For several weeks experts warned us of rising Covid-19 Delta Variant cases sweeping across North Texas. The Delta variant, SARS-CoV-2 B.1.617.2 (Delta), was first identified in India in late 2020. This strain rapidly spread worldwide and is now the dominant variant in the United States, including Texas.

The CDC reports that the Delta variant accounts for 93% of current US Cases. The Delta variant is the most contagious so far. It passes easily and quickly from person to person. Children also catch the delta variant at a higher right than the original Covid-19 virus. A mutation in the spike protein makes the virus more “sticky.” It is more contagious and spreads in children faster than the original Covid-19 strain.

All Texans want children back in school, but we disagree on how to do it safely. 

Governor Abbot, who typically advocates for local control, has switched gears and taken a top-down approach. The Governor’s May Executive Order mandated no mask mandates. Abbott took control away from superintendents and consolidated his power in Austin. 

Parents in Dallas and Tarrant County are faced with tough decisions. How do parents send their children to school safely in the middle of a North Texas Covid surge? 

So far, 52,555 Texans have lost their lives to Covid-19. Many people are still in the mindset of “this won’t happen to me.” Now is the time to shift our thinking and face reality in our communities.

The University of Texas Southwestern, located in Dallas, provides updated data to help parents guide their decisions. The medical school publishes publically available projections an epidemiological model. 

Three weeks ago, I had zero patients with Covid-19. This weekend I cared for seven pregnant patients with the virus. The three local hospitals where I work are full of patients in the ICU. 

The UT Southwestern data demonstrates the exact rise that I am seeing working as a local physician. The projections for the next few weeks are alarming. 

UT Southwestern is projecting a substantial increase in the number of hospitalizations over the next few weeks. Hospital admissions are up 99% in two weeks and 346% in the past month. 

Check out the blue line in the chart. The blue line is the estimate of hospitalizations for the next three weeks. If cases continue at this pace, we will be dangerously close to surpassing available hospital capacity in Dallas and Tarrant County. 

In our hospitals, more young people are coming in with severe Covid infections requiring hospitalizations. UT Southwestern data reports that people under 65 represent the largest share of hospitalizations.  

The data also shows the overwhelming majority of patients with severe disease requiring ICU care are unvaccinated people. 

The UT Southwestern projections also show the people of Dallas and Tarrant County have the power to change the course of the virus. 

In this chart, the data scientists show the effect of basic mitigation strategies. If we increase the rate of vaccination locally and keep our masks on, we can save lives. 

The orange line shows what happens if we do nothing different. The green line shows how quickly we can make a substantial difference by covering our faces and getting as many people a life-saving Covid-19 vaccine as possible. 

There are three FDA-approved vaccines for Covid-19. The two messenger RNA vaccines from Moderna and Phizer offer 95% protection against Covid-19. The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA). A single strand of mRNA delivers instructions to human cells to produce an antibody against the SARS-CoV-2 spike protein.

The Johnson and Johnson’s Janssen vaccine offers 72% protection against infection and 86% against severe disease. The Janssen vaccine uses Adenovirus 26 (AD26) as the vector to deliver DNA material into our cells to provoke an immune response.

The FDA expanded the emergency use authorization for the Pfizer messenger RNA Covid-19 vaccine for kids age 12–15 years old after Phase 3 study data showed the vaccine was 100% effective in preventing Covid-19 in this age group.

None of the vaccines contain a live virus. One can not catch Covid-19 from a vaccine. The vaccines do not enter the nucleus of the cells and do not alter our DNA. 

The Covid vaccines are not linked to miscarriage or Infertility. Research indicates most pregnant people who contract Covid-19 do well but have an increased risk of ICU admission and preterm labor.

The American College of Obgyn and Society for Maternal-Fetal Medicine recommends all pregnant women get a Covid-19 vaccine. The protective antibodies can save women’s lives and help protect the newborn.

Vaccines are available everywhere. They are free. We can help protect children going back to school by increasing vaccination rates.

Children who are 12 years old and older can get their Pfizer vaccine today. Adults can help protect the community by getting any of the three available Covid shots.

Children under age 12 are counting on us to protect them. We can slow the spread of Covid-19 by getting vaccinated. 

Protect yourself. Protect others. Protect the children. 

Get your shot today.

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The world is fighting two pandemics: Covid-19 and misinformation. Dangerous social media rumors and falsehoods continue to circulate, creating fear and mistrust among the general public. This week, the misinformation focused on a false link between Covid-19 vaccination and miscarriage.

