where in utero transmission is suspected, the baby went on to develop brain inflammation, but fortunately ultimately recovered. The Centers for Disease Control continues to report that in cases where infants tested positive for Covid-19, it isn’t clear whether the babies got infected with the virus before birth or shortly after they were born, so more studies on this need to be done to confirm in utero transmission. The Centers for Disease Control had reported that transmission of the coronavirus from the mother to child during pregnancy is unlikely, and that Covid-19 has not been detected in breast milk. Babies can contract COVID-19 after delivery, though, through normal person to person transmission (when viral droplets reach the baby’s mouth, nose, or eyes through the air, or through contact infection). COVID-19 is a non-persistent virus. Unlike HIV or Herpes, it does not live in the body for years.
- Does COVID-19 increase the risk of birth defects and other adverse pregnancy outcomes? The medical journal AOGS, notes that there is no evidence regarding what impact Covid-19 might have on pregnant women in the first and second trimester. We still don’t have data on the impact of Covid-19 in the first and second trimester. Women who developed Covid-19 in the third trimester went on to deliver healthy babies, though some women who became very ill due to Covid-19 had to undergo C-sections or early deliveries. (The virus is so new that we only have data for how Covid-19 affects late pregnancy, and nothing on how infection impacts early pregnancy. Research indicates that high fever in the first trimester can put the fetus at risk; see Daily Wellness. But it should be noted that a high fever from any disease could pose this risk, so this is not unique to Covid-19.) ASRM indicates that full-term newborns with active infections of Covid-19 have done well. The ASRM further notes that severe illness could increase the risk of premature labor or the need for a caesarian. ASRM also noted a study that indicated there might be higher risk of preeclampsia in Covid-19 pregnant women than in those without Covid-19.
- If I get pregnant will I be able to get the Covid-19 vaccine should one become available? The Kaiser Family Foundation notes that pregnant women are often excluded from vaccine trials, meaning that pregnant women may not have access to a vaccine should one be developed in the nine months when they are pregnant.
So what are the key takeaways? If you have underlying health risks that could result in a high-risk pregnancy, you might want to speak to your doctor before trying to conceive; and it might be best to delay your pregnancy until after the coronavirus threat has passed. The CDC lists high-risk women as those with STDs, diabetes, thyroid disease, high blood pressure, and those with chronic illness.
Limited Access to Prenatal Care and Changes in Birth and Delivery Plans:
The Centers for Disease Control calls for women to not skip their prenatal appointments. In order to prevent the spread of Covid-19, doctors may meet patients for some appointments through telemedicine rather than in person. In all cases, but particularly in areas with high infection rates, patients should work with their doctors to develop the best plan for prenatal treatment. This can have major implications for women who become pregnant during the Covid-19 pandemic.
- Some prenatal care appointments will be switched to telehealth appointments. Some women can monitor blood pressure and fetal heart rate at home.
- However, experts speaking to the Today Show warn that telemedicine may not be an option for high-risk pregnancies. Dr. Katherine Kohari, associate medical director of the Yale School of Medicine, spoke to the today show, noting that there isn’t research on how telemedicine can impact prenatal outcomes and there is a concern that doctors could miss key issues when seeing patients remotely.
- Even if many appointments can be performed remotely, women will still need to go in for in-person appointments.
- Hospitals have also been limiting visitors women can have in the delivery room, so women need to consider that their pregnancy plan may need to adjust.
- Women who have Covid-19 may be kept separate from their infants after delivery to prevent the spread of coronavirus to their newborn. The CDC’s guidelines are to separate babies from their mothers when their mothers have Covid-19, but each situation will be considered on a case-by-case basis because of the risks and added stress of separation. For example, preterm infants and those with certain medical conditions may be separated from the sick mother as a precautionary measure.
Women who are thinking of becoming pregnant will want to take into account the reality that healthcare options may be limited or evolving in the coming months. Women who might have high-risk pregnancies may want to consider waiting until the threat has passed.
The latest reports from the New York Times indicate that approximately 30 million people have sought jobless benefits. One in five workers is either unemployed, on unemployment benefits, or seeking jobless benefits. To make matters worse, the $600 unemployment bonus included in the last stimulus plan will expire at the end of July. It isn’t clear what the economic fallout will be if it isn’t renewed because these added benefits inject money into the economy as a whole because the benefits are used to pay landlords, pay for groceries, and support discretionary and non-discretionary consumption of goods and services. The New York Times reports that many households could see their incomes cut in half or worse, and there is concern that the loss of the unemployment bonus could lead to widespread evictions. Even if the unemployment bonus is renewed, it isn’t clear for how long.
