Short Wave - Pregnancy And COVID-19: What We Know And How To Protect Yourself

Episode Date: August 3, 2020

How dangerous is COVID-19 for pregnant women and their babies? The research has been scant and the data spotty. Dr. Laura Riley, the chair of obstetrics and gynecology at Weill Cornell Medicine and the Obstetrician-in-Chief at New York-Presbyterian, explains what we know at this point and what pregnant women can do to protect themselves. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. As a high-risk obstetrician, Dr. Laura Riley is used to dealing with her patient's anxiety. After all, pregnancy can be an anxiety-provoking situation. But the pandemic has ramped up the level of fear and questions way up. Am I going to get it? If I get it, what does that mean? Am I going to keep my job? What kind of a life am I, you know, creating for my business? Dr. Riley is the chair of OBGYN at Wild Cornell Medicine and the obstetrician-in-chief

at New York Presbyterian. And just like her patients, she's been scrambling to figure out exactly the right things to do. Literally, policies were changing every single day. And it was a matter of, what are we learning about this disease? You know, can you protect the patients? Can you protect the providers? It was tiring. Generally speaking, the research on pregnancy and COVID-19 has not been conclusive so far. There have been a lot of small studies, and in the U.S., the data has been spotty. Even a recent CDC report, a study with relatively large sample size of around 8,000 people, has been difficult to interpret because of gaps in the data.

One thing in medicine is that we like to study things and then we like to get answers, and then we like to operate based on those answers. And so that's been, I think, one of the more challenging pieces of it is just this year, you know, constantly saying, I don't know, I'm not sure, I think this. So today in the show, what we know at this point about pregnancy and COVID-19, and what an obstetrician has to say about protecting yourself and the baby. You're listening to Shortwave. from NPR. So, okay, Dr. Riley, a million-dollar question. At this point, what conclusions can we draw from the available research about how dangerous COVID-19 is for pregnant women?

That's a million-dollar question, right? So I would say the vast majority of the data suggests that, you know, pregnant women could get sick with COVID-19, just like anybody else. whether pregnancy itself makes you sicker, I think the jury's still out. I think that the new CDC data certainly raises concern, although I don't know that there's enough data to really suggest that. There is one finding from the CDC study that Dr. Riley is particularly concerned about, that pregnant women with the virus seem to have a substantially higher chance of being put on a ventilator. Though Dr. Riley says that was based on a relatively small number of patients.

I think the other thing that I remain concerned about is women who have other conditions that we know do not do well with COVID-19, like diabetes, long disease, whether or not you put that together with pregnancy in COVID-19. I think that might be worse, but we still don't know that even. had any pregnant COVID patients and, you know, what have you been seeing with those patients and how they're faring? Give us kind of an idea. So we've had several COVID positive mothers. We did see, you know, several women who were, what I would say, you know, pretty sick. We only had about three or four in the intensive care unit. And then we saw a bunch of women who had no symptoms, no idea that they were COVID positive, but were positive. And that gave us the sense that it was

really important to do this testing because there are many people who are essentially asymptomatic, or people who had symptoms that were just so mild, you know, a little short of breath, you know, maybe a little bit of a cough if, you know, they exerted themselves kind of thing. But that can be overlapped with pregnancy. Right. And the vast majority of those women did quite well. All babies did well. So that is something that I think is important and helpful to women to know is that at least,

you know, in the beginning we saw, I would say, in the NYP system, about 200, 300 babies now born to COVID-positive mothers. and like one positive or something, just not the numbers that people were afraid of. So what we can say about it is that at least for women who got it in the third trimester of pregnancy, we have not seen a lot of transmissions. I think the things that are yet to be known are, you know, sort of are there transmissions for women who got it earlier in pregnancy in the first trimester or the second trimester? And I think we don't know that yet.

Those people haven't delivered, but it'll be interesting to monitor that. Yeah. So you recently co-authored pandemic guidelines for practitioners and patients for the American College of obstetricians and gynecologists. So tell me, Dr. Riley, what can pregnant women do to protect themselves and their babies? Like, what are you telling your own patients right now? So I tell them that the protective equipment and all of the prevention strategies that have been suggested actually work. And I think we now have data that that's the case, right? We know that wearing a mask and washing your hands frequently, limiting your exposures.

So, you know, maintaining social distancing all seem to decrease the likelihood that you'll get infected. I think also I tell pregnant women when the opportunity is available to you. I think it's important to get outside. It's important to sort of not lose your mind being cooped up. Yeah. Okay. So Dr. Riley, since we have an actual doctor on the line, we got some listener questions that we wanted to run by you. Is it okay with you if we turn this into a doctor's visit real quick?

