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Pregnancy and COVID-19: Changing Needs, Evolving Care

Pregnancy and COVID-19: Changing Needs, Evolving Care

by Mary Beth TeSelle, Special to The Union

 

A recent global study found that certain pregnancy complications and pregnancy-related anxiety and depression have increased during the pandemic. Getting appropriate and timely prenatal care and sharing any mental health concerns with your doctor can help ensure a healthy pregnancy.

The impact of the COVID-19 pandemic is felt by all of us, regardless of our stage of life or unique health concerns. Pregnant women are no different. Questions about the impact of both the stresses of the pandemic as well as actual COVID-19 infection on pregnant women have been plentiful and physicians have adjusted their care accordingly.

Now, a new study from St. George’s University in London published in the journal The Lancet Global Health says the ripple effect of the pandemic may have also contributed to higher rates of pregnancy complications and pregnancy-related depression around the world.

The study reviewed data on more than six million pregnancies worldwide, in 17 countries, throughout 2020. Overall, the researchers found that ectopic pregnancies (when the fertilized egg grows outside the uterus) were six times higher than usual and the odds of stillbirth were 28% higher.



Researchers believe a contributing factor to these numbers was a hesitancy to seek care, especially in higher risk communities around the globe. Pregnancy outcomes were worse in low- and middle-income countries than in high-income countries.

Locally, Phillip Kintner, MD, an OB/GYN with Dignity Health Medical Group – Sierra Nevada, agrees, saying those numbers have not been reflected among his patients.



“Fortunately, I have not seen any maternal deaths or pregnancy losses associated with Covid,” Dr. Kintner says. “This is most likely due to my practice being a lower volume and lower risk environment. This study includes data from many different countries that may bias the conclusions due to different practice management and availability of resources in differing countries.”

Dr. Kintner says the complications that he has seen related to COVID-19 were limited to patients who had actually tested positive and were symptomatic of the virus. These changes included hypertension (high blood pressure) and changes in the placenta.

One aspect of the research that may be more likely to be present in our community is an increase in anxiety and depression found among study participants.

“As with any additional stressors during pregnancy, an increase in symptoms of depression and anxiety is expected during the pandemic,” Dr. Kintner explains. “Pregnancy alone can be a stressful and anxiety-provoking time and with the uncertainty associated with Covid and it’s many manifestations one would expect an increase in all categories of psychological abnormalities. Any time we are forced to change our daily lifestyles and limit our interaction with others this can lead to feelings of isolation and a sense of a lack of control in our lives.”

Dr. Kintner says he tries to support patients experiencing mental health struggles by listening to their concerns and providing access to resources that can be helpful.

“I believe education and listening help to alleviate some of their fears and uncertainty,” he says. “They are being exposed to a barrage of ‘facts’ from all sources of information — be it cable news, social media, or neighbors who are often misinformed. If their issues are serious, I may refer to a counselor and medication may be needed.”

Dr. Kintner says the COVID-19 risks associated with preexisting conditions are also a concern for pregnant patients.

“Certain underlying medical conditions may predispose these women to more serious complications if they do become infected with the virus,” he says. “These include hypertension, diabetes, immune disease or a predisposition to abnormal blood clotting. Pregnancy itself alters a woman’s immune system and that alone may have an effect on how Covid impacts pregnant women.”

Overall, Dr. Kintner agrees that the care he provides to pregnant patients has changed due to the pandemic – and it will likely continue evolving over time.

“My care has changed based on discussions with my maternal fetal colleagues,” he says. “We know that this is a new frontier in medicine and we still do not have a firm knowledge on exactly how Covid affects pregnancies and especially why it affects some patients but not others. Maybe with long term follow-up of these women and other patients we will continue to learn more about the disease and make adjustments to our care.”


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