COVID-19 facts about pregnancy, lactation, and vaccine recommendations

I started my career in maternity, and I have seen firsthand the importance of protecting yourself against any virus and seeking early intervention if you have any symptoms even if they seem like a mild cold or allergies. If you are pregnant, you were pregnant in the last 6 weeks, or you are breastfeeding, you're probably concerned about the impact of COVID-19 on you and your baby. You might also have questions about the safety of the COVID-19 vaccines. Here's what you need to know.

Hypoxia is the primary risk with COVID. It can cause brain damage to the mother and place the fetus at risk, so proper management of any respiratory or breathing issues is the top priority in pregnancy and for newborns. Additional risks include micro clotting, vascular inflammation, cardiac complications, multiorgan inflammatory syndrome, hormone disturbances, and other sequelae.

It is extremely important to talk to your partner and doctor about your questions and tune out the fears and rumors circulating in the news or amongst friends and family. This is the most important time of life to seek out facts supported by evidence based research from medical professionals.

Risks during pregnancy

The overall risk of COVID-19 to pregnant women is low. However, women who are pregnant or were recently pregnant are at increased risk for severe illness with COVID-19 requiring hospitalization, intensive care or needing ventilator to help with breathing. Pregnant women with COVID-19 are also more likely to deliver a premature baby (prior to the 37th week of pregnancy) and might be at increased risk for problems such as pregnancy loss.

In addition, pregnant women who are Black or Hispanic appear to be disproportionately affected by infection with the COVID-19 virus. Pregnant women who have underlying medical conditions, such as diabetes, also might be at even higher risk of severe illness due to COVID-19. Some research suggests that pregnant women with COVID-19 are also more likely to have a premature birth and cesarean delivery, and their babies are more likely to be admitted to a neonatal unit.

If you have COVID-19 and are pregnant, your treatment will be aimed at reducing the viral load with antiviral medications, relieving symptoms and making sure oxygen levels are maintained. If you're very ill, you may need to be treated in the hospital. Contact your health care provider right away if you have COVID-19 symptoms or if you've been exposed to someone with COVID-19. It's recommended that you get tested for the virus. Call your health care provider ahead of time to tell him or her about your symptoms and possible exposure before going to your appointment.

According to the CDC, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Severe illness that requires hospitalization may result in intensive care, need for a ventilator or special equipment to breathe. Additionally, pregnant women with COVID-19 are at increased risk of preterm birth and might be at increased risk of other adverse pregnancy outcomes, compared to pregnant women without COVID-19.

Women younger than 50 years old should especially be aware of the rare risk of blood clots with low platelets after infection or vaccination.

When to seek care

Seek medical care right away if you develop one or more of these symptoms of a blood clot for several weeks after infection or vaccination:

Fever - If you experience fever following vaccination you should contact your doctor immediately because fever associated with all causes has been associated with adverse pregnancy outcomes.
Severe or persistent headaches or blurred vision
Shortness of breath
Chest pain
Leg swelling
Persistent abdominal pain
Easy bruising or tiny blood spots under the skin beyond the injection site

Impact on prenatal care

Talk to your health care provider about precautions that can be taken to protect you during appointments. Ask if there are any tools that might be helpful to have at home, such as a blood pressure monitor or a pulse oximeter.

Prepare a list of questions before your appointments and take detailed notes to reference later. If COVID infections are high in your area, consider online childbirth classes.

Pregnant women who develop COVID-19 symptoms risk emergency complications and other problems with their pregnancies, according to two studies. The disease also puts their children at risk. Post COVID syndrome inflammation is extremely dangerous for both the mother and the development of the fetus. A chronic inflammation becomes a fight for the survival of the mother and the fetus, therefor aggressive interventions aimed at preventing chronic inflammation are necessary.

UCSF study: COVID positive mothers and babies 8 weeks postpartum

Research out of University of California in San Francisco revealed that infants born to women with asymptomatic-mild COVID-19 showed few adverse outcomes through eight weeks of age. The study suggests that babies born to mothers infected with the virus generally do well six to eight weeks after birth, however, there was a higher rate of neonatal intensive care unit (NICU) admissions reported if the mothers had more severe COVID-19 up to two weeks prior to delivery.

Among 263 infants in the study, adverse outcomes – including preterm birth, NICU admission, and respiratory disease – did not differ between those born to mothers testing positive for SARS-CoV-2, the virus that causes COVID-19, and those born to mothers testing negative. No pneumonia or lower respiratory tract infection were reported through eight weeks of age. Most Infants Are Well Even When Moms are Infected by COVID-19 | UC San Francisco (ucsf.edu)

The mothers with severe symptoms were more likely have emergency complications that were a danger to the baby. More babies were born breech, there was more likely to be decreased fetal movement, and some had too little amniotic fluid (possibly due to chronic dehydration of the mother in pregnancy). The study also found that babies born to these symptomatic mothers were much more likely to need oxygen support and more likely to be admitted to the intensive care unit, were more likely to need oxygen support and to be admitted to the intensive care unit.

Pregnancy and the vaccine

Vaccines help our bodies develop immunity to the virus that causes COVID-19 without us having to get the illness but may not always be necessary if you have been infected recently, have measurable antibody levels, or are at low risk of being exposed to other people who may be sick.

COVID-19 vaccines do not cause COVID-19 in mothers or their babies because none of the COVID-19 vaccines contain live virus. The idea is that the vaccine is safer that the virus for people who don’t have measurable antibody levels in their blood.

Studies show no increased risk for complications like miscarriage, preterm delivery, stillbirth, or birth defects from mRNA COVID-19 vaccines. COVID-19 vaccines during pregnancy have shown to be effective in reducing the risk of severe illness and post COVID complications for pregnant women.

When pregnant women receive a COVID-19 vaccine during pregnancy, their bodies build antibodies against COVID-19. Antibodies made after a pregnant woman received a vaccine were found in umbilical cord blood. This means vaccination during pregnancy might help protect babies against COVID-19.

Side effects can occur after receiving COVID-19 vaccines. Pregnant women have reported similar side effects from non-pregnant women after vaccination with COVID-19 vaccines. Contact your doctor immediately if you experience symptoms after being vaccinated, whether symptoms start immediately or weeks later.

Although rare, some people have had allergic reactions after receiving a COVID-19 vaccine. Talk with your healthcare provider if you have a history of allergic reaction to any other vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous). If you have an allergic reaction after receiving a COVID-19 vaccine during pregnancy, you can receive treatment for it.

As always, be sure to talk to your obstetrician about care considerations that are specific to you.

Things you can do to help yourself

Nutrition: Try to eat protein and vitamin rich foods daily.
Avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods. Don’t skip meals. Your body needs protein, vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that forced air into your lungs when it senses an apneic episode.
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

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