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The current Coronavirus pandemic is ever-evolving and we are learning more every day about SARS-CoV-2/COVID-19 and pregnancy. Click here to see the most recent episodes, articles, and resources on this topic.

Overview

More research has been released in the last week about SARS-CoV-2 and pregnancy and birth. This article is focused on the new evidence that is out and how you can protect yourself and your baby. Get tips on how to stay healthy and support your immune system. Learn what the experts are saying about how to keep your home safe and what you should be doing when you get groceries or takeout. This is an ever-evolving situation and this episode is the most recent info and data available as of March 29th, 2020.

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Article and Resources

More research has been released in the last week about SARS-CoV-2 and pregnancy and birth. This article is focused on the new evidence that is out and how you can protect yourself and your baby. Get tips on how to stay healthy and support your immune system. Learn what the experts are saying about how to keep your home safe and what you should be doing when you get groceries or takeout.

If you have not read the two previous articles (here and here) I suggest you go back and read those before this one. This is an ever-evolving situation and this article is the most recent info and data available as of March 29th. I will be updating info as we learn more. Let me know how I can help you. Send me your questions. I am here to help you navigate this situation as much as I can.

An Update on Testing

The U.S. now has more cases of COVID-19 than any other country. The upside is that it means we are testing more people, which is a good thing. All of the anecdotal reports I have seen and heard are that if you do not have symptoms you will not be tested. As I talked about last week, the World Health Organization still recommends that pregnant women with symptoms of COVID-19 should be prioritized for testing. That could be worth mentioning if you are trying to advocate for a test and are getting resistance. A close family member of mine was tested today and was told they would have results in 8-9 days. We are still a way off from testing being efficient. Keep in mind that I am sure doctors would love to test everyone, and they are working with the constraints of test availability and their resources for testing.

New Research on Whether SARS-CoV-2 is Transferred to Babies

Three new studies recently published in the Journal of the American Medicine  Association report new evidence that SARS-CoV-2 may be transmitted to babies during pregnancy.

The largest study of these looked at 33 babies born to mothers who were positive for COVID-19, 3 who tested positive for COVID-19. Due to the strict infection control and prevention procedures taken during the births, it is thought that these infants all contracted COVID-19 from their mothers and not from another source in the hospital. The good news is that all three babies recovered and were testing negative for COVID-19 by day 7. Another study showed that infants born to six mothers who were positive for COVID-19 all had antibodies present, even though they all tested negative for COVID-19. In a single case study IgM antibodies for SARS-CoV-2 were detected in a baby two hours after birth. The specific antibodies they tested usually do not appear until 3 to 7 days after infection. While they couldn’t definitively rule out infection after birth it was suspected the baby was exposed to the virus in utero.

The new data from these three papers tell us that it may be possible there is vertical transmission of SARS-CoV-2 during pregnancy. All of the research prior to this was indicative that it was not being transferred to babies in utero.

New Research on Pregnancy and SARS-CoV-2

In a study in a hospital in Wuhan, seven expecting mothers were presenting with symptoms of COVID-19. The most common symptoms were fever and cough, one pregnant mother had shortness of breath, and one had diarrhea. All seven patients had cesarean section after consultation with a multidisciplinary team. They noted that delivering as soon as possible might be a better choice for the sake of safety considerations. This is because we do not know the effects of the virus, or the effects of some of the medications being used to treat the virus, on infants. All patients were treated with antivirals, antibiotics, and traditional Chinese medicine, five were treated with steroids. There is no magic drug to treat this virus and a lot of different medications are being tried. Some of these medications, like steroids, are not given until after birth due to concerns about the effects on the baby.

There were no intensive care unit admissions for mothers before or after delivery. All patients recovered and were eventually discharged from the hospital. The neonatal birthweights and Apgar scores were all normal. Four infants were taken home and were not tested for SARS-CoV-2. During the follow-up call at 28 days after birth, they were showing no symptoms. Three of the babies were kept for observation and one of the three tested positive for SARS-CoV-2 and was released from the hospital 2 weeks later. At 28 days after birth, the remaining three neonates were healthy and had no symptoms. This study is all good news.

Your Chance to Participate in Research

More research is coming that will specifically look at pregnant women and babies. The University of Washington, UCSF, and UCSD are all starting studies specifically on pregnant women. If you are pregnant and have a suspected or known COVID-19 infection you are eligible to participate. We lack so much research that excludes pregnancy. If you can contribute to this research please do. Participation involves completing questionnaires and sharing your medical records. You don’t have to go spend your pregnancy in a lab. It is a relatively small investment of time to make a big difference for expecting mothers in the future who need this research.

