Coronavirus (COVID-19)
Information and Resources

Grow Baby Grow

Week 0

Estimated reading time: 15 min reads

first-trimsterIf you are planning to become pregnant and are able to plan ahead of time, consider changing your diet and exercise routine, start taking a prenatal vitamin and visit your dentist. Research suggests that a prenatal vitamin containing folic acid taken just six months prior to conception can be beneficial for a soon-to-be growing baby. If possible, consider getting yourself in optimal physical shape so you can create the healthiest environment for your baby. Remember, that by following PAK’s proactive forty-week gestational guidelines, an expectant mom will never walk into a doctor’s office in the same way again!

PAK’s NEW mobile app ME Preg is the ultimate guide for all things pregnancy! Available now on the App Store and Google Play. ME Preg will walk every mom from preconception to delivery day. Don’t have a Smartphone? Please download our MY EMPOWERED PREGNANCY CHECKLIST, so you can check off key markers of your pregnancy as you reach them.

Coronavirus/Novel Coronavirus (COVID-19)

Pregnancy is a time of great joy and excitement. However, when a global pandemic affects the world, expectant moms must take extreme caution and be vigilant.

The World Health Organization (WHO) states that Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases. The Novel Coronavirus (COVID-19) is a new strain that had not been previously identified in humans.

The United States reported the first confirmed instance of person-to-person spread with this virus on January 30, 2020. According to infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, all pregnant women should be aware of the symptoms of COVID-19.

Symptoms

Symptoms may include:

  • Fever
  • Cough
  • Shortness of breath
  • Chills
  • Repeated shaking
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell

This list is not all inclusive. The Centers for Disease Control and Prevention (CDC) believes at this time that symptoms of COVID-19 may appear in as few as 2 days or as long as 14 days after exposure.

Prevention/Precautions

Currently there are no vaccinations to prevent COVID-19 infection, but they are being researched and tested. The best way to prevent infection is to avoid being exposed to this virus. The CDC recommends:

  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who are sick.
  • Put distance between yourself and other people if COVID-19 is spreading your community. This is especially important for people who are at higher risk of getting very sick.
  • Wear cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
  • If you are sick: You should wear a facemask, if available when you are around other people (including before you enter a healthcare provider’s office). 
  • You should wear a facemask if you are caring for others.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Dr. Christopher Robinson MD, MSCR, FACOG is a Maternal Fetal Medicine Specialist and a member of Project Alive & Kicking’s Medical Advisory Committee (MAC.) He recommends the following guidelines for his pregnant patients:

  • Handwashing
  • Sheltering in place
  • Limiting trips into public places.
  • Letting spouse/friends get groceries.
  • Quarantining new groceries for 3 day prior to entering home.
  • Refrigerator items washed with Clorox solution
  • Recommending fetal movement counts daily
  • Calling with any symptoms of COVID to office to arrange testing
  • Working from home when possible

Dr. Robinson’s encourages his patients to visit his Facebook page with recommendations for going shopping and outside the home. He advises, “So much will change as rates of COVID-19 go up.”

Dr. Robinson shares PAK’s My Empowered Pregnancy Checklist brochure (in English & Spanish) and PAK’s Mom & Baby Tracking Chart (in English & Spanish) with his patients. He’s a proponent of PAK’s app ME Preg  and encourages his patients to keep track of their pregnancies especially movement/kick counting using ME Preg.

How Will This Impact My Pregnancy

With the rapid spread of COVID-19 globally, CDC, WHO, and American College of Obstetricians and Gynecologists (ACOG) pregnancy guidelines are constantly changing.

Pregnant women must be proactive. They need to be aware of the symptoms of COVID-19 and take the necessary precautions to protect themselves and their babies. Expectant mothers should be extremely attentive to their health if they have a preexisting condition such as diabetes, hypertension or asthma to name a few.

Dr. Robinson’s offices are following ACOG’s algorithm for COVID-19 and continuing their usual standards of care with seeing moms on a routine basis. If patients are “High Risk” they may be asked to check their blood pressure and weight at home. Ultrasounds are given depending on the indication such as decreased fetal movements. Movement/Kick Counting is done routinely in the third trimester.

Experts anticipate changes in obstetrical practices; such as fewer prenatal visits and faster postpartum discharges. Dr. Robinson has now been using Telemedicine for three to four weeks for visits that do not require an ultrasound.

As COVID-19 cases continues to surge, it’s feared that hospitals might soon ban visitors from their maternity wards, as several hospitals did briefly in New York and are currently doing so in Los Angeles. At this time in Charleston, South Carolina one partner or spouse can be present for delivery assuming they do not screen positive for COVID-19 according to Dr. Robinson.

A CDC edict recommends that if a mother shows symptoms of COVID-19, she will be separated and quarantined from her baby. “The CDC is recommending a seven-day separation, but it’s a tough one, and it keeps changing,” said Dr. Sarah Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai and an expert in maternal fetal medicine. “The patient can refuse, but we are hoping to encourage her to accept.”

