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COVID-19 and Preeclampsia

Last Updated on November 09, 2020

Do not let the fear of contracting COVID-19 virus keep you away from getting the care you need for preeclampsia signs and symptoms.  NOT going to the doctor or hospital if you have signs of preeclampsia is more dangerous than getting COVID-19. The following information has been developed by members of the Preeclampsia Foundation Medical Advisory Board and other credible sources. Check back often for updates. Thanks to our Patient Advisory Council for curating some of the most common questions facing our patient community during the Covid pandemic. 

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Things to discuss with your hospital staff or doctor

Heathcare providers are ready to answer your questions about hospital policies, prenatal care, labor and delivery, recovery.  Based on birthing moms just like you, click the image to the right for a checklist of things you may want to ask about.

Evolving COVID-19 and pregnancy research from the CDC

June 26, 2020 - These findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar.

 

Will newly delivered babies be separated from their moms? Newest CDC guidance

May 20, 2020CDC revisions were made today to reflect new Evaluation and Management Considerations for Neonates At Risk for COVID-19 and updated Guidance on Care for Breastfeeding Women. Testing is recommended for all babies born to women with confirmed or suspected COVID-19, regardless of whether there are signs of infection in the baby. And they're recommending temporary separation of the newborn from a mother with confirmed or suspected COVID-19. And if the mom and her baby are not separated, CDC offers several measures to minimize risk of transmission.  What does this mean if you do NOT have COVID-19 virus? Specific practices for labor, delivery and the postpartum period will vary across the country and by birthing center. It's best to talk to your healthcare provider ahead of time so you can mentally and practically prepare yourself. See our advice below.

 

Relevant clinical guidelines and research studies about COVID-19 and pregnancy

May 13, 2020 - The target audience for this website are perinatal clinicians and scientists, but we provide it here so our preeclampsia community can quickly access published reputable information on COVID and pregnancy. It is relatively scant but growing daily as peer-reviewed journals are fast-tracking bona fide research studies. Under the various headings, you can find protocols, opinions and reviews which may guide the kind of care you receive if you have your baby during this pandemic, as well as active clinical trials which you may choose to enroll in. On the topic of research, be careful when reading stories in the media about therapies in development. “It’s better than nothing” does not apply to toxic and powerful drugs with potentially lethal side effects.  Always discuss any treatments for COVID or preeclampsia with qualified healthcare providers.

 

What we're learning from the experts, and each other

April 16, 2020 - Making the most of prenatal or postpartum telehealth appointments, what doctors and midwives on the frontlines are experiencing today and what you can do to prepare for delivery in the midst of a pandemic.

 

Does pregnancy alone put people at higher risk for severe illness from COVID-19?

April 6, 2020 - ACOG and SMFM reported that the Centers for Disease Control and Prevention (CDC) recently removed pregnant people from their webpage that outlines “people who are at higher risk for severe illness” from COVID-19. Consistent with available data, the CDC continues to recognize that pregnant women have been at risk for severe illness, morbidity, or mortality compared with the general population in other related coronavirus infections, including severe acute respiratory syndrome coronavirus (SARS-CoV). The CDC’s current guidance regarding COVID-19 and pregnancy is based on limited data, which, at this point, does not indicate that pregnancy alone puts people at higher risk for severe illness resulting from COVID-19 infection. However, newer research (May 15, 2020) from the state of Washington, explained in this video, suggests that COVID-19 can severely affect pregnant women who are overweight or obese before becoming pregnant.

 

It's Official: Wear a mask in public

April 3, 2020 - CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.  Here’s how to make your own mask.

 

Are you pregnant or recently delivered with known or suspected coronavirus (COVID-19)?

March 22, 2020 - PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) is a nationwide study of pregnant or recently pregnant women who are either under investigation for Coronavirus infection (COVID-19) or have been confirmed to have COVID-19. This study is being done to help patients and doctors better understand how COVID-19 impacts pregnant women and their newborns. Sign up online today.

