The Changing Landscape of Pregnancy During a Pandemic
Pregnancy is a time of hope and excitement as well as increased concern for what the future will bring for your growing family. 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 first years of life and beyond. Expectant mom’s need guidance to help them navigate the changing landscape of pregnancy during a pandemic. 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 information 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 continually emerging and we can use the currently available data to guide our choices.
Prenatally, protection and prevention are absolutely the first line of defense. Follow standard recommendations for social distancing, frequent hand washing, 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 quarantine 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 andrographis, which are being touted as protection against SARS-CoV2, but they are unsafe 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 exposure) to the disease. Horizontal transmission, 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 respiratory concerns for mom, C-section deliveries 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 necessary for other reasons. The CDC does not support routinely isolating a newborn from its mother and WHO maintains the importance 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, however, 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 surfaces. 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 disorders, ADHD, developmental delay and depression in children. We suspect this is linked to disruption of the infant microbiome and alteration of innate immune function. Research is clear that healthy balanced gut flora 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 supporting normal immune and gut health in our newborns, and be especially mindful of those who have been exposed to SARS-CoV2. Being proactive includes breastfeeding for 6 months or longer whenever possible. Breast milk provides important immune modulating compounds as well as molecules called Human Milk Oligosaccharides (HMOs) that are used specifically by the gut flora to grow and thrive. If appropriate, Vitamin C and D, probiotics, omega 3 fatty acids, and zinc can be used to enhance immune function. While these nutrients are safe for both breastfeeding moms and babies, appropriate dosing is essential.
Parents should watch carefully for signs of digestive and immune dysfunction such as colic, reflux, poor sleep, eczema and ear infections. If you suspect your child is not achieving appropriate developmental milestones, then modify the familiar saying and, “if you don’t see something, say something”. Work closely with a provider experienced in functional care who will take your physical and developmental concerns seriously, and intervene early.
This information is not designed to scare but to educate. By knowing the facts, working closely with your healthcare provider to decide what is best in your individual situation, and making decisions with both short and long-term effects in mind, you can lay the foundation for a happy thriving child.
Please note: This article should NOT be considered medical advice. Information about COVID-19 is constantly evolving and subject to change. Following proper procedures for hand washing, social distancing, masking and surface cleaning remain the best interventions available. Personal recommendations for pregnancy planning should be discussed with your health care provider.
Vicki Kobliner MS, RDN, CD-N is a Registered Dietitian/Nutritionist and owner of Holcare Nutrition. Vicki has a passion for helping par-ents-to-be navigate preconception, pregnancy and baby’s first year of life in the face of increasing chronic childhood illness. Her practice employs a functional nutrition approach for optimal health and healing. Vicki also works with infants through adults with chronic illnesses, digestive disorders, food allergies, ADHD and autism and provides fertility and mental health focused nutrition counseling.
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