The Changing
Landscape of Pregnancy During a Pandemic
By Vicki Kobliner, MS, RDN, CD-N P for your growing family.
regnancy is a time of hope and excitement as well as increased concern for what the future will bring Pregnancy during
a pandemic can add to the fear that any parent-to-be may feel. The areas of concern are three-fold: What effects COVID-19 (SARS-CoV2) may have prenatally, how it will inform labor and delivery, and what effects it might have in the fi rst years of life and beyond. Expectant mom’s need guid- ance to help them navigate the changing landscape of pregnancy during a pandem- ic. Arming yourself with knowledge and a plan of action can help you navigate this confusing time.
What Can You Do Now to Protect Your Baby?
We do not have a lot of informa- tion about pregnancy and birth outcomes related to COVID-19 as of yet. Studies are based on small population size, and only exist from women in their third trimester. While we do not know what, if any effects, in utero or early exposure to COVID-19 may have on a baby’s early and long-term development, new information is continu- ally emerging and we can use the currently available data to guide our choices.
Prenatally, protection and prevention are absolutely the fi rst line of defense. Follow standard recommendations for social distancing, frequent hand wash- ing, thorough surface cleaning, and face covering. Discuss with your provider their policies regarding in person vs. telehealth prenatal visits. Basic health measures such as high-quality nutrition, physical activity, restful sleep and stress reduction become even more important, even while quaran- tine conditions add an additional layer of challenge to achieving these goals.
Consider pregnancy safe immune
support such as vitamin C and D, zinc and echinacea as appropriate, but be careful with any herbs such as licorice and androg- raphis, which are being touted as protec- tion against SARS-CoV2, but they are un- safe during pregnancy. Other compounds such as quercetin and melatonin, which may have anti-COVOD-19 activity, are lacking in safety data regarding pregnancy.
Minimize Risk to Mom and Newborn
Once baby is ready to enter the world, the goal is to minimize risk to mom and newborn. There is a higher risk of preterm delivery and low birth weight in babies born to infected mothers but thankfully, vertical transmission (from mom to baby in utero) of COVID-19 appears unlikely. In only rare cases has a baby been born with positive antibodies (a sign of prior expo- sure) to the disease. Horizontal transmis- sion, likely due to exposure to respiratory droplets after birth has occurred, but in most cases, the infants have recovered well, and appear less seriously affected than adults.
Because of the fear of both vertical and
horizontal transmission, as well as respira- tory concerns for mom, C-section deliver- ies and separation of mom and baby after birth were regularly initiated in early cases, but with more information these guidelines have changed. For COVID-19 infected mothers, the World Health Organization (WHO) currently does not recommend routine C-section, unless deemed neces- sary for other reasons. The CDC does not support routinely isolating a newborn from its mother and WHO maintains the impor- tance of room-sharing, skin to skin contact and breastfeeding to provide the baby with optimal immune support.
There is no evidence that the virus
can be transmitted via breast milk, how- ever, COVID-19 positive mothers must use precautions such as wearing a mask while nursing, washing hands before and after touching the baby, and disinfecting all sur- faces. In addition, if a mom is expressing her breast milk for any reason, including being too ill to nurse, all equipment must be carefully and thoroughly cleaned.
The First Year and Beyond
Preterm delivery, C-section birth, antibiotic use, as well as maternal fever, infection and use of acetaminophen during pregnancy have been associated with an increased risk for autism spectrum disor- ders, ADHD, developmental delay and depression in children. We suspect this is linked to disruption of the infant micro- biome and alteration of innate immune function. Research is clear that healthy balanced gut fl ora exerts powerful effects on not only digestion, but immune and neurologic function as well. Alterations in these pathways are correlated with a variety of developmental and mental health challenges in children and adults.
Having a baby should be a time of joy
and hope. We cannot and should not live in fear of negative outcomes. What we can do is be aware, and proactive in sup- porting normal immune and gut health in our newborns, and be especially mindful of those who have been exposed to SARS- CoV2. Being proactive includes breast- feeding for 6 months or longer whenever possible. Breast milk provides important immune modulating compounds as well as molecules called Human Milk Oligo- saccharides (HMOs) that are used specifi - cally by the gut fl ora to grow and thrive. If appropriate, Vitamin C and D, probiot-
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