Pregnant in a pandemic: ‘If you get sick, you get very sick, and that has led to some preterm births’

Local Coronavirus Coverage

JOHNSON CITY, Tenn. (WJHL) – The novel coronavirus has impacted the lives of people across the globe, but one subset of people greatly impacted are pregnant women.

The Centers for Disease Control and Prevention found in a study of 598 pregnant women, 55 percent were asymptomatic, and the rest suffered severe illness and even death. The study found that 2 percent of pregnancies are miscarried due to COVID-19 complications, but that almost 13 percent of pregnant women with COVID-19 had preterm births.

This is something that Dr. Timothy Canavan, professor and chair at ETSU Quillen College of Medicine Dept. of Obstetrics and Gynaecology; and Maternal Fetal Medicine Specialist at Niswonger Children’s Hospital, found to be true locally, as well.

“The rate of preterm birth during the pandemic has been about 12.5 percent. So, it’s up a little bit and we’re not exactly sure why, it may be that some people may be delivering slightly early because of exposure risks, because maybe they have COVID, maybe they’re at-risk to get COVID, maybe they have COVID and so, we’re not 100 percent sure if it’s the impact related to the exposure risk or it’s actually a true event, so it’s hard to say. Pregnancy has been kind of interesting for the COVID virus because the majority of pregnant women, about half of them are actually asymptomatic, they have maybe a runny nose, they feel a little rundown, but they don’t really complain about a lot of things, so the risk really has been the fact that healthcare workers have been lulled into letting down their guard a little because patients who have the virus don’t really look sick,” Canavan told News Channel 11’s Bianca Marais.

Canavan explained that COVID-19 causes a cascade effect in symptoms that has the potential to wreck havoc on a pregnant woman’s body. This could put the mother and baby at risk during labor, as the mother’s body is already working overtime to support both herself and the fetus.

“This virus, for whatever reason, can sometimes cause a cascade effect in the immune system, that results in multi-organ failure. So, what happens is, and we don’t quite understand it, but it attacks the lungs, the heart, and the kidneys, those are the major three things that it has and effect on. Those three organ systems are changed in pregnancy. They have to accommodate a higher level of care for the mother, because the baby is also using those organ systems. Uses the lungs for oxygen, uses the heart for profusion of blood, and uses the kidneys to remove waste and maintain a normal balance of salt and sugar in the blood, and so, if the virus starts to attack those organs, they’re already compromised, they’re already been asked to function at maximum capacity for the pregnancy, so when they get the virus and the virus causes a decrease in capacity, that’s what compromises the care of the pregnant woman, not just for her but for the baby, but the baby tends to compromise the for itself, so the effect is even magnified on the mother, because not only has she got kidney damage, or kidney dysfunction from the virus, she’s got kidney dysfunction from being pregnant,” Canavan explained.

Maternal fetal medicine specialists take care of pregnant women, particularly ones that have high-risk problems, and coronavirus has now become one of those things. Canavan explained that he also runs one of the busier obstetric ultrasound practices in the region, so he said they are seeing a lot of patients at early pregnancy.

“What we’ve noticed is when they get sick from the virus, they get very very sick. For a 20 or 30-year-old woman, who is the common age for pregnancy, you wouldn’t expect them to get as seriously ill as they do, and that has actually also been confirmed by the CDC, who has found that if you get the virus when you’re pregnant, you’re more likely going to have very few symptoms, but if you get sick you’re going to get very sick and you’re going to get very sick very quickly,” He said. “So, our experience has been very consistent with what the CDC has been reporting, here in Johnson City and we cover not just Johnson City, but we’re covering a little bit in Mountain City, we get patients from the Southwest part of Virginia, a little touch of Kentucky and Boone in North Carolina. So, in this kind of area, that’s what we’ve been experiencing.”

Canavan said that there is at least some good news – the virus doesn’t seem to transmit to the baby in utero, even though there are vague reported cases, but over 90 percent of people who’ve had the virus in pregnancy have not manifested any virus in their newborn at birth.

Newborns contracting COVID-19, especially those born preterm, does not seem to be a growing concern in the healthcare community, he explained.

“The big risk when you have the virus and you have labor and delivery, the first thing is it compromises your ability to have a baby because you’re not feeling well and you might be having a fever and that could get confused with other kinds of infections, you might be short of breath, but if you’re one of those individuals that’s pretty asymptomatic, you don’t have many symptoms, childbirth is actually routine,” Canavan said. “The big thing is then what to do with the baby and what we’ve been trying to do is then allow the mother contact while she wears a mask washes her hands breastfeeds her baby and then keeps her baby about 6 feet from her so that she limits their exposure. Newborns getting the virus does not seem to make them very ill either.”

