COVID-19 and Why I'm Waiting

[ajay24]

I’ve seen a ton of different posts and discussions about COVID-19 lately, so I thought it would be interesting to create a thread that includes my reasons to wait. I’m a microbiology professor and have been a science educator for years, so this stuff is my bread and butter. Now, I personally have chosen to wait, but I am taking the Emily Oster approach here: thinking about the data and presenting my case. You have different life circumstances, are a different age, and overall a different risk profile compared to me, so take this information and do what you will:

1. Pregnant women who have COVID-19 are more likely to be hospitalized.

From: https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm

After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit and receive mechanical ventilation. There was no difference in death rates (which may suggest that women who are pregnant are more likely to be admitted to the ICU for reasons relating to their pregnancy rather than their COVID status.)

The total number of women who did need a ventilator was small, though, but the American College of Obstetricians and Gynecologists is now recommending counseling patients on this risk, see also: https://www.acog.org/clinical/clini...isory/articles/2020/03/novel-coronavirus-2019

2) There is a startling number of stillbirths happening.

In one study from St. George’s University Hospital, researchers found a significant increase in number of stillbirths. There is no evidence that any of the mothers had COVID-19 and none tested positive. This is probably evidence that there is a reduction in medical intervention that prevents stillbirths- moms are more hesitant to go to the hospital if they don’t feel movement, etc.

The incidence of stillbirth was significantly higher during the pandemic period (n = 16 [9.31 per 1000 births]; none associated with COVID-19) than during the prepandemic period (n = 4 [2.38 per 1000 births]) (difference, 6.93 per 1000 births [95% CI, 1.83-12.0]; P = .01) (Table 2), and the incidence of stillbirth was significantly higher when late terminations for fetal abnormality were excluded during the pandemic period (6.98 per 1000 births vs 1.19 in the prepandemic period; difference, 5.79 [95% CI, 1.54-10.1]; P = .01). There were no significant differences over time in births before 37 weeks’ gestation, births after 34 weeks’ gestation, neonatal unit admission, or cesarean delivery.

From: https://jamanetwork.com/journals/jama/fullarticle/2768389

3) COVID-19 patients show evidence of placental injury

In one study, women who tested positive were more likely to show increased issues with their placentas. Note that all mothers did have a live birth except for one. MVM stands for maternal vascular malperfusion, a form of placental damage normally associated with mothers with hypertension.

Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

From: https://academic.oup.com/ajcp/article/154/1/23/5842018

Placentas with MVM are significantly associated with stillbirth.
From: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.16019

Placentas with MVM are associated with weight gain and lower birth rate in mothers with gestational diabetes.
From: https://pubmed.ncbi.nlm.nih.gov/28012449/

4) Fevers and other illnesses during pregnancy are associated with birth defects.

Maternal report of cold or flu with fever was significantly associated with 8 birth defects (anencephaly, spina bifida, encephalocele, cleft lip with or without cleft palate, colonic atresia/stenosis, bilateral renal agenesis/hypoplasia, limb reduction defects, and gastroschisis) with elevated adjusted odds ratios ranging from 1.2 to 3.7. Maternal report of cold or flu without fever was not associated with any of the birth defects studied.

From: https://onlinelibrary.wiley.com/doi/full/10.1002/bdr2.1147

5) Previous pandemics have had life-long complications for babies in utero.

In one study, individuals where were in utero during the 1918 flu pandemic were associated with increased rates of cardiovascular disease, suggesting that placental damage or maternal illness may play a role in later-in-life health outcomes.

Prenatal exposure to the 1918 influenza pandemic (Influenza A, H1N1 subtype) is associated with ≥20% excess cardiovascular disease at 60 to 82 years of age, relative to cohorts born without exposure to the influenza epidemic, either prenatally or postnatally (defined by the quarter of birth), in the 1982–1996 National Health Interview Surveys of the USA. Males showed stronger effects of influenza on increased later ischemic heart disease than females. Adult height at World War II enlistment was lower for the 1919 birth cohort than for those born in adjacent years, suggesting growth retardation. Calculations on the prevalence of maternal infections indicate that prenatal exposure to even uncomplicated maternal influenza may have lasting consequences later in life. These findings suggest novel roles for maternal infections in the fetal programming of cardiovascular risk factors that are independent of maternal malnutrition.

From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826837/

Now, this is only a REALLY short list of things. This disease has only even existed for 7 months- and more and more worrying symptoms and long-term consequences are being reported, which I won’t go into in this post. For me personally, this data suggests that waiting and collecting more data is the right approach for me. Will I try during the pandemic? I don’t know yet. I’m personally hopeful for a vaccine. This post doesn’t even touch the myriad of emotional reasons to wait or to try- and ultimately, that’s an immensely personal decision for everyone. I thought I would just help some people who maybe don’t know where to find the relevant information- or even start a conversation with their doctor. I’m NOT a doctor and this isn’t medical advice- this is just some information for you to use.

 

[kekeli]

@ajay24 Personally, I appreciate this post. I sometimes feel like I’m the only person who’s choosing to wait during the pandemic, and that perhaps I’m an idiot for it. I don’t judge others for trying - everyone’s situations and comfort levels are different, and I wish I weren’t so afraid. I have such severe anxiety around pregnancy though, after losing one and constant threatened miscarriages and signs of preterm labor with my second. Pregnancy terrifies me in normal times, so the idea of going for it when there are higher risks is enough to make me feel ill.

