Pregnancy in a Pandemic: An OB/GYN Answers Your Questions Joy Baker, M.D., FACOG

Disclaimer: Information about the SARS-COV2 that causes COVID-19 is evolving on a daily basis. My opinions expressed here as solely my own, and are based on the medical consensus TODAY, and may change based on emerging evidence.

Question 1- Can coronavirus affect pregnant women?
• SARS-COV2, the virus that causes the disease COVID-19 can affect anyone, including pregnant and postpartum women. We are still learning many things about SARS-COV2, so information about how this virus affects the pregnant or postpartum woman, and not to mention newborns, is pretty limited. The consensus in the Medical Community is that pregnant women should assume that they are just as susceptible to SARS-COV2 as any one else in the population, and, with the normal changes in pregnancy like decreased air reserve in the lungs and risk of blood clots, pregnant women may be at increased risk for worse outcomes than the general population if they develop COVID-19.

Question 2- Is immunity low during pregnancy?
• The short answer to this question is “NO!” Many years ago, the immune system during pregnancy was considered to be very similar to the immune system of a person after an organ transplant—where the fetus was viewed as the “foreign organ.” The biggest concern after and organ transplant is that the person’s body “rejecting” the transplanted organ. Because a baby is part of two different people, it was assumed that the mother’s immune system must be “suppressed” to avoid “rejecting” her baby. Today, we know better. Emerging research has proven that the immune system in pregnancy is actually quite complex. The fetus’ developing immune system, and the placenta also play a big role in how a woman’s body responds to viruses and bacteria. Depending on which trimester of pregnancy a woman is in, her immune system may respond differently to bacteria or a virus like SARS-COV2. The Medical community is learning more daily about the pregnant woman’s response to SARS-COV2. In some communities, hospitals are universally testing all pregnant women who come in. Many of these communities are finding that 20-40% of pregnant women are positive for the SARS-COV2 virus, but more than 80% of the moms who test positive have only mild symptoms, or no symptoms at all. This likely speaks to the very complex, efficient functioning of the pregnant woman’s immunity along with the fetal-placental immune complex. We are now learning that the pregnant woman’s immune system is working synergistically with the immunity produced by the placenta and the baby to form a sort of “super immunity”—so researchers conclude that it is much more likely that the immune system during pregnancy is changed and ENHANCED, versus “suppressed.” 1 (Am J Reprod Immunol. 2010 Jun; 63(6):425-433)

Question 3- What are the safe ways to boost the immune system while pregnant?
• Immune boosters are agents that can help boost our immune’s response to infection. Often, these are agents may be foods, vitamin or mineral supplements, herbs, or even exercise. I always recommend that my patients eat a very balanced diet with REAL food—especially plenty of fruits and vegetables, which are chock-full of vitamins and minerals that help boost immunity, and improve health overall. Moderate exercise is something I also encourage. For best results, mamas should get 30 minutes of moderate exercise most days per week, at the level that they are used to. For example, if a woman was a weight-lifter or a yogi before she became pregnant, she can certainly continue doing what her body is used to doing. Alternatively, if a woman decides to start a fitness journey during her pregnancy, I recommend she start with low impact exercise like stretching, walking, or swimming. Of course, every pregnant woman should consult her Obstetrician prior to starting a fitness journey. Other “immune boosters” may be helpful as well. I’m personally a big fan of essential oils, and use essential oil blends with clove, orange, cinnamon bark, eucalyptus, and rosemary in a diffuser. Many naturopathic immune-boosters can be used during pregnancy, however, each woman’s pregnancy and health condition is unique, so I always ask my patients to bring any supplements they are considering to their appointment so we can look at them together.

Question 4- How to protect your baby from coronavirus in pregnancy
• During an International Pandemic, almost every pregnant woman’s first thought is ‘How will this affect my baby?” The good news is that it does not appear that “vertical,” or mother-to-baby transmission occurs with this particular virus. In fact, many viruses that have been studied in pregnancy have a hard time breaking through the maternal-placental-fetal immunity “super team” I speak of above. There are some viruses that have been found to pass from mother to baby, and while we are learning more and more about SARS-COV2 each day, so far, there have been no case reports of babies being BORN with the virus. With that said, it is important to note that newborns ARE susceptible to this virus, and some newborns have contracted it from their mothers shortly after birth. Many hospitals are doing the best that they can to protect newborns from becoming infected by trying to practice “mother-baby social distancing”:
o Keeping babies of infected mothers in the nursery if there is space available, or placing the bassinet at least 6 feet away from the mother—preferably with a physical barrier between them such as a curtain.
o Strictly limiting visitors to the maternity and newborn care units. Many hospitals have limited visitors to 1 designated support person (the same person supports during the entire hospital stay), and in some extreme, rare, cases, hospitals have implemented a “no visitor” policy on their maternity ward.
There is much debate about visitor and infant separation protocols throughout the medical community. Personally, while I understand the importance of protecting newborns with fragile immunity, I also think it is very important for birthing people to have support. I am allowing one designated visitor.