The increased rates of preterm births in COVID-19 patients is a cause for concern for the medical community, Canavan explained.

“Preterm birth in and of itself is a problem because obviously, the last thing the babies develop is lung maturity, the ability to breathe, and so when you deliver premature, babies come out with respiratory distress and there is some concern that the virus on top of respiratory distress can complicate their recovery,” he told News Channel 11’s Bianca Marais. “However, being pregnant and having the virus if you get sick, you get very sick, and that has led to some preterm births because we’ve had to deliver the baby because the mom’s lung function and heart function has been compromised by the virus and we need to get the baby delivered before the mother is incapable of supporting the pregnancy any further due to the damage from the virus. That has been very rare, but we have had a few women get extremely ill from the virus, in pregnancy, it can require preterm birth.”

Timberly Buskill is just over 31 weeks pregnant and considered high-risk for COVID-19 exposure due to a heart condition. She is taking extra precautions to keep both herself and her unborn daughter safe, all while adapting to being pregnant during a pandemic.

“So far, it’s been a little difficult because I can only have one person at my appointments and stuff like that, so I have to like choose between my boyfriend and my mom, so that’s pretty hard, but my day-to-day life, I just kind of have to be, for myself, I have to be extra cautious, not only for myself but for my daughter as well,” Buskill explained. “At first they said that COVID didn’t effect pregnant women and then it came out that it did effect pregnant women. My doctor said that there are some girls that have been in the ICU, that they had to deliver early, things like that, because they have gotten COVID, so my doctor told me that it’s a by-case situation, they don’t really know.”

Buskill explained that she and her partner have been preparing for the possibility of a preterm birth due to her health condition and the higher possibility of contracting COVID-19.

“I’m high-risk for premature labor anyway, so we kind of have prepared for that. I kind of figured that if I were to get COVID, that it probably would speed things up a little bit, but yeah, we definitely have prepared for her to come early,” she said.

She has a message for people who plan on being around pregnant women during the pandemic, especially during the upcoming holidays:

“Mask up so you’re keeping everyone around you safe. It’s not just for you, it’s everybody else and the innocent people that can’t do it themselves,” Buskill urged.

Canavan also urged people to skip the big holiday events this year due to the pandemic.

“The first step is prevention, and I would say please, please, please skip the big family Thanksgiving event this year. We’re terrified, the medical community is terrified about what’s going to happen with Thanksgiving. We saw a huge increase in cases locally after Halloween and we’ve contributed that to people having Halloween parties. One person in a room of 50 people, that’s fairly confined with not-great ventilation for 15 minutes probably will expose about 95 percent of those people to the virus, and the majority of them will get it, it’s a very contagious virus. Thanksgiving, of course, everyone’s going to be eating, so no one’s going to be wearing masks and they’re going to be talking and that’s the most common way we transmit the virus, so if you can avoid a big family gathering, that would be the ideal thing. Stick with your very immediate family, don’t invite guests and people you don’t know. Anybody could have the virus and really not have any symptoms, you can’t just look at the and go ‘oh, you’re sick, you shouldn’t come in,’ some people look fine, and they feel fine, and they will pass the virus to you within 5 to 15 minutes of close, personal contact and when I say ‘close,’ I mean within 6 feet, probably even 8 feet, especially if they’re talking and if there’s any singing going on, that actually doubles the risk. Singing tends to transmit the virus,” he said.

Canavan also said that the pandemic has caused pregnant women to not seek out the appropriate medical attention, especially at the beginning of their pregnancies.

“As soon as you know you’re pregnant, make an appointment to see your doctor to confirm your pregnancy, make sure you’re getting all the proper testing, and all the proper support that you need in early pregnancy, I mean, those are the things that have the greatest impact on the health of pregnancy. You know, early prenatal care if one of the biggest things and I think a lot of women are backing away from that because they’re worried about the virus, they don’t want to go to the doctor’s office, and so they’re not getting prenatal care, and that probably is having a greater impact on pregnancy than the virus itself,” he said.

During a Wednesday COVID-19 press briefing Ballad Health officials said that they are confident they have the resources to support any possible local increase in preterm births.

“They’ve not been strained, we have had several COVID-19 deliveries and so, our teams are working, they move patients as they need to, we’ve got the resources if we need to move those patients. I feel like we’ve got a very strong NICU team in our children service line, so I feel like, right now, we’re meeting that demand,” Ballad Health Chief Prevention Officer Jamie Swift said.

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