Planning for Pregnancy During a Pandemic

Tune in to hear me talk about pregnancy during the pandemic on NBC Bay Area

Many of us have never seen the kind of devastation that we are witnessing today. Never in my life did I think that I would be setting up consults with people to help prepare for pregnancy during a pandemic. And that’s what I’m doing. I’m using my positive mental attitude and coping skills to help others deal with one of the most stressful times in their lives. Being a fertility doctor isn’t a job filled with happiness all day long. When you’re dealing with human reproductive biology, you’re dealing with the heartache that goes along with it.

And the information we have about this pandemic and the lasting impacts of COVID-19 is still murky at best. We don’t know if and when we can return to normal life. We don’t know if an antibody test will be reliable or mean anything. How long would you be immune if you’ve been infected already once? We just don’t know yet. When will we see a vaccine? I hope in the next year.

The news about COVID-19 in pregnancy though isn’t all bad. So far it looks like (aside from possibly 1–2 cases so far in the world), moms may not pass it down to their babies during pregnancy but we are still learning more. This would mean that what is known as “vertical transmission,” or the passing of an illness from mom to baby in pregnancy is not confirmed at this time. For pregnant moms, it seems like symptoms are pretty mild and the risk to the pregnancy is likely low. Again, we don’t have full clarity on what it means for existing and future pregnancies. The newborn babies that have tested positive aside from a single case report in the US so far, have done well. And it doesn't seem to pass through breast milk.

On one hand, we know that all fertility treatments have stopped for now. On the other hand, no one is saying women should stop getting pregnant. Should we?

In situations where it feels like we have no control, I like to find areas where we can still feel empowered.

Notice I use the word “empowered” vs. control. Control is elusive, that’s especially true with pregnancy. However, we can do some things to feel more prepared for if and when pregnancy is a “go” for us again.

Which brings me to my next point.

While the fertility governing and guideline bodies, ASRM and ACOG, have not indicated that women should stop trying to conceive, I do think it’s a personal decision.

I want to help so I’ve created a check-list for you to review to see if trying is something you can pursue without undue risk.

Part 1: How to decide if you should try to get pregnant or wait

If the answer is YES to any of these three things, please consider waiting to try to conceive.

1. Are you experiencing anxiety, are you unable to sleep, and not eating healthy or not as active as you usually are? If yes, then wait to try.

As you may have guessed, stress isn’t good and it’s especially not good in pregnancy. My recommendation is to regroup when your next period starts and see how things are going. Check-in with yourself and see how you’re feeling. Maybe at that time, you can reconsider.

When you do, make sure and build your (virtual) team. Surround yourself with care. Things to support your mental and physical health — online therapy, mindfulness practices through meditation apps, and plan your meals to eat healthy and find some time, even just a little, to move your body.

2. Does your employment situation make it such that you must work outside of the home? When you do so, are you able to stay socially distanced?

If your financial situation necessitates that you work outside of the home then I’d consider waiting to get pregnant. If you’re already pregnant and need to or want to work outside of the home, then please do your best to stay socially distanced.

Fever in early pregnancy has shown to be linked to birth defects in a baby. I always want women to make the choice that’s right for them — and everyone has that right, but I want you to make the most informed decision too.

If for example, you’re a doctor or nurse that’s coming in contact with COVID-19 patients, then please consider waiting to try to get pregnant. This is for your safety and the health of your potential baby.

For example, if you’re a nurse or doctor and you would like to work and to continue to see patients, I advise that you should hold off on trying.

3. Do you have a history of pregnancy complications? If so, do not try to get pregnant right now.

One of the highest risk factors for future pregnancy complications is a history of prior complications.

4. Do any of the following conditions apply to you? If so, you may want to wait.

If your BMI is over 35, if you have asthma, diabetes, or another issue that would make you immunocompromised like lupus, this would not be a good time to start trying.

If you are already pregnant, please talk with your doctor about your pregnancy management plan and their recommendations for maintaining a safe and healthy pregnancy.

5. Can you wait a couple of months? If so, then wait.

However, if you’re set on wanting to grow your family right now and don’t want to wait, then please consider the following.

• Your ObGyn office may not be available for an early ultrasound to confirm your pregnancy location. If you have a history of ectopic (which means a higher risk of a repeat ectopic), perhaps reconsider waiting to conceive.

