Question: I have a question for you — not sure if it would be good for your whole list, but either way I figured you may be able to point me to further resources I should look into! My spouse and I have been weighing the pros and cons of trying to conceive/pregnancy. We put our plans on hold back in March, thinking probably we should minimize our interaction with the healthcare system, and try to mitigate unknown risk to myself or potentially adverse effects to the pregnancy/birth outcome. We’re now re-weighing this as more time passes. Anything to add to your previous answer on this topic from 5/17?

Answer: We are learning more and more as time progresses, but there’s still so much we don’t know, especially when it comes to pregnancy, birth, and the post-partum period. Are pregnant women at increased risk of contracting COVID? Of having more severe outcomes in the event they do become infected? Of passing the infection on in utero? At delivery? Through breastfeeding? Does infection increase the risk of miscarriage? Of low birth weight? Of developmental disabilities? Answer: we are still unsure. In part, these limitations in our current knowledge are because we are only ~6 months into the pandemic, which means that we simply don’t have longitudinal data from women who became pregnant during the pandemic, gave birth, and completed the post-partum period. What a challenging time of limited information we’re living through. Please reach out to your doctor to discuss. In the meantime, here are a few helpful resources and new research findings:

A couple of recent news articles that address this issue well (in my opinion):

NY Times, “Why We Still Don’t Know Enough About Covid-19 and Pregnancy” (July 10)

NPR, “Safe Pregnancy As COVID-19 Surges: What’s Best For Mom And Baby?” (July 17)

Are pregnant women at increased risk of contracting COVID?

Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, and data from New York hospitals during the height of the State’s epidemic show that nearly 1 in 5 pregnant women who were tested at time of delivery were found to be infected with the majority being asymptomatic. That said, we do not have evidence as to whether pregnant women are more susceptible to SARS-CoV-2 infection as compared with non-pregnant women. More research is required.

Are pregnant women at increased risk of severe outcomes?

Data from a CDC report published in late June, “Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020” suggest that pregnant women may have more adverse outcomes — hospitalization, ICU admission, and mechanical ventilation — than non-pregnant women, though rates of recovery are similar between pregnant/non-pregnant women. This study had many limitations, including lots of missing data, so the findings are far from rock solid. More research is required.

Can the virus be passed on to the fetus/baby in utero?

Two new pieces of evidence help on this one. First, evidence from Italy shows that the virus can be passed on in utero through the placenta, as recently reported in Nature. Second, evidence from a recent NIH study shows that the placenta’s cells are missing the ACE2 receptors, which are the main receptors the virus uses to infect the cells. This means that in utero infection is likely to be rare. More research is required!

Does COVID infection increase risk of miscarriage or still birth?

We do not know. There are case reports (see this one from JAMA, for example) indicating that if the virus gets into the placenta, it can cause miscarriage. A small study out of Northwestern University published in American Journal of Clinical Pathology showed that among 16 women who were infected with SARS-CoV-2 while pregnant exhibited evidence of placental injury. More research is required!