COVID-19 and Pregnancy: The ASPIRE Study with Dr. Eduardo Hariton
COVID-19 has introduced so many unknowns into our world, and there’s much to learn about how it impacts pregnancy.
The ASPIRE study was launched by University of California, San Francisco. They have nearly 80 partner clinics all over the US participating in the study. Their main objective is to better understand the effects of COVID-19 on pregnancy.
Dr. Aimee: Dr. Hariton, thank you for joining us today. COVID-19 and pregnancy is such an important topic for us to be talking about, and it’s an honor to have you on as our special guest co-investigator of the ASPIRE study.
Before we get into COVID and pregnancy, I want our audience to learn a little bit about you. Tell us about yourself.
Dr. Eduardo Hariton: I’m originally from Venezuela. I came to the States about 20 years ago and did all my training here. I went to medical school, business school and residency at Harvard Medical School, Mass General, and Brigham and Women’s Hospital.
Now I’m doing my fellowship at UCSF in California, close to you.
Dr. Aimee: What inspired you to go into medicine and more specifically fertility medicine?
Dr. Eduardo Hariton: I always wanted to do something in healthcare. It has a really human aspect, where you could help people, and I was intrigued by the science. I shadowed a lot of doctors when I was in college. I felt like this was both stimulating, and it felt really good giving back.
I’d always thought I would be an oncologist; it felt like a really unique time to help people in need. When I got to medical school, I got into rotation and discovered that pregnancy is also a vulnerable time for people.
It is a time where women are willing to make changes as far as lifestyle choices, like long term drug addicts and smokers who are trying to quit. And it felt like being part of that experience, and being able to help women make smarter choices for themselves, and make changes that could be lasting would be a great way to go.
Then I got to residency, and saw the incredible impact that helping patients build families can have, and I was just sold. It’s an amazing field. We have a great patients, people who are truly motivated and being a father myself, I realize the tremendous impact that starting a family has had on my life. And I hope that I can give the same to my patients. It’s rewarding day in and day out.
Dr. Aimee: That’s so sweet. I think we all love everything that you’ve said right now. And your patients are so lucky to have you as their doctor. No doubt about that.
So tell us about the ASPIRE Study.
Dr. Eduardo Hariton: ASPIRE stands for Assessing the Safety of Pregnancy during the Coronavirus Pandemic. This study was launched at UCSF earlier this year. We have nearly 80 partner clinics all over the US, and we’re trying to understand the effect of COVID on pregnancy. COVID is a new virus, and we know very little about it, and we know even less about its effect on pregnancy.
It’s left a lot of women really worried. They want to start their families, but they want to do so safely. It’s that same desire: to have a healthy baby and make smart choices out there.
We want to understand more about the effect of COVID in pregnancy, and hopefully to help reassure women that it is okay to continue to get pregnant during the pandemic, but we just need to know more.
Dr. Aimee: I love that. And how does a patient enroll?
Dr. Eduardo Hariton: Patients can go to our website https://aspire.ucsf.edu/ to join our study directly.
A lot of our patients come through our clinic. And, we have about 80 clinics nationwide that have joined us as partners to help us recruit. Of course, you are one of them. We really appreciate your support.
We also allow patients in the community to sign up during their first trimester. Any patient who is pregnant and under 10 weeks along can enroll in the study on our site.
Dr. Aimee: As someone who has enrolled for this study, what can they expect? What is their involvement?
Dr. Eduardo Hariton: Patient involvement has multiple steps.
One of the things that we want to understand is whether a patient develops COVID during pregnancy, and at what time. We mail them a kit where they can prick their finger and collect blood. They do that every week in the first trimester, and then every month during the second and third trimester.
They also fill out baseline questionnaires. Initially, it’s daily regarding possible symptoms. They also fill out a baseline questionnaire to help us understand their fears and their habits.
The questionnaires are spaced out in the second and third trimester. Ultimately, they help us follow them and their child, until about a year and a half postpartum. This will give us a complete picture about what happens to women throughout their pregnancies — both during, and after.
