CDC study reinforces COVID-19 cautions with pregnancy

As more young people test positive for COVID-19, doctors are reiterating the importance of social distancing for a subset of younger Minnesotans — expectant mothers.

Federal health officials last month cited new study results when adding pregnancy to their list of conditions that might put people at greater risk of serious illness from the pandemic virus. Last week, the Minnesota Department of Health similarly updated online information for pregnant women while adding prevention tips.

Pregnant women shouldn't be alarmed, doctors say, but the study underscores the wisdom of following guidance on avoiding the coronavirus.

"I think everybody came into COVID saying: 'We don't think it makes a huge difference whether you're pregnant or not, but let's be cautious because we don't know for sure,'  " said Dr. Laura France, medical director for community birthplaces at M Health Fairview. "So, I think this just reinforces that caution."

The updates from health officials don't change the guidance to patients about wearing masks, washing hands and keeping at least 6 feet away from others, said Dr. Matt Banfield, an obstetrician with Park Nicollet in St. Louis Park.

"Be as careful as you can," he said.

To Angela Cady, 31, of Minneapolis, who expects to deliver her baby this month at Park Nicollet, it all boils down to four simple words: "Better safe than sorry."

The June report from the U.S. Centers for Disease Control and Prevention showed that pregnant women with COVID-19 were more likely to be hospitalized, need intensive care and receive mechanical ventilation than a comparable group of infected women who weren't pregnant. Both groups had similar risks of death.

The study also suggested that Hispanic or Black women were disproportionately affected by the virus infection during pregnancy.

Federal health officials discussed the findings at a June news conference that focused on how infections among young people have driven recent COVID-19 increases in Sun Belt states.

"Pregnancy, of course, is going to be always in younger people," said Dr. Jay Butler, the CDC's deputy director for infectious diseases. "And so, the emerging data on the increased risk of more severe illness among people who are pregnant is something that has become more visible as we have increasing numbers of cases occurring."

It's reassuring that the study found pregnant women don't have an increased risk of death, said Dr. Dana Meaney-Delman, a COVID-19 deputy incident manager with the CDC. Even so, expectant mothers should "take precautions with regard to coming in contact with others, the number of people they come in contact with, wearing face coverings [and] social distancing," she said.

It's not clear, she added, what a pregnant woman's COVID-19 infection means for her baby. Mother-to-child transmission of the coronavirus during pregnancy is unlikely, but a newborn after birth is susceptible to person-to-person spread, according to updated guidance from the state Department of Health.

Cady said that with her due date approaching, she and her husband have "put ourselves on a little bit of a lockdown." Gone are the occasional outdoor gatherings, complete with masks, social distancing and a few friends or family members.

Cady says she's not overly concerned about what COVID-19 could mean for her own health but is focused instead on what it would mean for her baby. Guidelines recommend that infected moms be separated from their babies after the delivery and spouses who test positive aren't allowed in the birthing room.

"My biggest concern is what it means for when the baby is here," she said, "and what that delivery looks like."

Following the recommendation for isolating babies is "terribly hard," said Dr. Don Wothe, a maternal and fetal medicine specialist with Allina Health. Some parents refuse, he said, but the idea drives home the prevention message.

"People of similar ages tend to associate with other people of similar ages," Wothe said. "So, if more young people are getting it, there will be young pregnant patients in there."

COVID-19 is a viral respiratory illness that brings most risk to people 65 and older, residents of long-term care facilities and those with certain medical conditions, ranging from lung disease and serious heart conditions to severe obesity and diabetes. Most cases, however, tend to be mild.

The state Department of Health on Sunday reported 519 new cases and five new deaths from the virus. All five were residents of long-term care or assisted-living facilities. The statewide death toll is now 1,471, with 1,155 of those cases involving residents of long-term or assisted-living care.

A total of 253 people required hospitalization, compared with 270 at Friday's data release, the Health Department said. The Sunday numbers show 132 patients required intensive care, unchanged from the number of ICU patients reported on Friday. Daily tallies for hospitalized patients in Minnesota have been trending down in recent weeks.

The latest figures cover two days' worth of data, since the Health Department did not release numbers over the July 4th holiday on Saturday.

Coronavirus cases across all age groups in Minnesota have increased by 42% since early June, according to Health Department data, but the rate of increase is even higher among people in their 20s.

Doctors haven't yet seen an influx of cases in pregnant patients, but they're concerned, said Dr. Todd Stanhope, medical director of women and children's services at Robbinsdale-based North Memorial Health.

COVID-19 has changed pregnancy by keeping women farther apart from friends and family, said Melissa Hasler, the director of nurse midwives for M Health Fairview. In some cases, the isolation can create more stress and anxiety.

The CDC report "does certainly make you pause and take note and counsel your patients even more strongly about the importance of social distancing and avoiding places like bars, restaurants — places where they can't maintain that social distance," Hasler said.

"A lot of pregnant women may not be going out to the bars and restaurants," added France. "But they may have someone who lives with them who does. So, we're just really reiterating that it's important for all their household exposures."

France noted, though, that the higher hospitalization rate documented in the study could be a function of doctors taking extra precautions when pregnant women get sick.

Medical centers across the state are trying to reassure patients that it's safe to have a baby in a hospital even with COVID-19 present. At M Health Fairview, doctors highlight factors from universal masking requirements to separate entrances for maternity patients, so they don't have to come through the emergency room after normal business hours.

It's all a reminder of the pandemic's far-reaching impact.

"While we're still at 1% or 2% of women perhaps who have gotten COVID, nearly every pregnant patient has had an alteration of their experience of what it's like to be pregnant — to be worried about their baby and then to have less close support than they've had before," said Wothe, with Allina.

Though the latest numbers suggest that pregnant women could get sicker with COVID-19, the reported difference is relatively small, said Dr. Steve Calvin, an obstetrician with Minnesota Birth Center in Minneapolis. While the study helps emphasize that expectant mothers should be careful, Calvin says, it shouldn't inspire fear.

"I just don't want mothers to think, 'Oh, my gosh, I'm pregnant now,' or 'I shouldn't be pregnant, because my life will be at risk,' " Calvin said. "That's not true."

Christopher Snowbeck • 612-673-4744