The baseless claims started after anti-vaxxers misleadingly shared posts from a popular Oklahoma OB-GYN physician. Michelle Rockwell, MD, publicly shared the tragedy of her miscarriage through her social media platforms. She also celebrated her Covid-19 vaccination three weeks later. Conspiracy theorists disregarded the timeline, took her Instagram posts out of context, and spread falsehood regarding the timing of her vaccination and pregnancy loss.  

Facebook also removed a false post claiming that the head of Pfizer research found a link between the vaccine and female sterilization. This particular false claim is based on a confusing twist of scientific facts.

The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA). A single strand of mRNA delivers instructions to human cells to produce an antibody against the SARS-CoV-2 spike protein. The conspiracy theory that Facebook addressed stems from the fact that the spike protein is genetically similar to an essential placental protein called syncytin-1.

The placenta is the organ inside the uterus that keeps the baby alive through its internal filtration system. Syncytin-1 and the coronavirus spike protein share a tiny string of amino acids, but the placental protein is unrelated to the SARS-CoV-2 spike protein. The genetic similarity is not close enough for vaccine antibodies to recognize syncytin-1.

These fabrications prompted a statement on February 4 by the American College of Obstetricians and Gynecologists (ACOG) titled “Medical Experts Continue to Assert That Covid Vaccines Do Not Impact Fertility.”

Leaders from the U.K. spoke up about the viral misinformation. The president of the Royal College of Obstetricians and Gynecologists, Edward Morris, MD, issued guidance in January to reassure the public, stating, “There is​ ​no biologically plausible mechanism by which current vaccines would cause any impact on fertility.”

Neither the Moderna nor Pfizer vaccine contains a live virus. One cannot catch Covid-19 from the vaccine. Pregnant patients can rest assured mRNA vaccines do not cause fetal genetic changes. The mRNA vaccines do not enter our cells’ nucleus and do not alter vaccine recipients’ DNA. 

Much remains unknown about the novel coronavirus’s effects on pregnant women, babies, and Covid-19 vaccination in pregnancy. Research indicates most pregnant people who contract Covid-19 do well but have an increased risk of ICU admission and preterm labor.

Based on the known risks of Covid-19 infection in pregnancy, the American College of Obstetricians and Gynecologists advocates offering vaccination to pregnant and lactating people.

More than 3.7 million individuals give birth in the United States per year. Excluding pregnant patients from vaccine eligibility or scaring them away with false information creates a significant risk for moms and babies.

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The American College of Obgyn and other Women’s health experts agree that Covid-19 vaccines should be offered to pregnant or breastfeeding people. Pregnant women were excluded from the initial Covid-19 vaccine clinical trials. Obstetrician/gynecologists, like me, follow the latest research to help our patients make safe decisions regarding their pregnancy.

The Boston research team published a study titled “Covid-19 vaccine response in pregnant and lactating women” in the American Journal of Obstetrics and Gynecology (AJOG). The paper is consistent with several small studies showing pregnant individuals have a robust immune response after the Covid-19 vaccination and secrete the antibodies into their breast milk.

This study analyzed blood samples and breast milk from 131 women in Boston and the surrounding area. The group included 84 pregnant, 31 lactating, and 16 nonpregnant individuals. The study also included five women who reported a previous SARs-CoV-2 infection. Each participant received the two-dose series of the Pfizer or Moderna Covid-19 vaccine following the FDA-approved protocols.

The research team tested blood and breast milk before vaccination and monitored the antibody response. The scientists compared antibody levels in pregnant women to 37 individuals with a history of natural infection during pregnancy and a cohort of nonpregnant people.

The results indicated a robust blood antibody response in all three groups. While scientists have shown already that moms pass protective antibodies to their baby after a natural Covid-19 infection, this study is important verification that pregnant women also develop an appropriate antibody response after vaccination.

Antibody transfer is good news for babies because a newborn’s immune system is not fully developed. Babies rely on maternal antibodies from blood and breast milk to protect against various infections during the first few months of life.

This study also reinforced encouraging news for lactating people. All the vaccinated mothers had antibodies in the breast milk samples. This finding provides further evidence that vaccinated women pass protective antibodies to their babies. Antibodies are present in breast milk within five to seven days of other viral vaccinations such as Tdap and influenza. Previous research also demonstrated women with a natural Covid-19 infection produce antibodies and secrete them into their breast milk. This study confirms published data from Portland that vaccinated women do too.

The side effects reported in the study were rare and similar in all three groups. The most common symptoms were fever and chills. These side effects are known to be good signs the vaccines are working to trigger an immune response.

This paper adds to the growing body of evidence supporting the safety and efficacy of Covid-19 vaccination in pregnancy and lactation. We continue to learn more about the novel coronavirus’s effects on pregnancy, newborns, and Covid-19 immunization in pregnancy.