Through COVID antibody testing, we’ll have a sense of whether they contracted COVID. Some women will have symptoms if they contract COVID. But, we already know that there are women who have been exposed to COVID and develop antibodies during pregnancy, but are asymptomatic and don’t realize they have it. This will give us data to understand when they got COVID (if they did), or if they didn’t. And then we will be able to see if COVID has an effect on their delivery, their postpartum period, and then their child’s development up to a year and a half.
Dr. Aimee: I would love to have that information. Thank you for all the work that you’re doing. With everything that you know about COVID, what kind of advice do you have for a woman, who’s just thinking about trying to get pregnant right now or already trying?
Dr. Eduardo Hariton: It’s very difficult to counsel a woman right now. One of the issues is that we are pretty much in a data free zone, as far as having information about the impact of COVID on pregnancy, especially in the first trimester. If you think about COVID: it started in Wuhan, China in December of 2019, and we are not nine months from that event.
It’s spread throughout the world more recently in the US in the last couple of months with a high prevalence of cases. Women who were exposed to COVID early on have not delivered yet. We know basically nothing about the first trimester. We know some about what happens in the second and third trimesters based on some studies that have been done.
For example, from a study out of Columbia University in New York, we know that about 12% of patients had known or suspected COVID. Most of the cases were mild to moderate. In Seattle, which had a lower prevalence than New York City, that percentage was closer to 3%.
There are cases of pregnant women who are affected. It does not seem to make them sicker than the average population with COVID, which is very reassuring.
Women who are pregnant or considering becoming pregnant should speak to their physician, Everybody’s risk tolerance is a little bit different. Everybody’s desire for pregnancy is a little bit different, and everybody’s timeline is a little bit different. You have to factor all of those elements into the equation. And your own physician is the best person to help you make that decision. Ultimately it is a very personal decision.
Dr. Aimee: That’s true. And what about for men? Are there any concerns about COVID for men and how it might relate to their fertility?
Dr. Eduardo Hariton: We don’t have a lot of data regarding men, either. There is one study recently out of China where they studied the semen of 38 patients. They were looking for COVID while patients were in the acute stage of illness. And basically it was somewhat inconclusive: they did find some COVID in the samples, but they had no evidence about how the samples were collected. This leads to questions like: How do you make sure that the men after producing the sample did not cough on their hands and or cough on the cup?
I don’t really have the ability to make a lot of conclusions out of that study. The jury is still out. So far, we are not making any different recommendations for males with COVID, at this time.
Dr. Aimee: I get a lot of questions from my patients and I imagine you do as well. And one of the most common questions I’m getting right now is can I fly in a plane when I’m pregnant? What kind of advice do you give your patients about that? Knowing about COVID.
Dr. Eduardo Hariton: This is a very special time. There are no guidelines or recommendations in terms of flying.
What I usually say to my patients is to practice social distancing, and avoid whatever you can avoid. There are situations where life makes it so that you have to do things that you otherwise would not do. Sometimes you have to fly, and there’s no way around it. But if you can avoid flying, and if you can avoid crowded space, make sure you do.
Because until we find out more, the safest thing is to stay safe and avoid those spaces.
Dr. Aimee: You’re very nice. I just say, no, you can’t fly. but I like your explanation a lot better. Maybe I’ll just say listen to Dr. Hariton’s explanation.
What about this one: Can I go to a party with around 20 people? What would you say to that?
Dr. Eduardo Hariton: I would not recommend it. Again, we don’t know the effects for sure. And if you want to do what is the safest, I would avoid going to crowded events, truly.
Even if you have to go out, I tell my patients, “Hand washing before you go out, hand washing while you’re out, hand washing when you get home. Disinfect surfaces, as much as you can, and always wear a mask.”
I know they’re uncomfortable. I know it’s not fun, but it is what’s going to keep you safe.
Dr. Aimee: And don’t touch your MEN. I heard that mnemonic: MEN: mouth, eyes, and nose. I like that one.
Dr. Eduardo Hariton: Right, because it’s transmitted by surfaces. Avoiding touching your face. No one realized how much we all touch our faces until COVID came around. Try to avoid touching your face.
