By Dr. Kristina AdamsWaldorf, Carly Baxter, Dr. Sylvia LaCourse, Isabelle Crary and Sara Rutz
The recent surge of COVID-19 cases nationwide due to the emerging Omicron variant has heightened the fear and stress surrounding COVID-19 infection. Being pregnant in the midst of all this does not make anything easier. While we don’t have all the answers yet when it comes to the Omicron variant and pregnancy, we do have 5 key takeaways to help inform and protect pregnant people and their babies.
We do not know if Omicron infections are less severe for pregnant individuals.
While early data suggests Omicron COVID-19 infections are less severe in the non-pregnant population, we do not yet have data to support if this variant is less dangerous for pregnant individuals and their babies. Studies on previous COVID-19 variants have shown that pregnant individuals with COVID-19 are 22 times more likely to die in pregnancy compared to uninfected pregnant people, and COVID-19 infections increase risk of stillbirth. Until we have more data on the effects of the Omicron variant in pregnancy, it is important to take precautions to protect yourself and your baby.
There are steps you can take to monitor and protect yourself and your baby.
The first step you can take is getting vaccinated and boosted against COVID-19 as well as encouraging the people you are exposed to do the same (family members, friends, coworkers, etc.). COVID-19 vaccination is recommended for people who are pregnant, trying to get pregnant now or might become pregnant in the future, as well as their partners. Nearly 200,000 pregnant individuals in the US have already received at least one of the COVID-19 vaccines. Next, upgrade your mask right away to a N95 or equivalent (KN95 or KF94) mask. Cotton or surgical masks are not sufficient to protect yourself against the Omicron variant.
If you do become sick with COVID-19 make sure to:
1) Make an effort to take deep breaths regularly. This will help to keep the smalllest air spaces in your lungs open and prevent a pneumonia.
2) Pay extra attention to your baby’s movements and kick counts. Call your OB provider if you feel a big change from normal fetal activity
3) Drink plenty of fluids
4) Get a pulse oximeter and learn how to use it. Call your OB provider if your oxygen saturation is less than 95%
If you are pregnant and have COVID-19, you may be eligible for monoclonal antibodies.
Monoclonal antibodies have been safely used in pregnancy for many years to fight various illnesses. During the COVID-19 pandemic, several different monoclonal antibody treatments were found to be effective in preventing progression to severe disease. These treatments have primarily been reserved for vulnerable patients, and as of May 2021, pregnancy was classified as a “high risk condition” by the FDA. Some pregnant individuals are eligible for this life saving treatment, particularly if one or more additional risk factors are present (obesity, chronic kidney disease, diabetes, heart disease). Of the available monoclonal antibody treatments, Sotrovimab has been found to be the most effective treatment against the Omicron variant. If you become sick with COVID-19 (even with a mild case) and you are pregnant, you may qualify for antibody therapy to prevent severe COVID-19 illness. Ask your OB provider for more information.
Talk to your obstetrics provider about the safety of the newly approved COVID-19 pills.
The FDA has approved two pills for the treatment of mild to moderate COVID-19 infections, Molnupiravir and Paxlovid. Both are antiviral medications that can be taken orally but have different formulas. These pills were approved recently in December 2021. We do not have much data on the safety of these medications in pregnancy. The Society for Maternal Fetal Medicine supports the use of Paxlovid in pregnant persons for treatment of mild to moderate COVID-19. Molunupiravir is not approved for use in pregnancy. The American College of Obstetricians and Gynecologists recommends having a discussion with your obstetric provider about the benefits and potential harms of treatments if you become infected with COVID-19. For pregnant individuals with severe COVID-19 infections, a different antiviral medication called Remdesivir has been shown to be safe in pregnancy.
Check in on your mental health.
Pregnancy can be anxiety-provoking even without the additional stress of a worldwide pandemic. A large study conducted prior to the COVID-19 pandemic found that nearly 10% of pregnant individuals experienced varying degrees of antenatal depression. Addressing your mental health, particularly in pregnancy, is a priority and can help both you and your baby. If you are feeling anxious or depressed, meet with your obstetrics provider or primary care physician right away to discuss your concerns. There are many available treatments, both medications and therapy, that are safe and effective in pregnancy.
Kristina Adams Waldorf, MD is a Professor of Obstetrics and Gynecology and Adjunct Professor of Global Health at the University of Washington School of Medicine. She is an internationally recognized expert in how infections impact pregnancy and how vaccines and therapeutics protect the mother and fetus. She is Chair of the National Institutes of Health Obstetrics and Maternal-Fetal Biology Study Section. She is a member of the Center for Reproductive Sciences and the Center for Innate Immunity and Immune Diseases. Her grant support has come from the National Institutes of Health, the March of Dimes, Burroughs-Wellcome Fund, the Canadian Institute for Health Research and the Australian National Medical Research Council.
Sara Rutz graduated from the University of Alaska, Anchorage with a Bachelor of Science degree in Natural Sciences and a minor in Psychology. She is now a third year medical student at the University of Washington School of Medicine. Prior to medical school, she worked with diverse & underserved populations in patient care settings and as an insurance specialist for 5 years. She has been involved in research on improving outcomes for infants with Neonatal Opioid Withdrawal Syndrome, quality improvement in obstetric care, and providing up to date information as a volunteer for the COVID-19 Literature Surveillance Team. She is passionate about reproductive medicine and improving access to care for rural and underserved populations.
Carly Baxter graduated from the University of Puget Sound with a Bachelor of Science degree in Biology and a minor in French studies. She is now a 2nd year medical student at the University of Washington School of Medicine. She has worked with the MaMHA (Maternal Mental Health Access) group coordinated by the University of Washington and WA Department of Health in an effort to reduce maternal mortality rates in WA state. She is passionate about reproductive justice, equitable health care access and volunteering within her community at local health fairs.
Isabelle Crary graduated from Stanford University with a Bachelors of Arts in Human Biology. She is now a second year medical student at the University of Washington. She has been involved in research on anemia in pregnancy, breast cancer prevention and treatment, and adolescent nutrition. She is passionate about healthcare for individuals who are pregnant, reproductive justice and nutrition education.