ASRM’s New COVID-19 Pregnancy Guidelines


Dr. Michael Homer discusses the latest COVID-19 pregnancy guidelines from ASRM

Hello everyone, this is Michael Homer talking to you from Reproductive Science Center here in Los Gatos. And I wanted to give you guys an update on the new COVID-19 pregnancy guidelines from the American Society for Reproductive Medicine.

COVID-19 is back on the rise in the U.S.

And as always, wear a mask. Please, ok? So unfortunately as we all know, the U.S. is now – the best analogy is a wildfire. There’s some strange debates about what embers and flames mean and COVID is raging ok? It’s surging again, but I think the wildfire analogy is the most apt because there’s hot pockets, there’s hot areas, there’s certain areas, municipalities or even states where it’s on the rise and others, say like the Northeast. Shoutout to Massachusetts hometown. Which is really trying to keep it under, which is doing a pretty good job of keeping it under control. Like Rhode Island.

And so, but if you look at the map, there’s those hotspots right? And so resources – I see hospital beds are being strained in certain areas. And um, this is just going to keep going. There’s going to be a new hotspot. It’ll get better, some other spots are going to pop up. So the guidelines that we were talking about here in these updates will always sort of need to be taken within the context of how your particular area is doing.

ASRM egg donor updates

Now I’m talking to you, most likely you live in the Bay Area, so keep up with your own city’s data and as well as the local health counties, ok? So, the updates include a couple of different things. One of the small updates is talking about people with egg donors. One of the main things about egg donors, what they’re trying to say is that if you’re planning for maybe an egg donation to receive eggs, then you would maybe be able to create the embryos but freeze all and not try to coordinate a fresh embryo transfer.

Ultimately what they are trying to say is that because someone might be COVID positive and there is more than one person, you know a couple involved, that there is higher risk of having a cancelled cycle. And just not going according to plan. So just plan to take things a step at a time. Small little part of the update.

COVID-19 pregnancy guidelines update from ASRM

The majority of the update is talking about, what I think most people want to know about is COVID-19 and pregnancy. So there’s good, there’s overall good news but we also have to be cautious about that. So birth outcomes, it does appear that full term newborns born from mothers with active COVID infections seem to be doing well overall with no severe illnesses, ok?

This is being shown in international studies as well as a lot of studies that have been done out of say, New York City, right? Cause that was the epicenter for a while there in the spring. Now specifically for mothers, um, COVID-19 is a risk while pregnant. So, depends upon the case reports, case series that have been reported, but between 20 to say 33% of heavily pregnant women, say second, third trimester who contracted COVID-19 were hospitalized.

Some reports have up to 10% were put on ventilators and unfortunately we know that people die from COVID-19. Including women who are pregnant. The good news, I guess, is that women who are pregnant were not having a higher mortality rate than those women who were not pregnant. So it doesn’t seem to be that the pregnancy itself relays a higher mortality rate or risk. But hospitalizations maybe because people are being more cautious, just depends. When they are being hospitalized they are more likely.

We do know that respiratory viruses and being pregnant is not the best combination, so women who get the flu, about 25% of women who are pregnant and contract influenza A will unfortunately be hospitalized. So this is in line with something along those lines and maybe just a little bit worse, which we would expect.

COVID-19 transmission from mother to fetus

Another part that they look at is vertical transmission. So, what is the evidence? Vertical transmission is when the mom contracts something and passes it to the baby. Ok, in utero, a congenital infection in a way. And there’s no evidence that happens, but there have been pathological studies and after deliveries showing that the virus is in say, the umbilical cord or in the placenta. These are just individual studies but there hasn’t really been a case where there’s been a flowing infection in an infant. That’s good news.

It’s not perfect news though because we know from experience from other maternal virus infections that in women the infection can effect the fetus inside – long-term health wise. Again, there’s a reason we call it a novel virus. It’s new, we don’t fully understand exactly what it does. So the preliminary reports come out that we know that getting COVID-19 while pregnant can lead to a high risk hospitalization.

We do know, at least so far as birth outcomes for full term, is that the infants seem to be doing well. And there’s no direct evidence right now. It doesn’t mean that there can’t be, it’s really hard to prove something can’t happen, right? But right now there is no obvious path that shows that the COVID-19 virus infection passes from the mom to the fetus inside of the uterus.

Premature deliveries are more common

One other point I’d like to make to make this complete is that there is one risk though to the baby that can happen with COVID-19. That is when a mom is infected, say second or third trimester, and maybe not doing well with lungs or respiratory. Because the bulk of the pregnancy, of the baby, the uterus is pushing up on the lungs. Sometimes C-sections and or early deliveries are used in order to try to help the maternal outcome. That means that premature deliveries are a bit more common. And in some cases, really common.

Ok, depends upon, and this will change with experience, but initially a lot of premature deliveries were happening with moms with COVID-19 because we didn’t know how they were going to progress. So, the risk of an early delivery is there with a COVID-19 infection in the second or third trimester and those are known risks of prematurity, for babies born early, in terms of breathing, lungs, how they feed, how long they are in the hospital afterwards just to kind of convalesce and grow and get better.

Take care of your mental health

You know, thats the quick, small update about what the latest updates from ASRM are. Another thing to keep in mind is that we all know, and it’s such a nebulous thing to talk about but its super important, is just mental well-being, alright? If you’re listening to this, maybe you’re having trouble having your family and on top of that we’re going through COVID-19 and, you know, everything going around in the U.S., right? And it’s really stressful.

So, the only thing I can kinda let you know is talk to someone if you’re feeling this way, right? So, talk to your partner, talk to your friends, talk to a counselor. You can literally, I forgot my phone today so I can’t hold up my phone but there’s apps where you can get in touch with someone who you can speak with, right? Or even text-based support to kind of just relay how you’re feeling.

We at RSC and any other fertility centers will have resources for you, as well as top counselors. You can do on Zoom or you know, wherever you guys feel comfortable, like in a larger room with masks on. So ultimately, things have changed and evolved, more experiences have happened so we’ve made some progress in knowing more about COVID-19 pregnancy guidelines but there’s still a ton more that is to come, right?

So as always please wear a mask, please ok? And take care out there and just know that if you’re in the Bay Area and you’re looking to grow your family or you’re already a patient with us, you know we’re here to help. Okay, take care. Bye.