Current research shows most pregnant people who contract Covid-19 have excellent outcomes but have an increased risk of ICU admission and preterm labor. Based on the known risks of Covid-19 infection in pregnancy, pregnant and lactating people are eligible for any one of the three Food and Drug Administration-approved vaccines.

None of the three FDA-approved vaccines contain a live virus. One cannot catch Covid-19 from the vaccine or spread the disease from the vaccines to a newborn through breastfeeding.

Pregnant patients can be confident knowing the three approved vaccines trigger an immune response to help protect themself and their babies.

Pregnant and lactating individuals are categorized as 1B in most states and1C in others.

To find a Covid-19 vaccine near you, click here.

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A new preprint study from the Florida Atlantic University Charles E. Schmidt College of Medicine shows more great news about vaccination during pregnancy. Their research confirmed the first known case of a baby born with detectable protective antibodies after maternal Covid-19 vaccination.

The paper titled “Newborn Antibodies to SARS-CoV-2 detected in cord blood after maternal vaccination” follows the clinical course of a pregnant healthcare worker who received the first dose of the Moderna mRNA vaccine. Florida Atlantic University offered all front-line healthcare workers the Moderna mRNA. The mother had no previous known Covid-19 infection. She qualified for and received her vaccination at pregnancy week 36.

The paper titled “Newborn Antibodies to SARS-CoV-2 detected in cord blood after maternal vaccination” follows the clinical course of a pregnant healthcare worker who received the first dose of the Moderna mRNA vaccine. Florida Atlantic University offered all front-line healthcare workers the Moderna mRNA. The mother had no previous known Covid-19 infection. She qualified for and received her vaccination at pregnancy week 36.

Three weeks later, she had a spontaneous vaginal delivery at term (39 weeks gestation). After delivery, she received her second dose as per the standard 28-day vaccine process. At the time of birth, the research team tested the healthy female infant’s umbilical cord blood for the presence of Covid-19 antibodies. The results showed a high level of IgG antibodies against the SARS-CoV-2 spike protein.

These findings are not surprising. Other vaccines given during pregnancy like Tdap and influenza are known to transmit immunity from mom to baby. Both influenza and Tdap vaccines reduce the risk for newborn babies who are too young to get vaccinated. These vaccines transfer antibodies from mom to baby through the placenta, protecting infants until they are old enough to receive their own vaccinations.

The placenta is the organ inside the uterus that keeps the baby alive. Maternal blood circulates through this internal filtration system allowing the growing baby to get oxygen and nutrients from the mother. The placenta removes carbon dioxide and waste products while also serving as the defense system against invading infections like bacteria and viruses.

This paper is critically important to Obgyns, like me, as it serves as a proof of concept verifying maternal vaccination offers some degree of protection to newborn babies. Improving our maternal vaccination rates can prevent hospitalizations and potentially save lives.

This case report showing maternal antibody transmission to the baby after vaccination comes on top of other news showing antibodies are passed through breast milk. Previous studies confirmed that moms pass protective antibodies to their baby after natural Covid-19 infection and secrete antibodies during lactation.

The United States is now vaccinating 2.5 million people per day and reached the 100 million dose milestone on March 19. At this rate, all adults who want it are on schedule to be vaccinated by the end of May. Pregnant patients need evidence-based, reliable, and actionable information as soon as possible to help make informed decisions about their pregnancies.

Scientists learn more each day to help find answers regarding the novel coronavirus’s effects on pregnant people, newborns, and Covid-19 vaccination in pregnancy. Guideline and recommendations will continue to change and evolve as more data becomes available. Based on current research, we know most pregnant people who contract Covid-19 have excellent outcomes and have an increased risk of ICU admission and preterm labor. 

Pregnant and lactating people are eligible for any of the three Food and Drug Administration-approved vaccines, including the two messenger RNA (mRNA) vaccines from Pfizer and Moderna and the single-dose vaccine from Janssen/Johnson & Johnson. The CDC states, “There is currently no evidence that antibodies formed from COVID-19 vaccination cause any problem with pregnancy, including the development of the placenta.”

To continue to monitor the safety and efficacy of Covid-19 vaccinations, the CDC established the v-safe COVID-19 Vaccine Pregnancy Registry. Any pregnant person may choose to participate in the registry to help the world gain more knowledge and improve vaccine recommendations.

To join the V-safe pregnancy registry, click here.

Pregnant and lactating individuals are categorized as 1B in most states and1C in others. To find a Covid-19 vaccine near you, click here.

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The US reached the 100 million dose milestone on March 19 and all adults who want to be vaccinated are on schedule to be vaccinated by the end of May. At the same time, states like New York and California are coping with a surge of Covid-19 variants. With 1 out of 6 adults now vaccinated, lactating people need information regarding the safety and efficacy of Covid-19 vaccination while breastfeeding.