I recently had an opportunity to participate in some research relating to this virus and jumped at the chance to contribute. I wear an Oura ring, which is a ring that tracks your sleep and other health data. Oura and UCSF teamed up to investigate whether the ring could be useful in identifying symptoms of COVID-19. It doesn’t directly relate to pregnancy, but it does allow me to contribute to more data being available in the future.

If you would consider participating in the UCSF or UCSD please do. Hopefully, you never come into contact with SARS-CoV-2. Thankfully the research we are seeing is that expecting mothers are recovering, and if you do come into contact with it you have the opportunity to make more data available for pregnant mothers in the future.

Changes to Your Prenatal Care & Birth

We talked in-depth about many of the changes coming to your prenatal care and birth plan in the last article. More parents are seeing doctor and midwife appointments move online. We are seeing a lot more reports of doulas and visitors being banned from hospitals and birth centers. In some cases, partners are not permitted to attend births. I am reaching out to some professionals in the birth world to bring you more information on these topics very soon.

Considering Home Birth

The changes happening in hospitals and growing concerns have prompted some expecting mothers to consider home birth as an option. This past week New Zealand declared that if you are positive for COVID-19 or have any symptoms you must give birth in a hospital. It was challenging to find an official opinion on this from an organization like the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. I can see reasons why they would do this, and the reasons why they shouldn’t. As more information is available, I will let you know. I have not seen any statements from other countries banning home birth for patients who have COVID-19 or are patients under investigation. 

Don’t Panic, Plan

This is my mantra right now. It is easy to panic when you read or watch the news and see how the effects of this current pandemic. I get emails every day from expecting mothers who are freaking out about this current situation. I get it. You should not panic. You should plan. There is a lot you can be doing right now to plan ahead and reduce your risks.

 Social Distancing is Still Critical

Social distancing is still critical right now and will continue to be for several weeks at least, if not months to come. I know this comes at a cost but it is the best chance we have at slowing this outbreak down and not overwhelming hospitals. This has a direct impact of expecting mothers because the vast majority of births in the United States take place in hospitals. Please stay home and encourage those around you to do the same.

Taking Care of Your Immune System

Think about the little things you can be doing to take care of your immune system. Stacking little things together can add up to a big difference.

Exercise

Even though gyms are closed and group fitness classes are canceled you can still get your workout in at home. Even without equipment or weights, you can find videos online for any type of workout. From high-intensity training to yoga you can find free videos on YouTube. A lot of fitness instructors are putting out free resources online right now.

With shelter in place orders, you are likely feeling very confined in your house. You can get out for a walk or run to get some exercise. It is a good idea to stick to areas with low foot traffic. You don’t need to sit down with a map and plan a route. You can go for a walk to explore your neighborhood. Where I live a lot of people have been walking around. If you are going towards someone you can cross the street or temporarily get off the sidewalk to avoid crossing paths. You want to be safe of course and getting some fresh air and moving your body will be good for both your physical and mental health.

Diet

You want to avoid sugar and eat healthy whole foods as much as possible. If it is challenging to find fresh fruits and veggies, buying them frozen is a good option. Anything with probiotics will help your immune system. Probiotic-rich foods include fermented foods like sauerkraut, kimchi or kombucha. Yogurt and kefir are high in probiotics. It is likely that you are spending more time at home and eating out less. Take advantage of this opportunity to fine-tune your diet to be geared towards healthier foods and recipes. Please also make sure you are drinking plenty of water and staying hydrated.

Vitamins & Supplements

In addition to including probiotic-rich foods in your diet and you can also take a probiotic supplement. There is even some evidence that taking a probiotic can reduce your chances of getting group B strep.

Another way you can support your immune system is by taking a high-quality prenatal vitamin. A good prenatal vitamin will ensure that you are meeting the requirements for all of the essential vitamins and nutrients you and your baby need during pregnancy.

You also may want to consider increasing the supplements you take to include some additional immune support. Zahler has several options for supplements that will help support your immune system and right now you can save 15% with the code IMMUNITY15. As with any supplements, it is always a good idea to run these by your doctor or midwife.

Sleep

Sleeping well is also a way to support your immune system. There is a past episode with tips for sleeping during pregnancy. This is especially crucial when you are likely experiencing fatigue in the first and third trimesters. When your body is telling you that you need extra sleep, please get more sleep. You need it and your baby needs it.

