COVID-19 and pregnancy: What moms-to-be need to know
How will this affect me and my baby? 
Is it still safe to go to the doctor's office for appointments?
Should I be doing more to keep me and my baby healthy?
Amid the coronavirus (COVID-19) pandemic, these are the kinds of questions you're probably asking yourself if you're pregnant.
There is still much for medical experts to learn about how COVID-19 could cause problems during pregnancy, whether it can be passed to the fetus, and how it can affect the health of babies after birth. But there is concern for women with high-risk pregnancies, including women who have diabetes, chronic hypertension or lung problems.
Pregnant women in general experience changes in their bodies that can increase risk for infection, and with viruses from the same family as COVID-19 and other viral respiratory infections (such as influenza), they may have a higher risk of becoming seriously ill, says the Centers for Disease Control and Prevention.
"Pregnant women have increased needs for good pulmonary function. Therefore, any pregnant woman who has significant lung problems would be at higher risk for COVID-19 infection. This would include severe asthma, HIV, chronic heart disease, chronic lung disease, kidney disease, and immunocompromise states," says Pedro P. Arrabal, M.D., director of maternal-fetal medicine at Sinai Hospital of Baltimore. "Our recommendations are extrapolations from women having been infected with influenza. However, much information is still unknown about the effects of this virus in pregnancy, and pregnant women should not be lulled into a false sense of complacency about this infection."
At the first sign of infection, "such as difficulty breathing, fever, shortness of breath, coughing up blood, chest pressure, nausea and vomiting," and dehydration, you need to be medically evaluated, Arrabal says. "There may be a higher risk of preterm labor and you should be evaluated ASAP. If there is a clinical need for radiologic studies such as a chest x-ray or chest CT scan, they can safely be performed during pregnancy and they should not be delayed," he adds.
Is it still safe (or necessary) to go to appointments?
Do you have to conduct all your pregnancy appointments at the doctor's office during the COVID-19 pandemic? Well, if your pregnancy isn't considered high-risk, and depending on how far along you are in your pregnancy, telemedicine visits may be an option for you. Sinai, for instance, recently implemented telemedicine visits via phone calls for checkups and, depending on how long the pandemic lasts, is prepared to conduct phone visits during the early weeks of pregnancy after the all-important initial in-person pregnancy visit.
"Coincidentally, we had recently instituted telemedicine for diabetes education and genetic counseling. This has worked out very well," Arrabal says.
Many patients, however, require ultrasounds and an evaluation of their vital signs, particularly those at risk for hypertension. "Many of the ultrasound procedures and fetal testing that we do in pregnancy have significant time limitations and need to be performed at specific times during the pregnancy," Arrabal says.
Also, if you are at 24 weeks gestational age and beyond, you will need to be seen in person. "It is important to have regular blood pressure checks and visits with a physician as you get closer to your delivery date," says Elizabeth Zadzielski, M.D., chief of Obstetrics & Gynecology at Sinai.
Zadzielski stresses that an in-person visit is necessary if you just recently found out you're pregnant.
"It is extremely important to have that first ultrasound to determine how far along you are. Important blood work and tests, such as the first trimester screen, still need to be done as well," Zadzielski says.
In addition, if you've been experiencing problems with bleeding or decreased fetal movement, or if there are concerns about preterm labor, you will need to be seen in a doctor's office or OB triage unit. "Patients whose fetuses are at risk for compromise and stillbirth need to be seen on a regular basis for fetal testing," Arrabal says.
He adds: "Delivery still needs to occur in the hospital or birthing center setting, and not at home."
Take precaution
What should you do if you're pregnant to protect you and your baby amid the COVID-19 outbreak? Essentially the same things as the general public: good hand hygiene (use soap and water or alcohol-based hand sanitizer), social distancing, plenty of rest and nutritious meals.
"Try to get outside and into some fresh air," Zadzielski says. "As compelling as the news may be, try to limit exposure to the media blitz that can provoke anxiety."
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