Every pregnant mom must be informed of how COVID-19 is impacting her hospital and how these changes may impact her carefully thought out birth plan.

If you are planning on breastfeeding your baby, for information on how COVID-19 may impact breastfeeding, contact your local hospital, breastfeeding center or visit the Breastfeeding Center of Charleston on Facebook for the most current guidelines.

When to Seek Medical Attention

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

Call 911 if you have a medical emergency. Notify the operator that you have or think you might have COVID-19. If possible, put on a facemask before medical help arrives.

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Treatment

Photo: Brian Wangenheim on Unsplash

Antiviral treatments, antimalarials and vaccinations for the COVID-19 infection are being researched and tested now. If you think you may have been exposed to COVID-19, contact your healthcare provider immediately. Follow care instructions from your healthcare provider and local health department. Your local health authorities may give instructions on checking your symptoms and reporting information.

COVID-19 is a globally emerging, rapidly evolving situation. For the latest information and updates on COVID-19, please visit the CDCWHO and ACOG.

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Healthcare Insurance Coverage

With the ongoing changes in healthcare plans today, be sure to review your healthcare insurance plan regarding pregnancy coverage prior to conception. If you have any questions or concerns, call your healthcare provider for clarification.

The Cost Of Having A Baby

Planning a pregnancy and the arrival of your expected baby is an exciting mix of anticipation and anxiety. Your pregnancy is an amazing forty-week gestational journey with a tiny bundle of joy awaiting massive doses of TLC from you on delivery day. So how much does this journey cost?

So How Much Does It Really Cost To Have A Baby you may ask? This information will help you  to understand the cost of your pregnancy and expected delivery.  Why not check it out now?

Zika Virus

All women considering becoming pregnant must be aware of the Zika Virus. Current research on Zika is in its infancy globally. There is a correlation with pregnant women infected with Zika and microcephaly; babies born with abnormally small heads.

How does it spread?

It is spread by Aedes mosquitoes. They are found throughout the Americas except for Canada and Chile where it is too cold for them to survive. The World Health Organization (WHO) expects Zika to spread throughout the Americas, but other scientists have warned that countries in Asia could face large outbreaks too.

The CDC updated its Zika virus guidance for pregnant women, advising them to protect themselves if their male sexual partner has traveled to or lives in an area where Zika virus is circulating as sexual transmission has been confirmed.

What are the symptoms?

Deaths are rare and only one in five people infected is thought to develop symptoms. These include:

  • Mild fever.
  • Conjunctivitis (red, sore eyes).
  • Headache.
  • Joint pain.
  • A rash

What is microcephaly?

The link between Zika virus, pregnancy and microcephaly has been confirmed. Microcephaly is when a baby is born with an abnormally small head, as their brain has not developed properly in utero. The severity varies, but it can be deadly if the brain is so underdeveloped that it cannot regulate the functions vital to life. Children that do survive face intellectual disability and developmental delays.

What can people do?trimester-img-2

As there is no treatment, the only option is to reduce the risk of being bitten. Health officials advise people to:

  • Use insect repellents.
  • Cover up with long-sleeved clothes.
  • Keep windows and doors closed.

The mosquitoes lay their eggs in standing water, so people are also being told to empty buckets and flower pots. The US Centers for Disease Control (CDC) has advised pregnant women not to travel to affected areas including Latin America and the Caribbean.

What is being done?passport-img

The CDC issued an early-release Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) in July, 2017 updating its short-term guidance for health care professionals that care for pregnant women with probable Zika virus exposure.

Please remember “the CDC’s definition of possible Zika virus exposure(www.cdc.gov) — that is, from ‘travel to, or residence in an area with risk for mosquito-borne Zika virus transmission, or sex with a partner who has traveled to or resides in an area with risk for mosquito-borne Zika virus transmission’ — remains unchanged.”

The CDC’s MMWR offered the following key recommendations:

  • All pregnant women in the United States and U.S. territories should be asked at every prenatal care visit about possible Zika virus exposure before and during the current pregnancy.
  • Pregnant women with recent possible Zika virus exposure and symptoms of Zika virus disease(www.cdc.gov) should be tested to determine the cause of their symptoms. The revised guidance calls for concurrent Zika virus nucleic acid test (NAT) and serologic testing as soon as possible through 12 weeks after symptom onset.
  • Asymptomatic pregnant women with ongoing possible Zika virus exposure(www.cdc.gov) should be offered Zika virus NAT testing three times during pregnancy. The optimal timing and frequency of such testing is unknown.
  • Asymptomatic pregnant women who have recent possible Zika virus exposure but no ongoing possible exposure are not routinely recommended to have Zika virus testing.
  • Pregnant women with recent possible Zika virus exposure who have a fetus with prenatal ultrasound findings consistent with congenital Zika virus syndrome should receive Zika virus testing to help establish the etiology of the birth defects. Testing in this instance should include both NAT and IgM testing.