 

Taking your blood pressure at home: how accurate is your reading?

March 20, 2020 - The FDA announced that it issued a new policy that allows manufacturers of certain devices which measure vital signs – such as blood pressure (BP) cuffs - to expand their use so that health care providers can use them to monitor patients remotely. There is often concern about the accuracy of automated BP devices that have not been validated which is more worrisome since people who may be at higher risk of COVID-19 must accurately monitor their BP at home. According to studies, 70 per cent of readings from home blood pressure monitors are unacceptably inaccurate, which could have serious implications for people relying on them to make informed health decisions. You can either read this 76-page document from the World Health Organization, or you can check out our quick infographic to make sure you’re getting an accurate BP measurement at home.

 

I’m pregnant and being watched closely for preeclampsia, or I have preeclampsia that is being managed at home. How should I protect myself from COVID-19, and how will it affect my pregnancy?

April 1, 2020 - Because this is a new virus (SARS-CoV-2) that causes a new illness (COVID-19), healthcare providers work with some uncertainty, but there are things you can do. Everyone in the general public, including pregnant women with or without preeclampsia, should lower the chance of infection by the virus that causes COVID-19 by:

  • washing hands frequently with soap and water for 20 seconds
  • using hand sanitizer when you cannot wash your hands
  • coughing and sneezing into your elbow or a tissue
  • social distancing
    • maintaining a 6 foot separation from others
    • staying home as much as possible
    • avoiding people who are sick
    • staying home when you are sick

 

We do not know if pregnant women or women with a history of preeclampsia are at greater or lesser risk from COVID-19. Early reports suggest there will not be as much risk as there was with H1N1, the so-called "swine flu." Pregnant women can have a weaker immune response to infection, but in women with preeclampsia this immune response is different from what is normal in pregnancy. We may learn more as this pandemic continues. The Centers for Disease Control and Prevention (CDC) is maintaining a page on pregnancy, breastfeeding and COVID-19.

The concerns around “vertical transmission” from infected mother to her unborn baby through the placenta are not well known yet. So far, no virus has been found in the breastmilk or the amniotic fluid of infected women. This probably means you will not be able to pass the virus to your baby through breastmilk and that it does not cross the placenta to the baby while you are pregnant. There is no guidance yet for how long newborn babies should be kept out of public places after birth to protect them from exposure, but right now everyone has been asked to stay home as much as possible to lower the risk of community transmission. We suggest this means keeping the baby at home until further notice. Somewhat older children do not seem to develop severe cases, although they can be infected. Teenagers can be sicker than younger children. Your pediatrician should offer more guidance. We will update our messages as we learn more.

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19, but there is ample evidence that practices vary from location to location.

 

Does having a history of preeclampsia put me at higher risk of getting COVID-19 virus?

If you are not currently hypertensive or if your hypertension is well-controlled by medication, no, probably not.  If your postpartum hypertension is not well-controlled roughly two months after delivery, you may be at higher risk. Most, but not all women who do poorly from COVID-19 has significant and active underlying heart disease or high blood pressure, or other health conditions that make you more vulnerable. Those who are at high risk of getting very sick from this illness include older adults or people with serious chronic medical conditions like heart disease, diabetes and lung disease.

Although preeclampsia can put you at a greater risk of cardiovascular disease, you would have to already have this condition to be considered in the higher-risk category.

 

Is there any connection between a history of preeclampsia or HELLP and how our bodies handle an infection by this coronavirus?

All viruses, including coronaviruses, find ways to duplicate themselves inside cells, and use proteins on the outside of those cells as “receptors” that help them attach to other cells.  The particular receptors for COVID-19 are called angiotensin 1 converting enzyme 2, or ACE2,  ones that we share in common with all mammals and also birds. 