It kills me to wait, since we just want to finish our family. I’ve been following a lot of similar research though, and for us, maintaining our ideal gap between kids has dropped in importance. I’m willing to wait (within reason, of course) if it means I’ll be able to emotionally handle a pregnancy, and if it’s a safer time all around. Thanks for sharing your research!

 

[ajay24]

@kekeli I feel this- my first pregnancy ended in miscarriage (right at the beginning of lockdown) and I felt firsthand the effects of an overstretched ER, and I wouldn’t recommend to anyone.

 

[kekeli]

@ajay24 I’m very sorry for your loss. That had to be so hard, especially with all the stress of the pandemic just starting.

 

[godsgatekeeper]

@ajay24 I'm so sorry for your loss, and for the extra stress you had to deal with during such a difficult time.

Really hoping things go smoothly once you are ready to try again!

 

[nativenh1]

@ajay24 Disheartening but important. Thank you for sharing.

 

[tammy1ed2]

@ajay24 This is great. I'm really really lucky that I live in a country that does not have community transmission. We definitely would not be considering trying soon if we had active COVID-19, and I was at any risk of catching. The pandemic has actually bought things forward for us as we won't be able to have our wedding until our boarders open again (overseas family and friends) and no overseas travel for the foreseeable future, for work or holidays.

 

[dancequeen12]

@tammy1ed2 This is exactly our situation too. Now it is hopefully baby first then wedding.

 

[tammy1ed2]

@dancequeen12 If it doesn't end up happening within a certain amount of time we may pause, get married, then carry on, but will just see how it goes

 

[greg231]

@ajay24 Thank you for presenting the information. I think looking at the data and science before making a life changing decision is important, no matter what you decide afterward.

 

[katrina2017]

@ajay24 Thank you for this. COVID definitely put the breaks on trying this fall for me, so many uncertainties scare the shit out of me. I’m 2/2 for PPD as well and the thought of having a third during pandemic+quarantine+no close familial support is nightmare inducing.

We live out of state from my family (and out of country from my husbands side), the whole thing stinks.

 

[101bruce]

@katrina2017 I’m in the same boat. I don’t have any children, but I’m worried about going into this chapter of my life without familial support.

 

[jestifex]

@ajay24 Thank you for this!! I feel like I have seen so many posts about “well yeah COVID isn’t great but there is never a perfect time to get pregnant.” In my lifetime, this is the ultimate definition of the most imperfect time I’d ever want to get pregnant. I already have a lot of anxiety around going to the doctor’s office (high blood pressure at the doctors but fine at home, and I know they’d insist on monitoring me more if that issue persists while pregnant, just because of past experiences ) so I can only imagine that’d be worse now. I am also (relatively) young at 30 and feel okay about waiting to try until things are more certain. I would never judge anyone trying to get pregnant right now but it’s nice to know I’m not the only one with concerns.

 

[dancequeen12]

@ajay24 This is super concerning. I feel so much for people in countries where this is such a big issue. Here we are doing better, though they are opening schools so we will see what is happening after that. Many people, myself and my partner included, are still working from home and will be indefinitely so our situation is rather different.

 

[caca]

@ajay24 This is really interesting, thanks for including the links to the articles and some extracts from them. I agree that these could be reasons to wait, but also think the risks are still small with the current evidence base. It will be interesting to see additional data in the future.

 

[ajay24]

@caca You’re welcome, I hope you found it useful! It is important to note that for many of these, the effects sizes are small- and I’m not telling anyone that there is no reason to try right now- there totally are. For me personally, I work a job that has me in contact with lots of people and so does my husband, so potentially getting infected is more concerning for me. But my point is really that we’re so new in this pandemic- and there really just isn’t a ton of data at all! But using previous experiences with similar viruses has given me pause to at least wait a few more months to see what other data rolls in. At the end of the day, even if you get pregnant right now and catch coronavirus, the statistics say you’re overwhelmingly more likely to have a healthy baby.

 

[caca]

@ajay24 Yeah I totally agree. I liked your presentation of the facts and your interpretation of how you have made your decision based on the available data and your experiences. But also like that you acknowledge that other people will look at the data and come to different conclusions based on their situation. You are brilliant

 

[skeeboat]

@ajay24 I think this is really valid. I haven’t considered a lot of this. I’ll talk to my husband but this makes me want to push back our date.

 

[theoseeker]

@ajay24 These are good studies to see. However I think it's also important to consider what sort of precautions are you taking? How high is your risk level on a daily basis? For instance, personally I go almost nowhere and have been for months. If I do go out, I wear a mask and I keep my distance from people. I work in medicine but I have zero patient contact and we wear masks at work. So I feel my risk level of exposure is pretty low. My husband also wears a mask at work/when going to the store and does his best to stay away from people. My hospital currently does not allow visitors for the vast majority of patients. Those that do, visitors (and patients) are screened at the entrances and everyone wears masks. They encourage 6ft social distancing in all halls and waiting areas as well. So I feel relatively safe continuing with my TTC timeline.

 

[cookiemon]

@ajay24 Thank you for the sound reasoning and scientific evidence behind it! I am in the exact same boat of not wanting to get pregnant right now for health reasons (for both me and the baby!). My fiance and I are very serious about not wanting to risk getting the virus at all, given that scientists are still finding out more about it every day, such as its potential long-term damage. I'm kind of shocked by the amount of Americans deciding to go forward with having a baby right now, given the pandemic ravaging our country. I so understand the yearning for a little one and I know it's a deeply personal decision so I am not judging, but we are going to be waiting to try for a while.