The novel coronavirus pandemic is a moving target. Our scientists don’t fully understand it, politicians can’t agree on what to do, and at least one at-risk population — pregnant women — are left in the dark.
COVID-19 puts us all at risk, of course, but pregnant women and their babies encounter additional risks. This would be concerning if the United States weren’t already in the midst of a maternal and infant health crisis today, but we are. Congress needs to take actions now to prevent a second COVID-19-related crisis — a wave of premature births and poor outcomes, especially among our most vulnerable populations.
I might be more sanguine if I hadn’t seen this play out during the last pandemic threat: H1N1 influenza in 2009. I was a public health official in West Virginia at the time and saw troubling developments in the care of pregnant women and the impact on pregnancies. H1N1 caused severe illness and death in pregnant and postpartum women. Severely ill pregnant women with H1N1 more frequently had adverse outcomes such as preterm births, a trend we’re already seeing with COVID-19. Then, like now, there was a dearth of data around pregnant women because no one was gathering it. Without tracking data on hospitalizations, severe disease and deaths, public health officials couldn’t provide guidance in real time.
COVID-19 concerns for pregnant women
Similarly, with COVID-19, there is still much we do not know. Today, pregnant women are stuck in a sort of limbo. It’s unclear whether they have a greater chance of getting sick from COVID-19 or whether they are more likely to have serious illnesses as a result, according to the Centers for Disease Control and Prevention.
Congress could solve this problem by authorizing and funding a series of studies specifically focused on COVID-19’s effect on pregnant women and their babies. This data would help us better understand what is happening at a point in time in obstetric offices, birth centers, and labor and delivery wards and would allow public health officials to provide real time clinical guidance.
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The little information we do have is troubling. We know pregnant women are at greater risk of severe illness when infected with viruses from the same family as COVID-19. We also know the underlying stress of living through a pandemic — compounded by the strains of social distancing — can cause pregnancy complications. A growing body of research shows that cultural, environmental and social stressors can harm the health of mother and baby. Sustained high levels of stress can cause or worsen health problems for pregnant women, such as high blood pressure, heart disease and preterm birth.
All this uncertainty can also disrupt normal sleep cycles, a person’s diet and exercise habits — factors critical to a healthy pregnancy. Increasing social isolation can also cause fear and anxiety in addition to aggravating mental illnesses, such as depression. Many pregnant women are being overwhelmed by home-schooling, caring for sick parents or working remotely, ramping up both physical and mental stress.
Finally, intimate partner violence is on the rise, a grave concern for pregnant women.
Lawmakers need to help
Before this pandemic, the United States was already in the midst of a maternal and infant health crisis. About 1 in 10 babies were born preterm, and every 12 hours a woman died due to complications from pregnancy. The numbers are worse for black women, who are three to four times more likely to die during pregnancy. We know that communities of color are being disproportionately impacted by COVID-19.
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To reduce the risks this pandemic places on moms and babies, Congress must ensure that every pregnant woman in the USA has insurance coverage and access to care during this crisis and up to one year after the baby’s delivery. This is aggressive but necessary. The coverage should not have out-of-pocket costs, copays for emergency room use or Medicaid work requirements. Medical professionals should expand the use of telemedicine during pregnancy, which is often underutilized in obstetrics and gynecology practices. This will allow critical prenatal visits without the additional risks of exposure.
As it becomes increasingly clear that we’ll be dealing with COVID-19 for years, not months, we need to ensure that we’re taking steps to protect women long term. Congress can do that by requiring that clinical trials include pregnant and nursing moms. Most drugs that receive Food and Drug Administration approval have not been tested on pregnant and lactating women. In fact, a current clinical trial of a possible COVID-19 treatment does not allow pregnant or breastfeeding women to participate.
If our studies neglect this vulnerable population, as is the case because of FDA guidelines, we can’t know how treatments or an eventual vaccine will impact pregnancies.
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We’re learning some hard lessons from our nation’s failure to properly plan for an epidemic that we knew would one day arrive. But if our experience with this pandemic teaches us anything, it’s that we cannot do enough to protect vulnerable populations, whether the elderly, communities of color, those with chronic conditions or, yes, pregnant women and infants.
Dr. Rahul Gupta is the chief medical and health officer for the March of Dimes and a practicing physician. Follow him on Twitter: @DrGuptaMD
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This article originally appeared on USA TODAY: Coronavirus pandemic is a lurking danger for pregnant women