Pregnancy In A Pandemic

The coronavirus pandemic has exacerbated pregnancy related risks globally, including in Ecuador, which has one of the two highest rates of adolescent pregnancy in South America. 1 in 5 girls give birth before age 18 in the South American country and now with the pandemic, complications from pregnancy in risky populations – both teens and adults – are exacerbated.

Due to the isolation of Covid, pregnancy is leading to more depression and anxiety than usual as well as less access to care, particularly in rural areas in North, Central and South American countries. This depression elevates the risk of early term birth, brain development and hospitalization, including mortality of child or mother, according to Barry Lachman, MD, a pediatrician who worked for the Parkland Health System in Dallas Texas for 30 years.

Early education and screening for depression are ways some US health systems and health plans are trying to reduce these risks, though Covid has complicated or delayed the ability to conduct these initiatives. Telehealth screening and education are options and will be important systems to put in place.

There is evidence that a mom’s extreme stress can affect fetal brain development. A study published earlier this year in JAMA Pediatrics found differences in fetal brain growth among pregnant women who were psychologically distressed. Stress levels have tripled in women pregnant during the pandemic, according to The Developing Brain Institute at Children’s National Health System in Washington D.C, which first surveyed pregnant women about their stress levels in 2014. 50% reported experiencing moderate to high levels of anxiety this year, up from 18% in 2014, while 35% felt depressed compared to 12% in 2014.

The sample had just 35 patients so researchers suggest a broader study to further understand implications.

Expectant mothers are also likely at an increased risk of getting the COVID-19 virus, according to the Centers of Disease Control, but unlike the Zika virus of 2016, there is no evidence that COVID-19 infection during pregnancy can directly impact the growing fetus.

The global pandemic has made pregnancy challenging in other unexpected ways. New mom Sara Littau, 26, of Connecticut, says her due date was square in the middle of the pandemic in April so she wasn’t able to bring her husband to appointments. “I pretty much stopped doing anything outside of the house aside from going for walks around our neighborhood to stay safe,” Littau says.

Post pregnancy challenges are arising as well. The incidence of postpartum depression was already high but with less of a support system able to help due to Covid travel restrictions, the number of new moms suffering from this is increasing. An OBGYN in North Carolina says 65% of moms who delivered during Covid are “having serious postpartum depression,” up from what is usually 20-30%, Pamela Fines, MD, says. Having Facebook or other video connection with family helps, but Dr. Fines says it doesn’t “treat” the depression.

The University of Pittsburgh in Pennsylvania created a remote monitoring program last year that has helped address postpartum. That story by clicking here

Families have had to make accommodations to have relatives meet their new child through a window, glass door or just through a phone screen. “Once we brought our son Nolan home we had originally planned to let visitors come and see our son after a few days, but the pandemic changed that plan completely,” Littau says. “We had visitors come over and see Nolan only through our sliding glass door.”

The delivery of a baby is different now than it was six months ago with new safety guidelines, extra layers of personal protective equipment and everyone wearing masks. Although it looks different, the same compassion and care is going into the delivery as before though telemedicine visits are more prevalent during the 9 month pregnancy to connect parents, families and doctors. Mothers typically need to do a COVID-19 test before being admitted into the hospital for safety measures and no visitors in the hospital.

Littau’s biggest fear was not having her husband in the delivery room but she ended up having an amazing experience at Bristol Hospital. “From the moment we entered my hospital room in the maternity wing it felt like we were in our own little bubble and the coronavirus didn’t exist there. The nurses and doctors did such a great job at making everything feel as normal as possible. I didn’t worry about the virus once while we were in the hospital. I felt safe.”

Parents now must pay close attention to their mental health when they’re in the postpartum phase because even under normal circumstances it’s extremely exhausting to have a newborn but during a pandemic it’s even more so.

Littau is thankful to have her family healthy and safe during the pandemic. “We spend a lot of time outside and together as a family of three. I continue to just look at the bright side of things and I feel blessed to have a happy and healthy baby, at the end of the day that’s really all the matters.”

-Report by Erin O’Donnell

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