There is no known correlation between preeclampsia and COVID-19 at this stage of research, and the existence of this cell receptor as a target for the disease doesn’t suggest there will be one (anything with kidneys has this cell receptor.) We need to learn more about this illness and how this virus works to be able to say much more.

We don’t know exactly why people with various underlying conditions are at higher risk from viruses, but probably it is just that they are less resilient - they make fewer of the proteins that would protect them against a viral onslaught, or they make too many. But this is not a fact we know with any precision about any coronavirus, let alone this brand new one.

 

What options do I have for having my pregnancy monitored from home?

Telehealth regulations have been relaxed in the face of the coronavirus pandemic. Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely. Most healthcare providers and facilities have now implemented ways to see you and talk to you from your home.

If you can, monitor your blood pressure (BP) at home: take your BP twice a day, at the same time each day. Report signs and symptoms of preeclampsia you may be experiencing during each of your telehealth visits. If you are having serious symptoms or very high blood pressure (a reading reaching either of 160/110 or numbers close to those), you will need to be seen by a healthcare provider. Call ahead and ask how the hospital wants to evaluate you. This may happen in the parking lot, or with infection controls in place to protect you.

 

What might I expect if I go to the hospital to deliver my baby or to be checked for preeclampsia?

You will likely be screened for symptoms when you arrive at the hospital, probably with a nasal swab. Some newer tests give results in an hour or so.

If you have symptoms and/or a positive test you will be treated differently. Your providers will wear special equipment to protect themselves. Some communications may be through digital devices to limit the number of entries to the room. Your nurses may want to learn your cell phone number so they can call you to ask about your needs without entering the room.

The number of support persons may be limited and well as the traffic in and out of your room restricting coming and going. We are finding that this varies from state to state and hospital to hospital. Your hospital will let you know about the local guidelines. Some parts of the country have been less affected and may have looser restrictions. Check with your hospital and don't assume anything based on what you've heard about elsewhere.

Prepare your “labor bag.” Have a cell phone or other communication device and a charger. If you are going to be evaluated, bring it in with you – don’t leave it to be retrieved from the car.

 

How can I manage labor and delivery without a support person?

Have a technology plan and a virtual partner plan. Use technology such as Skype, FaceTime, or Zoom to be in touch with your support team, including a doula, during delivery.

  • Download and test the apps in advance.
  • Make sure to pack chargers.
  • Is there WiFi at the hospital?
  • Do you have a stand or tripod?
  • Create a playlist of your favorite music
  • If you don't have a phone, tablet or computer, is there a telephone in the room?

 

Walk through your birth plan with your support person in advance so they can advocate on your behalf if needed.

 

What should I expect after delivery, either with or without disease?

If you have confirmed disease, you are likely to be isolated postpartum. You may be separated from your baby until you clear the virus. This is to protect your baby. While your breast milk is unlikely to transmit the virus, the close proximity associated with breast feeding is a high risk scenario. You’ll have to wear a mask.

If you do not have the virus, you may be moved to a “clean” area of the hospital or, in hot spots like New York City, to a hotel for your postpartum period. You may find the hospital is eager to get you home quickly.

 

Wondering what it’s like to be pregnant during the COVID pandemic and have preeclampsia?

Check out the stories of Elise SagaspeAllison AdamsJessica Lawler, Whitney Williams and Jessica Runyon.

 

Have your own COVID pandemic and preeclampsia story?

Share Your Story

 

Other Resources for Pregnant and Postpartum Mothers and Families

ACOG has assembled some of the most common questions posed by patients such as "Am I safer having my baby at home?" and others. Our partners at BabyCenter and SMFM also answer moms-to-be most pressing questions

If you are interested in diving into more scientific information, the New England Journal of Medicine has made its COVID-related articles and other resources freely available, including clinical reports, management guidelines, and commentary.

Coronavirus (COVID-19) information is constantly evolving. If you discover outdated information or you have other suggestions for resources that may be useful to our preeclampsia community, please email us.

 

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