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Emily Oster: Are Pregnant Women an “At Risk” Group for COVID-19?

coronavirus

Essential Takeaways

  • There’s not much data yet about the risks to pregnant women, sample sizes are small, and it mostly comes from China. But the data we do have is reassuring.
  • COVID-19 does not appear to pose any specific risks to pregnant women based on the data available so far.
  • If it were very serious for pregnant women, we would likely know by now. But you should still take precautions like everyone else.  

Hi! I’m Emily Oster, author of Expecting Better and Crib Sheet. I teamed up with Ava on March 30 to do a Q&A session about fertility, pregnancy, and COVID-19. Here’s a transcript of the conversation. To hear more from me about pregnancy and COVID-19, sign up for my newsletter.

Should I pause trying to get pregnant?

Whether you should stop trying to get pregnant because of coronavirus depends a lot on where you are in the process. If you aren’t very concerned about when you get pregnant, then I’d probably wait because there is so much uncertainty about what the future holds.

But if you feel strongly that this is the right time for you to get pregnant, it’s okay to go ahead with it. I don’t think we’ll have a handle on the coronavirus situation in the next few weeks.

What are the risks to pregnant women of COVID-19?

There’s not much data about this, the sample sizes are small, and it mostly comes from China. But the data we do have is reassuring. Pregnant women have risks similar to others in their age group. There does not seem to be any specific risks to pregnant women, which is quite different from SARS or MERS, which did have significant risks to pregnant women. 

I think that if it were very serious for pregnant women, we would know by now, because there have been a large number of COVID-19 cases. You should take precautions just like everyone else, but pregnant women are not known to be a specific risk group in this case. 

When there is a lift in social distancing measures, should pregnant women continue to take special precautions? 

My guess is that it’s going to be a very long time before we are back to normal and social distancing measures are lifted. In a month or two, schools and some businesses might reopen, but it’s going to be a long time before we’re doing large gatherings. And I’d guess that handshakes are going the way of the dodo. 

I don’t think there’s much chance that things will go back to normal soon enough that you would have to make a decision to keep socially distancing when the rest of society is no longer doing so. 

Do you think pregnant women will have less access to prenatal care due to staff shortages and cancellation of non-essential appointments?

I wouldn’t be overly concerned about that if you expect to have a low-risk pregnancy. A lot of the care pregnant women receive can be done over telemedicine. And look at prenatal care in the UK: it’s way fewer visits than in the US. I wouldn’t be particularly concerned about this. 

If I get the virus while I’m pregnant, can I transmit it to the baby in utero?

There were two papers (here, here) published which suggested possible vertical (i.e. in utero) transmission of the virus. This transmission was suspected due to antibody detection in the infants. The total sample size between the two studies is seven infants, so this is a small group and it is difficult to know when the transmission occurred.

It remains possible that even in these limited cases the transmission was outside the womb. In addition, it is important to note that none of these infants showed any symptoms of COVID-19.

Should we be worried about the impact of coronavirus symptoms, like fever, to a fetus?

It is true that some data has seen links between fever in early pregnancy and neural tube defects (this is the reason why you’re not supposed to go in a hot tub). But my read is that the most reliable data doesn’t see this. 

I think the best study here—it’s large and followed women over time—focused on a cohort of 100,000 women in Denmark. The data includes about 8,000 women who had  a fever during early pregnancy. They see no link with birth defects.

This is not a reason to be cavalier about the virus (or other illnesses like flu), but should be reassuring.

My hospital has offered the option of induction at 39 weeks because I expressed concern about COVID-19. Is there any reason not to do this?

There’s no reason not to get induced at 39 weeks if you want to. The most recent data would suggest that 39 week inductions are quite safe. It does not seem to be linked to higher risk of C-section; if anything, the outcomes with 39 week inductions are better. If that seems to be more practically appealing to you, I would not have any hesitation in recommending it.  

Is COVID-19 more dangerous for preemies?

The disease seems to be really mild in babies and kids. In the Chinese data they actually see a number of very preterm babies who were exposed, and either did not get it or had very mild cases. This is reassuring!

After giving birth, should I ask if I can get discharged early to avoid the risk of getting exposed to COVID-19?

This depends a lot on your birth experience. If you feel good and are recovering well, then it’s probably fine to push for an early discharge—this would be true with or without the COVID-19 situation. Just make sure you have a good follow-up plan with your doctor.

Can we allow our new baby’s grandparents into our home to meet her, given the delicate status of her immune system?

Actually, you or your baby giving the virus to grandparents or other visitors is more of a concern, since older people are more vulnerable to coronavirus. If you wanted to be really cautious, it might be a good idea to do a two-week isolation period after coming home from the hospital before having visitors. 

Is the world overreacting to coronavirus?

This is a super interesting question and I have been thinking a lot about it also. I don’t think we are overreacting given what we have seen in New York. But I do think that there is a lot of ramping up of restrictions without waiting to see if they work. It will take time for these changes we make to show up in hospitalizations, and I feel like people are overreacting to individual pieces of incomplete data.

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Emily Oster, PhD

Emily Oster is an economics professor at Brown University, and a writer of books on pregnancy and parenting. She holds a PhD in Economics from Harvard. Oster’s academic work focuses on health economics and statistical methods. In addition to her academic work, Oster has written two books. “Expecting Better” analyzes the data behind many common pregnancy rules, and aims to improve decision-making for pregnant women. “Cribsheet” does the same for early childhood — what does the evidence really say on breastfeeding, co-sleeping or potty training.

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