Like many people, back in April, Christin New needed something to look forward to. Not only was a pandemic spreading around the word, she’d just had a miscarriage. So when she and her husband found out they were expecting, they were overjoyed.
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“Especially after having a loss ... it was sort of like this really bright spot,” New says.
Another silver lining? Her husband has been able to actually experience the pregnancy literally by her side, since they’re both working from home. But with those silver linings come some big worries.
“One of the first things I remember that I thought of was when Zika virus had an outbreak in South America ... babies were born with small heads, serious birth defects. And, you know, there's a much higher rate of infant mortality,” she says.
And then there are the symptoms themselves. The novel coronavirus attacks your respiratoryandcardiovascular systems and can cause some serious problems with blood flow, which is really important for a fetus.
“And so I think my greatest fear was that if I were to contract it, what would the damage be? Even if I only had a moderate case and I was never hospitalized?”
So, when she asked her doctors these types of questions, they had some answers, but not that many.
There’s growing evidence that people who get COVID-19 while pregnant may be more likely to have a miscarriage, preterm birth, or need a cesarean section. And, they may be more likely to end up in the ICU. But so far, there’s no evidence of birth defects,most studies have not shown the transfer to fetus in the womb or through breast milk, and theAmerican College of Obstetricians and Gynecologists says there’s no reason to delay having a child right now.
But because COVID-19 hasn’t been around that long, researchers really don’t know all the specific ways the virus could affect a pregnancy, especially if someone contracts it during their first trimester. But, New’s doctor told her she could be part of a nationwide study called ASPIREtrying to figure it out, so she signed up. Here’s one of the study’s leaders, reproductive endocrinologist Dr. Marcelle Cedars.
“In almost every viral infection you look at, whether it's rubella, Zika, any viral infection, infection in the first trimester is always much, much more critical, which makes sense,” says reproductive endocrinologist and one of the study’s principal investigators, Dr. Marcelle Cedars. “That's when the fetal organs are forming.”
The hypothesis is that this could be the same for COVID-19. So, she’s recruiting over 10,000 pregnant people in their first trimesters across the nation and asking them to give blood samples. They’ll be able to see if and when they contract COVID-19, and notice other small biological changes. Researchers will continue following the babies until they are 18 months old.
“Are there higher rates of preterm birth? Are there higher rates of preeclampsia, high blood pressure with pregnancy? Are there higher rates of fetal growth restriction? And then we're really specifically focusing on neurodevelopmental issues,” Cedars says.
Cedars says what they’re paying most attention to is the effect COVID-19 has on the placenta. Even an asymptomatic person's strong immune response could impact the placenta, harming the fetus’s development.
“It's a little bit of a scary thought that there may be this sort of silent infection. But I think it's information we need to have, not only for COVID-19, as this is not the first coronavirus, it won't be the last coronavirus.”
It’s why there are a handful of studies at UCSF alone looking at pregnancy and COVID-19.
Before the pandemic, epidemiologist and biostatistics professorDr. Laura Jelliffe-Pawlowski was looking at how stress could lead to pregnancy orbirth complications.
“Things like 9/11 in New York, we saw a huge spike in preterm births, for example. We've also seen that around the world with tsunamis ... where these really big, huge punctuated stressors have caused some women to go into delivery quite soon after those big events,” Jelliffe-Pawlowski says.
It’s also been shown that loss of a job or income while pregnant is associated with higher rates of preterm birth, low birth eight, even miscarriage or stillbirth. So when COVID-19 hit, her team wanted to begin collecting data right away.
The HOPE COVID-19 study plans to enroll 10,000 pregnant people over the next two years. Jelliffe-Pawlowski says almost every pregnant person she’s heard from so far is reporting much higher levels of stress.
“Terrified women, lower income women who are having to choose between staying at home and going to work, especially in customer facing environments where they might be at higher risk,” she says.
Half of the study participants will be low income, and half will also be Black or Latinx because the team wants to see how COVID-19 is already magnifying existing birth disparities
“We were already having an epidemic of Black mothers and babies and people dying or nearly dying because of pregnancy and childbirth.
Dr. Karen Scott works on the stress study with Jelliffe-Pawlowski, and is also the principal investigator of another study called SACRED Birth. She says the coronavirus has ripped a huge bandaid off — even before the pandemic, Black people are more likely than white people to have a preterm birth or die in childbirth. So as part of SACRED Birth, over the past few years Scott has been developing ways to measure how racism shows up in the care a Black person receives, from pregnancy to labor to post partum. It’s a way to look at their experiences, not just the outcomes of their pregnancies.
“When the pandemic hit, ‘it was like someone's finally going to listen to me,’ obviously, because everyone's talking about racism, everyone is talking about differential outcomes, why is this one group dying at this rate.” Scott says.
With help from Black women-led organizations, she’s making a survey that will gauge how Black pregnant patients were spoken to, if they felt safe, treated with empathy and dignity. It'll ask about experiences of birthing alone, the separation from a child at birth, or whether they were taught how to breastfeed with their own bodies. Eventually, she says the public will be able to see how different hospitals and insurance plans score across different areas. And now, it’ll take into account COVID-19.
“Hospitals responded to the pandemic with these policies that they thought would contain the spread, but they ended up reinforcing these very harmful experiences or policies for the most marginalized people, like having nobody at your birth.”
Scott says people often share that hospital nurses and physicians aren’t welcoming to Black men in birth spaces — this was happening long before COVID-19 was a thing.
“So my question to hospitals and health plans will be, ‘now what? What is your excuse?’ You can't say you don't know what racism is. You can't say you don't know how to define it ... I don't know what the excuse is going to be after that.”
With Scott’s work, and with the other pregnancy research happening right now, the goal is to provide solutions alongside the data. So that everyone can have healthy pregnancies, regardless of the pandemic and racial disparities it’s laying bare.