Dr. Aimee: Do you think that people should consider egg freezing, sperm freezing or embryo freezing because of COVID? As in, more now than before COVID?
Dr. Eduardo Hariton: I don’t think so. I don’t think we have enough data to say. For some women who feel uncomfortable getting pregnant at this time and want to extend their reproductive lives by pursuing egg or embryo freezing, I think a discussion with your physician is warranted. You or me or anybody around the country would be more than happy to see you and entertain that discussion, explain the risks and benefits.
Some women will want more information, and to see the findings of something like the ASPIRE study before they get pregnant. That’s perfectly acceptable for some women. I do not recommend that for my patients. I just explain what we know and what we don’t know, and then most of them are able to make the decision for themselves.
Dr. Aimee: I have a lot of people telling me that they are going to wait until there’s a vaccine. I feel like you’re right. Waiting for findings from the ASPIRE study makes a lot of sense for sure. So I’m looking forward to all the data that’s going to come out.
When do you expect your first findings or first study reports that you’re going to be presenting to all the world?
Dr. Eduardo Hariton: We are enrolling now. We have over 300 patients enrolled (now over 800 as of August 15th), thanks to people like you. Some of our social media friends, and some of our partners around the country are working really hard to spread the word, and get women enrolled. We are incredibly grateful for our patients who have given us their time, their blood, and access to what is otherwise a very personal experience to help contribute to a greater good.
We want to get to a place, in a short period of time, where we have more answers about COVID and pregnancy than we have now. We don’t have a set timeframe right now. It depends on how fast recruitment goes. We are committed to getting answers out to the medical community, to patients, and to everybody, as soon as we can.
We’re not going to wait until the end of the study is to start sharing. We know that this is something that’s on everybody’s mind. That said, we have to make sure that the data that we present is safe and sound.
I think one of the interesting things about the ASPIRE study is that we are following people prospectively. That means that instead of only enrolling people who already confirmed cases of COVID, we are following them before they prospectively get COVID. So we’re going to have a more methodologically sound understanding of what’s going to happen long term. We will see whether COVID has an effect, because we will be able to compare people who have it to people who did not get COVID.
And within the group that does have COVID, we will be able to look at the impact during first trimester, second trimester and third trimester both with symptoms without symptoms. And that’s going to be really helpful in determining if there is a difference or is there no difference.
Dr. Aimee: Thank you for all this information, and for coming on the show.
Can you remind us where someone can find the study if they want to sign up?
Dr. Eduardo Hariton: Absolutely. If you’re interested in signing up, please come to our website:
https://aspire.ucsf.edu/. You can read more about the story. We have videos. We have information. You can fill out a questionnaire.
If you’re eligible (anybody between four and 10 weeks of pregnancy is eligible to sign up), we will walk you through consent to make sure you understand what we’re doing with the study. And, to make sure you want to participate. If that’s the case, you can sign the consent online. And then you can have everything mailed out to you.
We do not require anyone to come to the hospital to sign up. Everything that we ask you to do can be done in the safety of your own home.
Dr. Aimee: That’s very reassuring. What’s the most important thing you want people to know about COVID and fertility or COVID and pregnancy?
Dr. Eduardo Hariton: Everybody’s risk tolerance is different, and every person is unique. I pride myself (and I’m sure you do too) in treating patients and individuals. I try to understand where they’re coming from. What kind of urgency they have, what kind of values they bring to the table? I look at the dynamics of our partnership as doctor and patient. I try to help them make an educated decision about what the risks and benefits are, and what kind of treatment or timeline for pregnancy they want to take on.
What works for your friend or your sister is not what necessarily works for you. It’s okay to feel different about pregnancy and about potential risks, and it’s important to work with your physician to figure out what is best for you. We are more than happy to entertain your questions. We hope to be able to answer them better, but just feel comfortable that whatever you choose will be the right thing for you.
Dr. Aimee: Thank you. Thank you again for coming on. We really appreciate you and hope that when some of the findings come out, you can come back on and update us again?
Dr. Eduardo Hariton: That would be my pleasure.
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For more information, watch or listen to our follow up Fertility Expert Q&A interview: