Congratulations on your pregnancy! Annandale OB/GYN is committed in the care and safety of your child. We have been delivering babies since 1997.
Prenatal care services are dependent upon the education, training and experience of the medical care providers and the functional capabilities of the physical facilities designated to your care. To achieve optimal outcomes and ensure the best in services, Annandale OB/GYN is privileged to be part of INOVA Women’s Hospital. Doctor Le and her staff are experts in high-risk or complicated pregnancies, including treating women with pre-existing conditions and those carrying multiples. In addition, INOVA Women’s Hospital Fetal Care Program offers a Level IV neonatal intensive care unit (NICU) and one of the largest teams of infertility and reproductive endocrinology perinatology specialists in the region.
Coronovirus and Pregnancy:
The American College of Obstetrician and Gynecologist recommends pregnant women should continue or resume necessary preventive health care visits and should also receive care, as needed, with specialists for non-obstetric conditions during the COVID-19 pandemic. At the beginning of the pandemic, data suggests that preventive health care visits drastically declined consequently causing a decrease in important routine screenings, tests, and vaccines. Although COVID-19 exposes certain health risks, it should not jeopardize the health of you and your baby. Pregnant patients who require care for serious medical conditions are strongly encouraged to maintain or resume necessary appointments. The use of proper protective equipment and protocol can control the spread of the coronavirus.
Annandale OB/GYN has taken precautions to protect patients and our staff from SARS-CoV-2 infection. This includes mask requirements, screening individuals for SARS-CoV-2 exposure before their appointment, and increased cleaning protocols. You are always encouraged to ask about our facility precautions against the COVID-19 and welcome any concerns that you identify. Pregnant patients should follow recommended prevention measures when entering a health care facility.
Pregnant Women in Covid-19 “increased risk” Category:
Data suggest that symptomatic pregnant women with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers (Ellington MMWR 2020, Collin 2020, Delahoy MMWR 2020, Panagiotakopoulos MMWR 2020, Zambrano MMWR 2020), the CDC now includes pregnant women in its “increased risk” category for COVID-19 illness. Pregnant patients with comorbidities such as obesity and gestational diabetes may be at an even higher risk for severe illness consistent with the general population with similar comorbidities (Ellington MMWR 2020, Panagiotakopoulos MMWR 2020, Knight 2020, Zambrano MMWR 2020). Importantly, analyses so far are limited by a large amount of missing data. Additionally, similar to the general population, Black and Hispanic individuals who are pregnant appear to have disproportionate SARS CoV-2 infection and death rates (Ellington MMWR 2020, Moore MMWR 2020, Zambrano MMWR 2020).
We recognize many patients are experiencing new concerns because of the COVID-19 pandemic, and desire to give birth at home. However, hospitals remain the safest settings for birth (AGOC Committee Opinion 697, “Planned Home Birth”). Although the absolute risk for severe COVID-19 is low, the data of increase risk in pregnant women conforms with an increased risk of ICU admission, need for mechanical ventilation and ventilatory support (ECMO), and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women (Ellington MMWR 2020, Zambrano, 2020). This highlights the importance of delivering at a hospital. Patients concerned that delivering in a hospital will increase their risk of exposure to COVID-19 should be assured that hospitals continue to be safe with strict infection control procedures.
Mitigation of COVID during Pregnancy:
Importantly, the correct and comprehensive use of recommended PPE, alongside hand hygiene and environmental cleaning, leads to the optimal decreased risk of transmission of respiratory viruses; and this is true for COVID-19. Recent data suggests that universal masking and close evaluation of extended use or reuse of N95 respirators in the health care setting can play a crucial role in decreasing health care-related COVID-19 infections (Degesys 2020, Seidelam 2020). Annandale Ob/Gyn follows ACOG’s recommendations and emphasized that pregnant individuals are encouraged to take all available precautions to avoid exposure to COVID-19 and optimize health including:
- Maintaining prenatal care appointments
- Wearing a mask and other recommended PPE, if applicable, at work and in public
- Washing hands frequently
- Maintaining physical distancing
- Limiting contact with other individuals as much as practicable
- Maintaining an adequate supply of preparedness resources including medications
Vertical transmission of COVID during pregnancy:
Although there are cases of reported vertical transmission of SARS-CoV-2, currently available data indicate that vertical transmission appears to be uncommon (Dumitriu 2020). Some studies have suggested that there may be an increased rate of preterm delivery and stillbirth in pregnant women with active SARS-CoV-2 infection compared with those in the general population (Knight 2020, Delahoy MMWR 2020, Panagiotakopoulos MMWR 2020, Woodworth MMWR 2020). It is unclear if these outcomes are directly due to SARS-CoV-2 infection or an indirect effect that results from severe maternal illness or iatrogenic intervention. Further, in a report from the PRIORITY study, among 263 initial infants enrolled, no difference in adverse outcomes, including preterm birth, NICU admission, and respiratory diseases, were found between those born to mothers testing positive for SARS-CoV-2 and those born to mothers testing negative. Black and Latina women were underrepresented in the PRIORITY study population as compared with previous assessments of the racial/ethnic distribution of SARS-CoV-2 infection in the U.S., highlighting a key limitation of the study (Flaherman, 2020). Another report of pregnancy outcome by SARS-CoV-2 exposure of 252 individuals in a more racially and ethnically diverse cohort also suggested no differences in a composite outcome of preterm birth, preeclampsia with severe features, or cesarean for abnormal fetal heart rate (Adhikari 2020). Specifically, preterm delivery rates did not differ between groups (RR 1.02, (95% CI 0.70-1.48).
The psychological impact of COVID on pregnancy:
Perinatal mood and anxiety disorders are among the most common complications that occur in pregnancy or in the first 12 months after delivery. Especially during this challenging time, obstetrician–gynecologists and other maternal health care professionals can help you through the perinatal period for depression and anxiety symptoms using a standardized, validated tool (Committee Opinion 757) . You should rest assure that even during this time, there are effective treatment and support options. If you are concerned that you may be at imminent risk of harm to yourself or others, please refer to emergency services for further evaluation.
COVID-19 Vaccination while Pregnant:
There are limited data about the safety of COVID-19 vaccines for people who are pregnant. CDC reports that animal developmental and reproductive toxicity (DART) studies are ongoing and studies in people who are pregnant are planned. CDC and the Food and Drug Administration (FDA) have safety monitoring systems in place to capture information about vaccination during pregnancy and continues to closely monitor reports. Additionally, CDC states that while studies have not yet been done, based on how mRNA vaccines work, experts believe they are unlikely to pose a risk for people who are pregnant. mRNA vaccines do not contain the live virus that causes COVID-19 and therefore cannot give someone COVID-19. mRNA vaccines do not interact with genetic material DNA because the mRNA does not enter the nucleus of the cell. Cells break apart the mRNA quickly. Nevertheless, the potential risks of mRNA vaccines to the pregnant person and the baby are unknown because these vaccines have not been studied in pregnant women.