Absolutely. Okay. So this is an interesting question that I think I've heard kind of floating around. especially in my age demographic, which is, should I even get pregnant during a pandemic? You know, if you're trying to plan your life, is this a time to say, well, maybe now is not the time? Many patients will ask me that. I think it's a fair question. I also think that it is difficult for me to say that you should put your life on hold indefinitely because it's unclear to me sort of when this is quote unquote over.

I think that it may be that we need to continue to take these kinds of precautions for a really long time, even when there's a vaccine. So I don't know that now is the time, you know, to say, oh, I'm going to wait until, you know, what, 2022, 23. That may not be, for all sorts of medical reasons, the right thing to do, depending on what your age is. Gotcha, gotcha. And we got another question that I thought was made a lot of sense. I shouldn't say that to all of your questions made sense, listeners, if you're listening. Okay, so there's another question, a question about how to decide who can visit a newborn. Like how much, when, do you have advice about what kinds of precautions new parents should be taking?

I mean, it's kind of a hard time to have a baby and then not be able to have people around you to support you and celebrate that, right? Yeah, exactly. I think that this is one of those things that just sort of adds to the anxiety and the difficulty of sort of having a baby in a pandemic. So you do need to think about those things when you're making that decision from the last question. But what I've been saying to patients is that, you know, you do need to minimize those exposures, right? So the same way that we wanted to keep, you know, women and children safe during the midst of really, high numbers of, you know, exposures, we were saying stay at home and, you know, wash all those high touch surfaces. So yes, people can be tested, but, you know, how practical is it for them to be

tested every single time they want to come visit? But, you know, I understand that there is a balance there between people coming just to, you know, see the baby, in which case there's Zoom, versus people coming to help you and support you. And that may be, you know, a reason that you have to take that little bit of risk. But again, if they take precautions, it should decrease the risk. Okay, Dr. Riley. So obviously not all pregnant women can afford the luxury of staying home, right? So what are kinds of challenges you're seeing your patients have to deal with during this pandemic?

And how are you trying to kind of support them through that? Yeah. So, you know, in my own mind, I worry most about those women who are literally the frontline workers, right? So not so much the frontline healthcare workers, which, yeah, I worry about them too because of the exposures. But they can take precautions with, you know, masks and gowns and gloves and, you know, knowledge and, you know, all of that. I worry about the people who are the food service workers, the mass transit workers, you know, people who will not be able to necessarily, clearly, one, can't do their job from home. And two, may not have all the protection that they need and deserve. And then three, don't have the luxury to say, you know what, this job is too high risk.

So, you know, I remain very worried about that group of patients. And in this country, a lot of that group of patients is, you know, black and Latin necks. So what kind of conversations are you having with those people? What's your role in trying to support them? So I think that, you know, this is where I go over as much as I possibly can, what prevention strategies people can take, but just also recognize that it's just not that easy to say, oh, you should stay home. I'm very cautious about saying things like that, because that may not be appropriate, right? Oh, you should stay home may mean that you have no way of eating. I think also we've been very slow in medicine and really actually quite reluctant in healthcare in general to deal with the

social determinants of health. I think people are like, yeah, talking about it, but no one really wants to ask the questions because, of course, if you ask the questions, you'll get answers that you don't necessarily want and don't know how to deal with. But I think that this pandemic has definitely shown us that, one, it's important to ask. And two, there are things that we can do. It's going to force us to work within our communities to see if we can help people. It's not just food insecurity. It's that lack of transportation. It's that need to continue to work. You know, I feel like obstetrician gynecologists need to advocate for those women who are working in Walmart or working in wherever who need to work to make sure that they have masks, to make sure that

they're able to take those breaks, to make sure that their employers are helping them with transportation or whatever the issues are. I do think that we can have a role there. Yeah, absolutely. Okay, Dr. Laura Riley, I really, I really appreciate you. I appreciate your time, and I know our listeners do too. So thank you. Oh, my pleasure. Thanks for asking because I think that it's interesting. I can say these things in the office, but if I say it on NPR, people actually find it more believable. Patients are like, oh, I read about that or oh, I heard you on the radio. I'm like, I told you that like an hour and a half ago, but I'm glad it's more believable on NPR. There we go.

This episode was produced by Yo-Way Shaw and edited by Deborah George. Rebecca Ramirez checked the facts. I'm Maddie Safaya, and you've been listening to Shortwave from NPR.