The American College of Obgyn and other Women’s health experts agree that Covid-19 vaccines should be offered to those who are breastfeeding. New evidence from a Portland research team shows the vaccine benefits might be even better than we thought. Their preprint report shows vaccinated individuals pass protective antibodies through breast milk.

The Portland researchers published a study titled “SARS-CoV-2 antibodies detected in human breast milk post-vaccination.” Although the study numbers are small, the findings are critically important as the paper verifies that moms pass protective antibodies through breast milk after vaccination. These findings are not surprising as breast milk contains antibodies within five to seven days of other viral vaccinations such as Tdap and influenza.

This paper is important as we had not previously confirmed that the Covid-19 vaccines worked similarly to other vaccinations by producing breast milk antibodies. Previous studies confirmed that moms pass protective antibodies to their baby after a Covid-19 infection and secrete them during lactation.

The research team tested breast milk samples from vaccinated women in Portland and the surrounding areas in Oregon. The milk was tested for SARS-CoV-2 specific IgG and IgA antibodies until 14 days after the mothers received their second dose of the Pfizer or Moderna mRNA vaccines.

The research team from the Providence Portland Medical Center was supported by grants from the Chiles Foundation and Nancy Lematta, a retired Portland business person who donated $2 million to the Providence Health system’s Covid research fund.

The results demonstrated a high-level antibody response in breast milk starting seven days after the first maternal vaccine dose. The study’s sample size was small with only six patients. This proof of concept study will lead to further, more robust research. Newborn babies have undeveloped immune systems. Maternal antibody transfer is important for protection against various infections.

The study also showed that Covid vaccination induced higher antibody levels than from a natural infection. We do not know how long the breast milk antibody response persists or how much protection they offer the baby.

Each day scientists learn more about the novel coronavirus’s effects on pregnant people, newborns and Covid-19 vaccination in pregnancy. Guidelines change as we discover new information. We are no longer separating Covid-19 mothers from babies or discourage breastfeeding.

Because we have only studied SARS-CoV-2 for one year, the recommendations will continue to evolve as we learn more. Our current research indicates most the majority of pregnant people who contract Covid-19 do well but have an increased risk of ICU admission and preterm labor. We also know that the risk of transmitting Covid-19 to the newborn is very low.

Pregnant and lactating people are eligible for any of the three Food and Drug Administration-approved vaccines. The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA) in which a single strand of mRNA delivers the genetic code to produce anti-SARS-CoV-2 spike protein antibodies.

The Academy of Breastfeeding Medicine supports the use mRNA vaccines in their statement, saying that “while there is little plausible risk for the child, there is a biologically plausible benefit. Antibodies transferred into milk may protect the infant from infection with SARS-CoV-2.”

The FDA also authorized a single-dose vaccine from Janssen/Johnson & Johnson. The Janssen vaccine uses an older technology in which a denucleated Adenovirus 26 (AD26) delivers genetic code to cells to induce an immune response. The FDA data show the adenovirus gets rapidly removed from our bodies and does not appear in breast milk.

The FDA-approved vaccines do not contain live virus. A person cannot catch Covid-19 from the vaccine or spread the virus through breastfeeding. Lactating people can rest assured knowing the early research shows the protective antibodies from vaccination do pass into the breast milk.

To find a Covid-19 vaccine near you, click here.

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Although much remains unknown about the coronavirus’s effects on pregnant women and babies, scientists continue to learn more every day. Evidence shows most pregnant women who contract the virus will do well, but there is a slight increase in ICU admissions and preterm labor for those who have severe disease. 

Two new independent studies reveal highly encouraging results showing pregnant women with Covid-19 pass protective antibodies to their babies. No one wants pregnant women to contract the virus, but these studies offer promising hope that maternal infection may provide some protection for their babies after birth.

These studies evaluated fetal cord blood from the placenta to determine if Covid antibodies were transmitted from mom to baby. The placenta is also the defense system against invading infections like bacteria and viruses. 

The first study was published in JAMA Pediatrics. Researchers from Children’s Hospital of Philadelphia collected blood from the placenta from 1471 women and tested it for antibodies against the spike protein of SARS-Cov-2. Positive IgG antibodies were identified in 83 women. 

The researchers then tested the baby’s cord blood to see if the antibodies were also present. In 87% of the newborns born to Covid antibody-positive moms, IgG antibodies were also present. 

This finding indicates pregnant women with Covid-19 are passing protective antibodies through the placenta to their babies. 