Jobless numbers improved slightly when states in the south and west pushed to reopen their economies early, but most of those job gains have been erased with increasing coronavirus caseloads in the south and west. Many believe that the rush to reopen the economy was counterproductive and that we are once again heading toward widespread shutdowns. Already states have had to rollback openings. Barring a widespread flatten to zero plan that involves a more robust isolation plan in the short-term that doesn’t involve half-measures (see our plan at www.flattentozero.org) similar to the successful one implemented in New Zealand, where the total of new cases in the country on July 28, 2020 was about 1 new case per day (that’s not a typo; one new case), or the development and implementation of a vaccine, we are likely to see continued infection and continued economic difficulties.
If there are widespread shutdowns again, we could once again see glitches in the supply chain. As the virus affected more food processing plants, the New York Times reported that food shortages could occur. USA Today reported on shortages of diapers. At the end of the day, couples will need to decide for themselves whether they can afford to have a baby at this time, and whether they can tolerate the financial uncertainty, along with the added expenses of having a child.
Social Effects of Covid-19:
The last thing women need to consider is the reality that social life may not return to normal for some time. Women may not be able to readily visit relatives while pregnant. Because of the increased risk of serious illness in pregnant women, pregnant women are being urged to take additional precautions to avoid infection–staying home when possible, socially isolating as much as possible, and working from home . Pregnancy is a time when women may experience higher levels of stress and the lack of social support during this time can have mental health effects. Couples should consider how they’ll feel about not being able to visit with older relatives or at-risk relatives during this important time in their life. Those who are planning to become pregnant should consider their mental health and the effect that social distancing might have on them while they are also pregnant.
Mental Health Effects of Covid-19:
Living in an era of global pandemic is stressful. Pregnancy can be stressful. Economic uncertainty can lead to anxiety. If you are planning a pregnancy at this time, be sure to have a mental health self-care and wellness plan in place. The Centers for Disease Control recommends the following for mental health self-care:
- Limit exposure to news stories
- Eat healthy well-balanced meals
- Meditate, practice deep breathing, stretching, or yoga
- Avoid drugs and alcohol
- Connect with others: Zoom calls, text messages, phone calls, video calls
- Make time for joy: cook a nice meal with family, go for a walk, be in nature, make art, the list goes on and on.
Pregnancy is a time when many couples connect more deeply to their social networks, calling on family and friends to support them at this crucial transition. It is important to consider the effect of Covid-19 on your postpartum period. At a time when older relatives could come and help, mothers and babies might be asked to self-quarantine. Couples might find themselves juggling multiple responsibilities at home including work from home duties and homeschooling duties for older children. Parents who might have returned to work after maternity or paternity leave may find that childcare centers are still closed and may need to negotiate caring for the children and work.
Some women also suffer from postpartum depression as a result of hormonal changes and the life changes a baby brings. In the past, women could seek physical social support. In pandemic times, women may need to connect digitally with therapy, friends, and family, and find acceptable self-care activities that don’t involve going out into crowds. The pandemic can make tapping into these networks more challenging–but not impossible. As we adjust to our new normal, there are more resources than ever out there for new parents struggling with the unique challenges of this time.
Still Trying to Get Pregnant?
Even though the news regarding Covid-19 remains somewhat discouraging (people are still getting sick, though we appear to be flattening the curve in some regions) , the decision to keep trying to have a baby is ultimately up to each couple to decide. Much can change between now and nine months. If you do plan to try to have a baby at this time, here are some key things you can do:
- Book a telemedicine appointment. (Speak to your doctor about current medications and risks, and to check that you’re up to date on vaccines; review family history, weight, and speak to your doctor about other risk factors).
- Take folic acid; choose a prenatal vitamin.
- Consider taking a daily wellness supplement. (FertilityBlend is supported by research to improve fertility rates and can also provide you with key nutrients.)
- Stop drinking, smoking, and drug use.
- Maintain prenatal appointments when you do get pregnant. Don’t skip appointments. If you are concerned about getting sick, talk to your doctor about telemedicine options.
- Avoid toxins: BPA, fragrances, and caffeine (Daily Wellness has an excellent article on foods that are high in pesticides).
- Wear a face mask in public, wash your hands frequently, and maintain social distancing.
The decision to have a baby is one that is embarked on with hope. The courage to start a family in the midst of tough times and social distancing is one that isn’t taken lightly. But if you do choose to continue trying right now, there are a range of support options still available—from telemedicine to online communities that can support you in your journey.