Question 5- What type of food increase pregnant women immunity?
Here are some examples of foods that help boost the immune system and promote health:

Berries, especially Elderberries have Antioxidants
Button Mushrooms have Selenium & B vitamins
Watermelon had glutathione
Wheat germ contains zinc, antioxidants, and B vitamins
Low-fat yogurt- Vitamin D, Probiotics
Spinach -fiber, folate, vit C,
Black, White, or Green Tea contain disease-fighting polyphenols and flavonoids.
Sweet Potatoes have beta-carotene, which becomes Vitamin A
Broccoli- vitamins A and C,Glutathione
Fresh Garlic(Not powder) has ability to fight bacteria, viruses, and fungi
Chicken Soup had carnosine that can protect your body from the flu virus.
Pomegranate Juice may help your body fight bacteria and several kinds of viruses, including the flu.
Ginger contains Antioxidants and is effective against nausea

Question 6- What exercises and routine helps boost immunity system?
• 30 minutes of moderate exercise most (at least four) days per week has been proven to improve overall health—especially heart and lung health. In pregnancy, I recommend exercising at the level your body was used to prior to being pregnant. For example, if you were walking 2 miles a day before you became pregnant, you can safely continue doing so. In addition, swimming, yoga, and dancing are great options for pregnant women at any fitness level.
• Along with exercise, good sleep routines are essential to maintaining optimal health and immunity. When we are tried, our immune system is not functioning at its optimal capacity. Sleeping 6-8 hours out of every 24 hours is a great way to allow your body to repair itself and function normally. Late second and third trimesters are often the most difficult times for pregnant women to achieve restful sleep. Talk with your doctor if you are having trouble sleeping. For my patients, I often recommend Sleepy Time Tea with chamomile and Valerian; warm baths with epsom salt and lavender, as well as online sleep stories or meditations. If these are not successful alone, I often add Benadryl or Unisom before bedtime, which are both safe mediations to take in pregnancy.
Question 7- How to prepare for doctor or hospital visits during pregnancy?
• Every hospital or doctor’s office may not have the same policies. This is because policy is often made based on how many really sick people are in your area. In areas with fewer outbreak, policies may be more lax, whereas, in areas that have been hit hard by COVID-19, you are likely to find stricter policies on visitors, appointment availability, and ability to schedule certain surgeries. Nearly every hospital has temporarily stopped allowing visitors with the exception of one designated visitor on the maternity floor. Most clinics are allowing limited or no visitors in the office for prenatal care
o Prepare by calling ahead to find out your doctor’s office or hospital policy on visitors.
o If you have other children, Make sure you arrange childcare before your appointment or hospital stay. Children under 18 have not been allowed in most offices or hospitals unless they are being seen by the doctor. Also, be prepared for the real possibility that children may not be allowed to visit while you are in the hospital.
o Choose one designated labor support person. Make sure you also have a backup support person on standby just in case your original Support person becomes ill or is screened upon entry to the hospital and is found to have a fever or other COVID-19 risk factors and is unable to accompany you.
o Be prepared to have a nasal swab and be tested for Corona virus—many labor and delivery units are moving toward rapid testing for every mom. You may also be asked to wear a mask.
Question 8- Can coronavirus transmit from mother to child in the womb?
• Based on the limited data we have, it does not appear that this Coronavirus is transmitted from mother to baby in the womb, however, it is very important to make sure mothers are not potentially transmitting the virus after giving birth—that is why social distancing is so important, even if it mean distancing yourself from your baby if you have the virus. Being away from your baby for a few days is definitely painful, but certainly less painful than being away from them forever!
Question 9- Can breast milk help shield infants from coronavirus?
• Yes! The antibodies, or proteins that we make to fight infection, are passed to our newborns in breast milk. Breastfeeding is still definitely recommended. If a mother has tested positive for Coronavirus, it’s important that she wash her hands, neck and chest with soap and water, or a skin-safe disinfectant prior to breastfeeding. She should also wear a mask while feeing her baby. If she is continuously coughing or sneezing, it’s safer to have the baby stay at a safe distance away and hand express or pump milk and feed the newborn with a bottle. Breast milk is ALWAYS best!
Question 10- What home remedies can lower the risk of COVID-19?
• The best “home remedy” for lowering the risk of developing COVID-19 is social distancing as much as possible and frequent hand-washing with soap and water for at least 20-30secs (sing the “happy birthday” song through twice to help you keep track of the time).
• Avoid touching your face unless you have thoroughly washed your hands.
• Drink something warm daily, like black, white, or green tea. I usually add clove, cinnamon, and orange to my tea.
• Sanitizing every frequently touched surface like door knobs, fridge handles, countertops, and your phone at least once per day (sanitize more frequently if you have guests) has also been shown to help prevent spread of the virus as well.


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