This study also showed that the high rate of antibody transfer did not depend on the maternal disease level. Even the mothers with asymptomatic infection transmitted antibodies to the baby. The data also indicated infection earlier in pregnancy correlated with a higher degree of antibody transfer.

In this study, there were no cases of newborn COVID-19 infections. 

A second study presented at the Society for Maternal-Fetal Medicine’s (SMFM’s) annual meeting also showed promising results. This study also evaluated the fetal cord blood for IgG antibodies but also tested for neutralizing antibodies. 

In this study, 91% of the cord blood samples were positive for IgG antibodies. Like the JAMA research, these findings indicate that Covid positive moms transmit immunity to the baby through the placenta against SARS-CoV-2 infection.

Neutralizing antibodies were identified in 25% of the cord blood samples. While this is also supportive evidence of mom-to-baby immunity benefits, the neutralizing antibody transfer rate was lower than what we see in other infections like pertussis and influenza.

Antibody transfer to good news for babies 

When a baby is born, the immune system takes time to develop. Babies rely on maternal antibodies to help protect against various infections. These two studies provide essential information to guide further research.

Pregnant women who contract SARS-CoV-2 can find some comfort knowing they will pass protective antibodies to their babies. 

It is important to note that these findings do not indicate these babies are immune to Covid-19. Further studies will be needed to determine how long the antibodies last to what degree they offer protection. 

These studies also offer highly significant insight into maternal Covid-19 vaccination strategies. Pregnant women were not included in the Pfizer and Moderna vaccine clinical trials. The American College of Obgyn and other leading experts agree that life-saving vaccines should not be withheld from pregnant women.

The confirmation of transplacental Covid antibody transfer will help guide further research on the safety and efficacy of Covid vaccination in pregnancy and newborns. 

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A new paper published in the medical journal JAMA offers more encouraging news for pregnant women. Researchers at the University of Texas Southwestern Medical Center in Dallas published a study titled Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

The results show that 95% of women who tested positive for Covid-19 during pregnancy had no adverse outcomes. Five percent of infected women experienced severe complications such as pneumonia and respiratory distress.

This study also showed a low rate of newborn infections (3%) consistent with our previous reporting. Previously published data from the PRIORITY Study(Pregnancy Coronavirus Outcomes Registry) showed babies born to Covid-19-positive women do well with no increase in negative metrics such as low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

Based on current scientific understanding of Covid-19 infection in pregnancy, there is no evidence at this time indicating pregnant women are more at risk for severe illness from Covid-19 than the general public. In general, viral infections in pregnancy can lead to poor outcomes in mothers and newborns.

Pregnant women have a suppressed immune system and experience changes in the way the respiratory system functions. These physiological changes are essential but put pregnant women at a higher risk for respiratory problems when they contract other similar viruses such as MERS, SARS, influenza, or pneumonia.

This paper from UTSW adds to the growing body of medical evidence that most women who contract Covid-19 will do well. The authors acknowledge the scientific consensus that viral infections place pregnant women at risk but highlight the low number of sufficiently powered, large-scale studies conducted to accurately assess the specific risks associated with SARS-CoV-2. The purpose of this study was to address this gap in scientific research.

This large urban county health system’s research compared outcomes in 252 SARS-CoV-2-positive and 3,122 negative pregnant women. The data was collected from March 18 through August 22, 2020. The study population included 2,520 Latinx (75%), 619 Black (18%), and 125 White (4%) women. The statistical analysis controlled for variables such as age, parity, body weight, and other medical conditions.

The study found SARS-CoV-2 positivity was more common in Latinx women, accounting for 90% of the cases. Latinx women make up 75% of the 12,000 women delivering at UTSW.

Thirteen women (5%) developed severe respiratory complications requiring interventions, and one patient developed venous thromboembolism.

There was no difference in preterm birth rates, preeclampsia, C-section rates, or stillbirth in women with Covid-19. This data is further supportive evidence that pregnant women who test positive for Covid-19 and their newborn babies have a low risk of developing severe symptoms.

This study also evaluated the placenta for evidence of pathological changes. Scientists have been concerned the viral illness could lead to placental vasculopathy and inflammatory infiltrates. Pathologists studied the placentas of patients infected with Covid-19. This study found the majority were not affected by the virus.

NIH research indicates that in utero mom-to-baby transmission is rare because the placenta is missing key components the virus needs to enter the fetal circulation, namely ACE2 receptors and the TMPRSS2 enzyme. Both the ACE2 receptor and TMPRSS2 are present in the placenta but only in tiny amounts. The low levels likely explain why SARS-CoV-2 is unlikely to cross the placenta from mom to baby.

How do pregnant women protect themselves from Covid-19?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations:

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.
9. Get your flu shot.