Director General Dr. Margaret Chan states that the priorities are to protect pregnant women and their babies from harm and to control the mosquitoes that are spreading the virus. Dr. Chan reaffirms that pregnant women should not travel to countries affected by Zika and to seek advice from their doctors if they are living in areas affected by Zika as well as protect themselves against mosquito bites by wearing repellent.

Currently, there is a concerted global effort to develop a vaccine for the Zika virus that will protect the general population against its adverse effects.

For more information on Zika virus, please visit Zika Virus: What It Is, Affected Countries, Symptoms, Treatment and More [Guide.] 

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Vaccinations Before Pregnancy

The best time to receive vaccinations is before you become pregnant according to the U.S. Department of Health and Human Services (DHHS) so discuss this possibility with your health care team if this pertains to you. Vaccinations will help safeguard your body from infection and this protection passes to your baby during pregnancy. You are encouraged to have a preconception exam to make sure you are up to date with your “adult” vaccines; bring a copy of your vaccination record with you. If you don’t have this record, a simple blood test will let your health care team know what vaccinations you need. If you aren’t current, ask your doctor for the requisite vaccines. Women are generally advised to wait one month following anyvaccinations to become pregnant. Your health care team may or may not advocate vaccinations during pregnancy.

According to the Centers for Disease Control (CDC), the “risk to a developing fetus from vaccination of the mother during pregnancy is theoretical. No evidence exists of risk to the fetus from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines administered to a pregnant woman pose a theoretical risk to the fetus; therefore, live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.”

There are a few vaccines that are usually recommended before pregnancy. You may be familiar with three of the most common ones. The first is Influenza IIV (Inactivated). “Inactivated” means the vaccine does not contain a “live” virus. Vaccinations containing “live” viruses are contraindicated and not given to pregnant women per the CDC. The second recommended vaccine is Tdap (tetanus, diphtheria and pertussis). This vaccine is not only recommended for you, but also relatives, close friends and caregivers who will spend time with your baby. The third is MMR (measles, mumps and rubella). Measles contracted during pregnancy may be dangerous to pregnant women and result in miscarriage.

Several vaccinations are given “if indicated” before or after pregnancy. One reason a vaccine may be indicated is because you have the potential for exposure to an infection. For example, your health care team may suggest you be vaccinated for rabies if you are a technician working in a veterinarian’s office and may possibly come in contact with a rabid animal. Another reason a vaccine may be indicated is that you have a medical condition that increases your risk for contracting an infection. One example is that you may have had your spleen removed (splenectomy). Your spleen helps your body fight infections so your health care team may recommend that you receive the Pneumococcal vaccine to prevent pneumonia. Some other vaccinations which may be given “if indicated” before or after pregnancy are Hepatitis A, Hepatitis B, Meningococcal Polysaccharide/Conjugate, HPV (human papillomanvirus), Varicella (chicken pox) and Tetanus/Diphtheria (TD). Tdap is the preferred vaccination of choice over TD as it also contains pertussis (whooping cough).

The CDC states that if you are pregnant and not up to date on your flu vaccine, you may be at a higher risk for developing flu and flu-related complications. They recommend that all women who are or will be pregnant during the influenza season be vaccinated with the Influenza (Inactivated) vaccine.

The National Institute of Health (NIH) acknowledges the concern among pregnant women receiving Influenza (Inactivated) in a “multi-dose” form as it contains a small amount of mercury (thimerosal), a preservative. Although this vaccine has not been shown to cause attention deficit hyperactivity disorder or autism, the fear among expecting moms still exists. Routine vaccinations are available without the preservative thimerosal added. It is important that all pregnant women know that they may request their vaccination be free of this preservative if they so wish.

Every woman must thoroughly research any medication or vaccination recommended to her during pregnancy. Any concerns or the possible side effects of any medication or vaccination should be discussed with her health care team. Please refer to the March of Dimes and the CDC for more information on vaccinations before, during and after pregnancy, Guidelines for Vaccinating Pregnant Women, and breastfeeding and vaccinations.

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Pre-pregnancy Caffeinecaffeine

A study conducted by the NIH and the Ohio State University recently published in the journal Fertility and Sterility found a worrisome link between caffeine consumption and miscarriage. Quite simply, the data proves that couples who drank more than two caffeinated drinks a day during the weeks prior to conception had a greater risk that the woman would miscarry.

That’s correct – the research found that both Mom’s caffeine and Dad’s caffeine consumption could play a role in miscarriage! This study also confirms previous research showing that women who drink more than two caffeinated beverages each day during the first seven weeks of pregnancy are also more likely to miscarry. On the bright side, this study did show that women who took a daily multivitamin before and after conception appeared to greatly reduce miscarriage risk!

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