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COVID Crisis Post 68: Pregnancy Impacts - What We Know So Far.


It may be a rainy day here in New York City, but it has been a good day for me.


It is my first day not wearing my sling at all at home, and honestly, the increased freedom I have without having it on - even with my shoulder movement still SUPER limited - is phenomenal. The fact I can type on a keyboard now instead of a phone alone is worth the elation.


Thank goodness my high school mandated keyboarding. Like most high school kids, I was too stupid to realize learning how to type is arguably the most important thing I learned in high school. Sorry everyone else.


I had brunch with a close friend this morning/afternoon, and we were discussing numerous topics, with one of the topics focusing on whether we wanted to have kids or not - no, NOT with one another, so hush children.


I am not married, nor have any children, but the idea of having a child without being married has become a more realistic option in my mind as I get older. Obviously there are a LOT of considerations to take into account first, but as someone who takes care of children and loves their cute little cheeks, a child is something I definitively want.


Preferably three. Because middle children are da best. Obvi.


And before anyone says well your Indian mom would probably freak out about it, she told me well over a year ago she no longer cares if I get married but to just give her a grandchild. An Indian mom said this.


Times be changing, I tell ya. Or desperation in ways I had never seen or expected.


So it got me thinking a lot about the fears and uncertainty so many soon-to-be parents may be feeling at this time during the COVID-19 era, especially since I personally have friends who are currently pregnant. So I figured I would give a brief update in that regard.


Early on, there were concerns that pregnant women could be at increased risk of contracting COVID-19 as this is the case with other respiratory illnesses, but this has not been borne out in the case of COVID. And in those who have contracted the virus, it is unclear if the disease is more severe in this population or not - though obese patients and other chronic illnesses may contribute to increased severity as seen in the general population. But what we do know is, other concerning things have emerged.


I know, shocking.


One study published yesterday - a VERY small study where NOTHING DEFINITIVE can be drawn from it but still interesting nonetheless - demonstrated signs concerning for placental injury in patients diagnosed with COVID-19, most who presented without symptoms: https://academic.oup.com/…/advance-article/doi/10.1093/ajcp…


There was evidence the placentas had histologic features consistent with maternal vascular malperfusion (MVM), where the blood vessels of the placenta are abnormal with evidence of microthrombi - miniature clots - found in the vasculature as well. These findings are not surprising given the fact abnormal clotting has been a hallmark of this disease, but it is another organ system to garner concern.


MVM is usually associated with abnormal vascular or inflammatory states, and is associated with abnormal fetal growth and even death. Diseases of high blood pressure associated with pregnancy commonly lead to MVM, though there was not evidence of elevated blood pressure in this patient population.


The placenta provides oxygen and nutrients to the baby, while removing waste products - so a heavily diseased placenta is BAD, but there is a lot of redundancy built into the placental system in terms of perfusion, which is GOOD. The liver is another example of an organ which has incredible reserve and can withstand a lot of injury before showing signs of dysfunction.


Like the injury you caused by downing a 12-pack of Shlitz during the lockdown. You know who you are.


So even if a chunk of placenta is unhealthy, there can still be enough healthy tissue to get the baby through pregnancy without complications. And at least in this study, this was the case with all of the babes being born healthy, including one preterm baby. Other studies have shown possible evidence of preterm labor or more frequent C-sections, but nothing conclusive.


These findings suggest pregnant patients who test positive for COVID-19 may benefit from additional monitoring during pregnancy, though exactly what has not been determined at this time. Non-stress tests, which measure reactivity of a baby's heart rate during movement or contractions, or growth ultrasounds are possibilities. My opinion is if these are easy tests to add-on during pregnancy, it may not be a bad idea to do so until more data comes out.


There have also been rare cases of newborns testing positive for COVID-19, but without adverse outcomes. It is unknown if the baby contracted the virus prior to birth or was exposed during or after delivery. Like most things with this disease - we still do not know. So protect yourself the best you can in the meanwhile!


And most importantly - ENJOY your babies!!! NO ONE is saying mommies and daddies should not provide all the love possible to their child, but wear your masks, especially if you are sick, and practice good hygiene whenever possible. If you want to breastfeed, go for it, but wear a mask during it since it is one additional opportunity to limit exposure to your cutey.


One thing that really irks me is the CDC not coming out early in this pandemic and just blatantly saying, "look, we have no idea how this virus will affect people with pre-existing conditions since we do not have the data for x, y, and z. Until we do, protect yourself and please keep taking all of your prescribed medications and do not make any changes unless directed by your physician." This statement could have prevented SO MUCH CONFUSION.


We know the damage most chronic illnesses can cause if not treated properly. So do not un-treat an illness we know how to treat for an illness we are still trying to figure out how to treat. Say that last sentence three times fast.


COVID-19 has caused SO much chaos for so many, especially those with kids or who are expecting.


But one thing that will always remain the same, even if the apocalypse were to occur, is my mom calling me and complaining about how I am not yet married, nor have a child.


Mummies gonna Mummy.


#covid19 #nyc

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