Adhikari EH, Moreno W, Zofkie AC, et al. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open. 2020;3(11):e2029256. doi:10.1001/jamanetworkopen.2020.29256

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The U.S. Centers for Disease Control and Prevention (CDC) provided an early release document on November 6th titled Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy. This paper verifies growing scientific consensus that pregnant women are at a higher risk of preterm labor if they acquire Covid-19 during pregnancy.

Based on current data, there is no evidence at this time indicating pregnant women are more at risk than the general public. We know that viral infections in pregnancy and postpartum can lead to poor outcomes in mothers and newborns.

Preterm labor most likely results from the severity of the maternal illness and is not caused by the virus itself.

Data so far indicates a pregnant woman who contracts Covid-19 has a low risk of passing the virus to her baby. The PRIORITY study(Pregnancy Coronavirus Outcomes Registry) showed that only 1.1% of infants contract the virus. The PRIORITY study also showed babies born to Covid-19 positive women do well. These babies showed no increase in key metrics such as low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

This new CDC paper adds to our current understanding of the effects of Covid-19 during pregnancy, showing an increase in preterm labor and providing more information on infant infection rates.

During pregnancy, women have a temporarily suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk of respiratory problems when they contract similar viruses, such as influenza or pneumonia. OB-GYNs, therefore, consider pregnant women to be an at-risk group for respiratory compromise if they contract Covid-19.

Additionally, preterm labor is a known risk when pregnant women contract viral illnesses such as MERS, SARS, and influenza. Preterm labor most likely results from the severity of the maternal illness and is not caused by the virus itself. In other words, preterm labor is not merely a result of contracting these viruses but rather dependent on the degree of illness that results.

Public health departments report Covid-19 pregnancy data to the CDC through the National Notifiable Diseases Surveillance System. Sixteen jurisdictions collected pregnancy and infant outcome data on 5,252 women with laboratory-confirmed SARS-CoV-2 infection.

This data was submitted to the CDC Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). SET-NET monitors the emerging and re-emerging threats to pregnant women and infants.

The authors studied 5,252 pregnancies. Three hundred nine women were still pregnant, so no delivery outcomes were available. Five hundred one pregnancies did not have a reported pregnancy outcome, or the gestational age at delivery was not available. This report analyzed the 4,442 women who had reported delivery outcomes and gestational age data.

Preterm labor rates increased in Covid-19 + Moms

Preterm labor increased by about 2% in pregnant women with confirmed Covid-19 infection.The gestational age was known in 3,912 cases. 12.9% of babies were born preterm compared to 10.2% in a national estimate of preterm labor rates. This finding suggests that pregnant women with SARS-CoV-2 infection might be at risk for preterm delivery, similar to other viral illnesses.

The authors are clear this data is preliminary and subject to change as scientists continue to learn more. These data studied mostly women with second and third-trimester infections and included a higher percentage of Non-Hispanic Black and Hispanic women.

Low rate of transmission to newborns

This report showed a low rate of neonatal transmission in line with previous reports. Among the 610 infants with SARS-Cov-2 testing results, only 2.6% of infants contracted the virus.

The neonatal infection rate was higher (4.3%) in babies born to women who tested positive for Covid-19 within 14 days of delivery.

Limitations of the study

The findings of this report are subject to at least six limitations.

1. Data collection was not standardized as interviews and medical record abstraction varied by jurisdiction.
2. The data are not nationally representative and included a higher number of Hispanic women.
3. Fetal death reporting data was dependent on linkages to existing data sources.
4. There was a lack of available information on women with first-trimester Covid-19 infections limiting long term surveillance.
5. The data did not ascertain participants’ baseline risk factors for preterm delivery.
6. Many of the infants had no SARS-CoV-2 RT-PCR results reported.

How does this report help doctors manage pregnancy?

This CDC report adds to the growing scientific literature to assist OB-GYNs in providing counsel and care to their pregnant patients. OB-GYNs can monitor pregnant women with Covid-19 for early signs and symptoms of preterm labor. Pediatricians can monitor babies born within 14 days of a maternal Covid-19 infection with extra caution.

Pregnant women with Covid-19 can also take comfort in knowing more evidence has emerged showing the risk of transmitting the virus to their baby is low.

Hospital staff can increase awareness of preterm labor risk in Covid-19 + women. This data also supports hospital policies supporting keeping mom and baby together after delivery.

How do pregnant women protect themself from Covid-19?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations.

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.

CDC Morbidity and Mortality Weekly Report, “Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy — SET-NET, 16 Jurisdictions, March 29–October 14, 2020.

