by Lisa-Marie S. Cook BSN, RNC-OB, ICCE, C-EFM, CD

The COVID-19 pandemic has significantly impacted the care provided in childbirth centers across our nation. The question: “What are the chances of me getting infected with COVID-19 while I’m pregnant?” is a question that is brought up weekly in my virtual childbirth classes. As of August 20, 2020, America has surpassed 5 million cases of COVID-19 (SARS-CoV-2) positive patients–5,506,929 cases and 172,416 deaths. These staggering figures are creating anxiety amongst pregnant women. The reality is that nationally– from January 22 until August 20, 2020— 18,040 pregnant women tested positive, comprising 0.3% of the general population testing positive.¹ Amidst the pregnant population entering the hospital, in a JAMA study, 782 pregnant women were tested forCOVID-19. Twelve (1.5%) had previously tested positive for SARS-CoV-2, the virus that causes COVID-19. Of the remaining 770 women, 30 (3.9%) tested positive, 22 (73%) were asymptomatic, experiencing no signs or symptoms. Later in this study, the prevalence of women WITH symptoms who tested positive while in-hospital for childbirth fell from 1.4% to 0.7%.² In a New York study, the patterns of acuity for pregnant women were similar to those of non-pregnant adults of 43 women who tested positive: 86% had mild disease, 9.3% had severe disease, and 4.7% developed critical disease.³ Since US data collection has begun, Pregnant women with COVID by race/ ethnicity (CDC. 8/20/2020) are as follows:

• Hispanic/ Latino: 6,845 women
• White/ non-Hispanic: 3,930 women
• Black: 3,237 women
• Multiple race/ Other: 656 women
• Asian/ Non-Hispanic: 458 women

Of the 18,040 pregnant women testing  positive COVID-19 results, 4,472 women were hospitalized (29.3%), 193 women admitted to ICU, and 68 women required mechanical ventilation.⁴ New therapies have begun producing better outcomes. Education in COVID-19 prevention and symptom recognition is key for pregnant women. Prevention is what has kept the obstetric population positivity rates low. Symptom recognition allows for early intervention, prevents COVID-19 condition from worsening, and could reduce hospitalization time. With this in mind, ACOG makes these COVID-19 prevention recommendations during pregnancy⁵:

1. Maintain prenatal care appointments: Keeping appointments decreases risks for complications of pregnancy.
2. Self-Quarantine/ Socially Distance: Limit exposure to other individuals as much as possible, especially large groups, gatherings, community events. Consider the risk before going out, attempt to maintain at least six feet from those around you.
3. Wear a mask and avoid others who are not wearing masks: Research finds that wearing face masks in public is the single MOST EFFECTIVE way to prevent SARS-CoV-2 transmission.⁶
4. Keep these items on-hand when venturing outside: Mask, tissues, and hand sanitizer with at least 60% alcohol.
5. Maintain an adequate supply of preparedness resources: medications, water, etc.
6. Clean and disinfect high-touch surfaces daily: doorknobs, light switches, electronics, and counters.
7. Frequently wash hands with soap and water for at least 20 seconds. If soap and water are not readily available, use hand sanitizer. Cover all surfaces of the hand and rub them together until dry. It’s especially important to wash:

• • Before eating or preparing food
  • Before touching your face
  • After using the restroom
  • After leaving a public place
  • After blowing your nose, coughing, or sneezing
  • After handling your mask
  • After changing a diaper
  • After caring for someone sick
  • After touching animals or pets⁷

Knowing the signs and symptoms of COVID-19 and when to notify health providers is equally important to increase better outcomes. Studies have shown that recognizing COVID-19 symptoms can help physicians treat patients and intervene earlier in the disease process. Early recognition also prevents COVID-19 conditions from worsening and could reduce hospitalization time.⁸ Pregnant women should contact their healthcare provider should they experience any of these symptoms:

• Fever or chills (99%)
• Cough (59%)
• Shortness of breath or difficulty breathing (31%)
• Fatigue (70%)
• Muscle or body aches (35%)
• Headache
• New loss of taste or smell
• Loss of appetite (40%)
• Sore throat
• Congestion or runny nose, mucus or phlegm (27%)
• Nausea or vomiting
• Diarrhea

People should call their primary care provider immediately if they have:

• Trouble breathing
• Constant pain or pressure in your chest
• Inability to stay awake
• Bluish lips or face
• Sudden confusion

Teaching students and their families about COVID-19 prevention is the best way to decrease the numbers of COVID-19 positive rates in our community. Identifying COVID-19 symptoms can mean early intervention to increase recovery rates. It is reasonable to say that these COVID-19 educational tips are the “New Guidelines” until a vaccine or cure is found.

References

1-https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/index.html. Accessed August 21, 2020. 2 Campbell KH, Tornatore JM, Lawrence KE, et al. Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut. JAMA. 2020;323(24):2520–2522. doi:10.1001/jama.2020.8904 – 3-Breslin, Noelle; Baptiste, Caitlin; Gyamfi-Bannerman, Cynthia; Miller, Russell; Martinez, Rebecca; Bernstein, Kyra; Ring, Laurence; Landau, Ruth; Purisch, Stephanie; Friedman, Alexander M.; Fuchs, Karin (2020-04-09). “COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals”. American Journal of Obstetrics & Gynecology MFM: 100118. doi:10.1016/j.ajogmf.2020.100118. ISSN 2589-9333. PMC 7144599. PMID 32292903. 4-https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html. Accessed August 21, 2020. 5- Narang K, Enninga EAL, Gunaratne MDSK, et al. SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review. Mayo Clin Proc. 2020;95(8):1750-1765. doi:10.1016/j.mayocp.2020.05.011 6- Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J. 2020;55(6):2001260. Published 2020 June 18. doi:10.1183/13993003.01260-2020 7- Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020;508:254-266. doi:10.1016/j.cca.2020.05.044 8-Joseph R. Larsen, Margaret R. Martin, John D. Martin, Peter Kuhn, James B. Hicks. Modeling the Onset of Symptoms of COVID-19. Frontiers in Public Health, 2020; 8 DOI: 10.3389/fpubh.2020.00473