If you have an early pregnancy complication, you may not get the kind of care you are used to at the time you’re used to getting it.

Many women over 40 want to try but are scared because they feel like they are at a higher risk of miscarriage and may not have access to the care they would normally get. The best way to know? When your period starts, call your OBGYN’s office and ask: Are you able to see women who may be having an early pregnancy complication?

I consider this an urgent situation and I am seeing my pregnant patients who have this issue. I want to keep them out of urgent care centers and emergency rooms to prevent them from being exposed to COVID-19.

• If you have a history of hyperemesis gravidarum which can lead to hospitalization or frequent IVs, please consider waiting to get pregnant. Keep in mind that resources could be limited in the near future to this kind and other types of hospital care.
• If you’re using fertility treatment that could put you at a higher risk for multiples then please hold off as this may increase your risk of pregnancy complications.

Part 2: How to decide if you should start fertility medication

It’s probably safest to hold off starting any fertility medication for the next several weeks.

My reasoning is that there are small risks with fertility treatment medication that may lead you to need emergency services.

The hope is that we leave the ERs open to those who need the most help during this pandemic. Talk to your fertility doctor and follow their recommendations because everyone’s situation is different.

Part 3: What you should know if you are pregnant right now:

a. If your OBGYN has stopped seeing patients in person, call them about what they are doing moving forward. I have seen incredible examples of doctors leading the field in terms of telemedicine. They are asking patients to buy equipment for home such as a fetal dopplers urine sticks, and blood pressure cuffs to help facilitate check-in visits over video! If this is something you’re interested in doing then please talk to your doctor.

b. If you’re having COVID-19 symptoms then please get medical advice ASAP. This is not the time to wait things out or to see what happens. We have evidence from other respiratory illness that pregnancy outcomes if not treated could be worse. Other known coronavirus infections during pregnancy, such as SARS, have been associated with spontaneous miscarriage, preterm delivery, and intrauterine growth restriction.

c. What the research shows about pregnancy and infants

An analysis of reports of pregnant women in China with COVID-19, just accepted for publication in AJOG MFM found that in mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, preterm birth is the most common adverse pregnancy outcome. Miscarriage, preeclampsia, cesarean, and perinatal death (7–11%) were also more common than in the general population. Evidence is accumulating rapidly, so these data get updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy.

There has been 1 or 2 possible reported cases of COVID-19 being transmitted from a pregnant woman to her fetus. Initially, few newborns were reported to have acquired COVID-19 and none had symptoms serious enough to need intensive care. More recently, unfortunately, there has been one recent case reported of infant death.

There is a pregnancy registry now which will be used to gather data quickly and provide high yield information that can improve patient care. The PRIORITY study includes all pregnant and postpartum patients that are PUI or COVID positive.

CDC MMWR of actual USA death rates — risk of death in reproductive-aged women is <1%

Here’s what you should do to reduce the chance of being infected with COVID-19:

• Wash your hands frequently with soap and water or an alcohol-based sanitizer.
• When coughing or sneezing, cover your mouth and nose with your flexed elbow or disposable tissues.
• Do not touch your eyes, nose and mouth with your hands.
• Avoid close contact with others, keeping a distance of at least 6 feet.
• Stay home as much as you can.
• If you develop flu-like symptoms contact your doctor.
• Wear a mask in public.

Tips to improve your emotional health:

1. Read a book
2. Take a walk
3. Turn off the television and stop scrolling social media
4. Don’t pressure yourself to be productive
5. Call and talk to someone every day. Social distancing just means physically apart but not socially distant.
6. If you’re concerned about your finances, start figuring out what is essential and non-essential for this current situation. Stop all recurring monthly fees that you don’t need anymore. And if you need someone to help you with this, do so. We are all in this together. Talk to people around you and ask for help.
7. If you are struggling, and need someone to talk to, reach out to a therapist and one that specializes in fertility may understand what you’re going through even more.
8. You can use this time to prepare for pregnancy. Reconnect with your fertility doctor or meet one for the first time. Our “doors” are open. You can also sign up for the Egg Whisperer School to learn more about fertility.

I hope this article was helpful to you while on your fertility journey during this unprecedented time.

Please comment below or send me a note if you have any questions about fertility and COVID-19.

You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!