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The U.S. Centers for Disease Control and Prevention (CDC) provides updated guidance for public health information and recommendations through the weekly Morbidity and Mortality Weekly Report (MMWR). On November 2, the CDC released a report on pregnant women’s maternal outcomes who contract Covid-19.

The report, titled Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status, evaluated symptomatic women aged 15–44 with laboratory-confirmed infection with SARS-CoV-2.

This paper verifies the growing scientific consensus that women are at a higher risk of severe complications if they acquire Covid-19 during pregnancy compared with nonpregnant women. The analysis of approximately 400,000 women with symptomatic Covid-19 infections had a low overall risk of serious complications. Still, pregnancy increased the risk of intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation (ECMO), and death.

Based on current data, there is no evidence at this time indicating pregnant women are more at risk for severe illness from Covid-19 than the general public. We know that viral infections in pregnancy and postpartum can lead to poor outcomes in mothers and newborns.

Pregnant women have a suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk for respiratory problems when they contract other similar viruses, such as MERS, SARS, influenza, or pneumonia.

On the plus side, data so far indicates that a Covid-19-positive pregnant woman has a low risk of passing the virus to her baby. The PRIORITY study(Pregnancy Coronavirus Outcomes Registry) showed babies born to Covid-19 positive women do well with no increase in important metrics such as low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life. The PRIORITY study showed that only 1.1% of infants contract the virus.

A November 6, a CDC paper titled Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancydemonstrated that pregnant women are at a higher risk of preterm labor if they acquire Covid-19 during pregnancy.

Although the increased risk of preterm labor is problematic, the low rate of infant transmission is encouraging. Yet obstetricians and pregnant women need more information revealing how moms do when they contract Covid-19.

This MMWR report sheds some light on this topic. Pregnancy data was collected through the National Notifiable Diseases Surveillance System (NNDSS) and reported to the CDC. Health history data was analyzed from 23,434 symptomatic pregnant patients from January to October. Asymptomatic carriers of SARS-CoV-2 were excluded from this analysis.

Most Covid-19-positive moms do well

The data showed symptomatic pregnant women with Covid-19 had a low overall risk of complications. This finding is important for health care providers, pregnant patients, and their families.

Most symptomatic Covid-19-positive moms do not experience severe disease. For example, ICU admission rates were 10.5/1,000 cases, invasive ventilation 2.9/1,000 cases, and death 1.5/1,000 cases.

Overall, most pregnant women experience mild symptoms and do not require hospitalization.

Covid-19-positive moms are at higher risk than nonpregnant women

Importantly, this study demonstrates pregnant women who contract SARS-CoV-2 do not fare as well as nonpregnant women of the same age group. Covid-19-positive pregnant women were more likely to be admitted to the intensive care unit, nearly four times more likely to need invasive ventilation, and twice as likely to die.

Even after adjusting for age, race, and preexisting medical conditions, the severe disease and respiratory compromise risk were present in all age groups.

ICU admission risk was higher among all pregnant women but highest among Asian and Native Hawaiian/Pacific Islander women. Among Latinas, Covid-19-positive pregnant women had 2.4 times the risk of death.

The study mentions an interesting and unexplained finding that pregnant women reported symptoms less often than nonpregnant women. The most common symptoms mentioned by pregnant and nonpregnant women were cough, headache, muscle aches, and fever.

Limitations of the study

The authors report limitations to this important publication. There is not a national standard for reporting data. National case surveillance data for Covid-19 is reported voluntarily by health care providers and public health agencies.

Case reporting varies by jurisdiction. Race and ethnicity were missing in 25% of reported cases. Symptoms and preexisting condition data were missing in approximately 50% of cases.

This study was limited to symptomatic patients with known pregnancy status, but in 64.5 % of reported Covid-19 cases, the pregnancy status was not reported.

How does this report help doctors manage pregnancy?

This CDC report adds essential information to the growing scientific literature to help health care providers manage pregnant women with Covid-19.

We can reassure women and families that the overall risk of severe complications from Covid-19 is low, but pregnant women should be counseled that their risk for severe Covid-19-associated illness is higher than that of nonpregnant women.

Health care providers should take extra caution, knowing that when a pregnant woman is symptomatic with Covid-19 she is more likely than nonpregnant women to experience respiratory distress and require ICU admission.

How do pregnant women protect themselves from Covid-19?

We all must do our part to prevent the spread of the virus. Pregnant women should follow the same global recommendations:

1. Wash your hands with soap and water for at least 20 seconds.
2. Use hand sanitizer containing at least 60% alcohol.
3. Avoid touching your face.
4. Practice social distancing.
5. Cover your mouth if you cough or sneeze.
6. Clean your cellphone and household surfaces.
7. Avoid travel.
8. Wear a mask when out in public.