Keeping Your Home Safe

You should be diligent about habits when anyone or any new items enter your home. Some of the tips we will talk about in this article may seem extreme. That is because they are. I will share what the most prudent tips are and you decide which if any you want to implement in your home and your routines. These tips are about limiting your risk of exposure to SARS-CoV-2 as much as possible. How many precautions you take is up to you. Anyone you live with should also be taking every precaution. Talk to anyone you live with and make sure everyone is on the same page.

The first thing you should do when you walk in the door is to wash your hands. During pregnancy, your skin can be more sensitive. If your hands are dry with all of that washing use a moisturizer or lotion after washing your hands.

Your home does not need to be laboratory clean all the time. You can clean frequently touched surfaces like light switches or doorknobs regularly. Since hand towels are being used more often you want to wash those more frequently. It is also a good idea to open windows and get fresh air in your home. It is important to be diligent about making your home safe. If you know you are taking precautions when you enter your house you can relax at home knowing your space is safe.

If you live with someone who has any symptoms you want to isolate them to keep yourself as healthy as possible. In practice, this seems almost impossible. Reach out to your doctor or midwife for their recommendations and do your best to stay away and avoid exposure.

Exposure to SARS-CoV-2 From Packages

This study looked at how long SARS-CoV-2 survives on various surfaces. Aerosols can remain in the air for up to 3 hours. On copper, the virus can survive up to 4 hours, up to 24 hours on cardboard, and up to 2-3 days on plastic and stainless steel. The danger is that you could be touching a surface contaminated with this virus and then touch your face, which introduces the virus to your body.

Getting Take-Out

Local restaurants are struggling right now and almost all restaurants are offering takeout or delivery. Takeout food is often thought to be safe because it is cooked. The World Health Organization recently released data on how SARS-CoV-2 survives at different temperatures. There is only minimal reduction in virus concentration after 21 days at freezing temperatures (4°C and -80°C). Heat at 56°C/132.8°F kills the SARS coronavirus at around 10000 units per 15 min. Another study from 2012 on SARS-CoV-1 found the virus was undetectable after being heated to 56°C/132.8°F for 30 minutes. In general, foodborne illnesses are killed if food is heated to 140°F, but few foods are heated to that temperature for 30 minutes. It could be the case that food cooked at these temperatures for this duration cannot contain SARS-CoV-2, however, we do not have that data. Given the information we do have, cooked food is likely less of an exposure risk than uncooked food like sushi or a salad. 

If you are going to pick up food from a restaurant see if you can pay ahead of time either online or over the phone. This can minimize the amount of time you are in the restaurant and you don’t have to hand someone your credit card or exchange cash. While you are there you want to avoid touching door handles or any other surfaces when possible. If you do touch anything you want to wash your hands as soon as possible or use hand sanitizer.

You can ask food delivery services to leave bags on your doorstep rather than greeting the delivery person at your door. If you can tip ahead or on an app rather than handing off cash. Please tip your delivery drivers they are working hard so you can stay home. Once you get your food inside you can dispose of any bags it came in. Next, you can move your meal from the container it was packaged on to a plate. Any packaging can be thrown away and you want to wash your hands before enjoying your food.

Getting Groceries

According to the FDA, currently, there is no evidence of food or food packaging being associated with the transmission of COVID-19.  It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

If you can send your partner or a friend or family member to a grocery store you should do that. If you need to go to a store yourself find out if they have special hours for high risk or older shoppers. Many grocery stores are allowing individuals who are over the age of 60 or who are at a higher risk in an hour before the store is opened to the public. If you can get in earlier being a higher risk because you are pregnant you may want to consider that. Stores may be less busy during this time, which means you will come into contact with fewer people. Plus, the shelves will be better stocked earlier in the day.

You can opt not to use reusable grocery bags and get bags from the store you can dispose of. If you do choose to use your own reusable bags you can wash or disinfect them after each use.

To reduce the amount of time you avoid picking up items that you know you may not put in your cart. You don’t want to touch anything you do not have to. This will reduce the number of things you are exposed to as well as protect other shoppers who will be touching products you put back on shelves.

Another tip to limit your time in the store and limit the number of trips you have to make is to meal plan, make a shopping list, and plan to buy groceries for 2 weeks. I am not talking about hoarding large amounts of food but being thoughtful about the food you buy so you do not have to run back to the store in a few days.

When you are in the store avoid touching your face. Leave your phone in your pocket or purse. When you are standing in line keep some distance from other people, preferably six feet or more.

When you leave the store, once you have loaded groceries into your car and returned the cart, sanitize your hands.

Grocery Delivery

If you have the option to order groceries online take advantage of that. Be prepared for limited delivery windows or longer shipping times. Ordering some items online can limit the number of things you need to buy in a store and cut down on the time you are spending shopping for groceries in person.

If you are ordering food from an online service like Thrive Market or ordering meat from Butcher Box the CDC notes that in general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging that is shipped over a period of days or weeks at ambient, refrigerated, or frozen temperatures.

If you are ordering groceries through a local service like InstaCart you may be exposed to fewer people but it is possible that the groceries delivered do carry some risk.

Bringing Groceries in Your Home

When you get home from the store or when groceries are delivered there are some things you can do to limit your risk of exposure to SARS-CoV-2.

The FDA doesn’t have great guidelines on how to protect yourself when you are bringing groceries into your home. They say if you are concerned about contamination of food and food packaging you have purchased from the grocery store, wash your hands after handling food and food packages when you return from the grocery store and after removing packaging from food. In addition, it’s always critical to follow the 4 key steps of food safety—clean, separate, cook, and chill – to prevent foodborne illness. Those guidelines really apply more to food borne illnesses than SARS-CoV-2.

Once you get home from the grocery store or have groceries delivered you can be diligent about unpacking your food. You may have seen a video recently posted online from a doctor showing the safety measures you should be taking.

The safest bet would be to leave your groceries outside your home or in your garage for 3 days. That isn’t ideal for anything perishable or that you plan to eat within 3 days.

To be as prudent as possible, you want to eliminate any chance that the surface of a package could possibly contain SARS-CoV-2. You can do this by either wiping down packages with a disinfectant wipe or cleaner or by removing the outer packaging. Remember that a study shows that the virus can live on cardboard for 24 hours and plastic or metal for up to 3 days. As you are doing this you want to be careful that you are being diligent about what has been sanitized and what hasn’t. You could split the surface of a countertop between two sides, one for things that are potentially contaminated and one side that is designated for items that have been disinfected or that you have removed from the outer packaging. You could also choose to do this outside your home or in a garage and move things that have been sanitized from one area to another before bringing them inside.

If you are using a strong disinfectant, like a Clorox wipe, this works fine for items going in your pantry, but the chemical smell from these cleaners can stick around longer in the fridge and the freezer. You can wipe cold items down and let them sit out for a little bit before putting them in your fridge or freezer. You could also choose to wash them with soap and water if that would work with the packaging.

For fruits and vegetables, you obviously do not want to rub down an apple with a Clorox wipe. You can wash produce with mild dish soap, just like you would any dish in your home. If you do this with all of your produce when you get home you can batch this work so you do not need to do it every time you want to eat something.

These precautions may seem like overkill. They are an inconvenience, and they take time. There is a cost to everyone who is being inconvenienced by this pandemic. Of course, you can decide that these measures are not necessary. We are still learning about this virus, and this is a constantly evolving situation. For the current time, I am taking every precaution to protect myself and my family.

Stay Informed & Talk to Your Doctor or Midwife

Continue to check in with local resources for your city, county, or state for instructions that will apply to you. Please discuss this topic with your doctor or midwife for their thoughts and recommendations. They are your trusted partner during your pregnancy and birth and can help you navigate this. Hopefully, they are communicating any changes in their practice, policies, or recommendations with you as this situation evolves.

How Can I Help?

Please email me and let me know what resources I can help you find and how I can help you navigate this challenging time.

Helpful Links

 

Thank you to the amazing companies that have supported this episode.

Zahler makes high-quality prenatal vitamins that have the active form of folate plus omega 3s and DHA. For the current promo code to save on an amazing prenatal vitamin click this link Zahler Prenatal + DHA. During the month of March 2020 you can save 20% off the Prenatal +DHA, plus get free infant vitamin D3 drops with your purchase. Click here for details.

Thrive Causemetics makes high-performance skincare and makeup that are formulated without parabens, sulfates, or phthalates. Plus, all of their products are 100% vegan and cruelty-free. You can save 15% off your first purchase with the promo code PREGNANCYPODCAST by clicking here to visit the Thrive Causemetics website.

Boppy makes a lot of incredible products for you and your baby. My favorite products are their pregnancy pillows which are going to help you get in a comfortable position to get a good night of sleep during every stage of your pregnancy. You can click here to check out the pillows and use the promo code PREGPOD20 to save 20% until 06/30/20.

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