CDC Morbidity and Mortality Weekly Report, “Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020.”

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Much remains unknown about the coronavirus’s effects on pregnant women and babies, but a recent pre-published manuscript titled “Infant Outcomes Following Maternal Infection With SARS-CoV-2” demonstrates highly encouraging results.

The new data shows that babies born to women with Covid-19 demonstrate no increase in low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

Based on what scientists know right now, there is no evidence indicating pregnant women are more at risk of contracting Covid-19 than the general public, but they are at a higher risk of getting sick from the virus.

During pregnancy, women have a temporarily suppressed immune system and physiologic changes in their lung function. These changes put pregnant women at a higher risk of respiratory problems when they contract similar viruses, such as influenza or pneumonia. OB-GYNs, therefore, consider pregnant women to be an at-risk group for respiratory compromise if they contract Covid-19. Additionally, preterm labor is a known risk when pregnant women contract viral illnesses such as MERS, SARS, and influenza. Preterm labor most likely results from the severity of the maternal illness and is not directly linked to the virus itself. In other words, preterm labor is not simply a result of contracting these viruses but rather dependent on the degree of illness that results.

In addition to preterm labor, OB-GYNs are concerned about a pregnant woman’s potential to pass Covid-19 to her baby during gestation. This is an example of what doctors call vertical transmission. Fortunately, data surveillance so far indicates that in utero coronavirus infections are very rare. According to the American College of Obstetricians and Gynecologists July practice advisory, “the data are reassuring that vertical transmission appears to be uncommon.”

The new data shows that babies born to women with Covid-19 demonstrate no increase in low birth weight, difficulty breathing, apnea, or respiratory infections through the first eight weeks of life.

NIH research indicates that in utero mom-to-baby transmission is rare because the placenta is missing key components the virus needs to enter the fetal circulation, namely ACE2 receptors and the TMPRSS2 enzyme. Both the ACE2 receptor and TMPRSS2 are present in the placenta but only in tiny amounts. The low levels likely explain why SARS-CoV-2 is unlikely to cross the placenta from mom to baby.

Over the past few months, scientists have studied more than 1,500 cases of maternal coronavirus infections. Current management guidelines for infants born to mothers with SARS-CoV-2 are based on data from the National Registry for Surveillance and Epidemiology of Perinatal Covid-19 Infection.

Current guidelines are based on data from previous experience with maternal respiratory infections, such as SARS and MERS, combined with incoming studies on Covid-19. The PRIORITY study(Pregnancy Coronavirus Outcomes Registry), a collaborative project between researchers at UCSF and UCLA, is an ongoing effort to track outcomes of pregnant women who contract SARS-CoV-2. This data surveillance adds valuable additional infant-outcome data beyond the neonatal period to better inform management policies and guidelines.

The PRIORITY study’s first publication brings some encouraging and reassuring news to the medical community.Data indicates that infants born to Covid-19-positive mothers do well in the first six to eight weeks after birth.

The manuscript, accepted for publication in Clinical Infectious Diseases, reports the infant outcomes of 179 pregnancies complicated by Covid-19 infection compared to a control group of 84 Covid-19-negative gestations.

The PRIORITY study data showed no increase in preterm birth, NICU admission, or upper-respiratory infections. The study cohort yielded no pneumonia or lower-respiratory infection cases through the first eight weeks of life.

The babies born to mothers with Covid-19 also showed a very low rate of acquiring the infection. Only 1.1% of infants tested positive in the first six to eight weeks when born to a mother who had Covid-19, confirmed by a positive SARS-CoV-2 PCR test. The Covid-19-positive infants demonstrated minimal symptoms.

The study authors note the limitations of the paper and encourage further studies to confirm newborn incidence rates, as they “were unable to estimate the incidence of infant SARS-CoV-2 infection because infant testing was incomplete and might be biased by both false-positive and false-negative results.”

The PRIORITY study’s control group includes both symptomatic and asymptomatic women who tested positive for SARS-CoV-2. The researchers indicate this cohort may not be representative of all U.S. pregnancies. The authors also note an underrepresentation of Black and LatinX moms in the study cohort compared to the current CDC statistics of pregnant women infected with SARS-CoV-2.

To improve future study participation, PRIORITY launched a Reproductive Health Equity and Birth Justice Core to increase enrollment of underrepresented groups.

Finally, the authors note that infant admissions to the NICU were higher among infants born to Covid-19-positive moms, and the babies were born at an earlier gestational age. The study authors were unable to determine if the increase in NICU admissions was directly related to SARS-CoV-2 or if the hospital practices for the management of mothers testing positive for Covid-19 explain the difference.

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