Trying to Conceive, pregnancy, and breastfeeding in a world with Covid-19 / Coronavirus.

Posted by Chantelle Meikle on March 18, 2020

Are you worried about what Covid-19 means for your TTC Journey or Pregnancy?

Last updated: 7 AM 25/03/2020

LEVEL 4 UPDATE:

All fertility clinics in NZ have now postponed treatment, please contact your fertility specialist.

If you have started the fertility medications (eg: gonal-f), then your cycle will continue, however all embryos will be frozen for a future transfer date.
If you have not started your fertility medications yet (are still taking the pill, or have started a natural cycle), then your treatment will have been postponed.
Consultations will now be done online or via phone.
Early pregnancy scans are still going ahead at this stage.

All of us now need to stay home for the duration of the 4 week shutdown
If you are pregnant, consider yourself at high risk and send another member of the household to do food shopping.

Ensure that on their return they wash their hands
If possible, order online and pick up your groceries

Contact your midwife to discuss your birthplan if you were due to deliver anytime in the next 6 weeks.
If you are trying to conceive naturally, then my advice still stands, please turn your focus towards working on your fertility health for the next few months until this situation changes and medical services are back to normal.

This update supercedes the advice given below, please contact your midwife if you are pregnant and have questions about your birth plan.

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Over the last 18 months prospective and pregnant mothers have had to contend with the Zika virus, Measles outbreak and now Covid-19 – while at the same time working to limit their exposure to seasonal Influenza.

When compared to Zika, and Measles, the good news is that there is no evidence to show that a respiratory infection like Covid-19, SARS, MERS or Influenza negatively impacts on the developing baby. There have been no deaths reported of pregnant women who have contracted Covid-19, and there is no evidence for an increase miscarriage risk.

👶 You are probably wondering whether to pause your baby making efforts, and if you are already pregnant – what can you do to protect both yourself and your baby?

I have reviewed the recommendations from Ministry of Health (MOH) in NZ, the CDC in the USA, and Royal College of Obstetricians and Gynaecologists (RCOG) in the UK – as each of these areas of the world are at differing stages of the outbreak.

It is important for those in NZ to refer to the MOH guides – however at this point in time ‘pregnancy’ is only mentioned once in their 18 page document for health professionals. There does not appear to be any publicly available information for pregnant women.

The small sample sizes and case studies that have been coming out of China as well as historical data on the effects of SERS and MERS form the basis for the current recommendations from the CDC and RCOG.

What if I am already pregnant?

According to the MOH in NZ, if you are pregnant, you are considered a high risk population – this is because during pregnancy the immune system is suppressed and you are more susceptible to catching cold’s and viruses, and passing it on to others. Therefore it is about limiting your exposure to bugs and viruses.

During early pregnancy (the first 12 weeks) the biggest risk factor for the developing baby is if the mother has a prolonged fever (from any cause). There is also suspicion that if the mother is in her 3rd trimester when she contracts Covid-19, then the lungs may not have as much capacity due to the baby putting pressure on her internal organs – this may lead to complications.

If you have asthma, diabetes or other chronic respiratory conditions then you are at a higher risk for complications from Covid-19, ensure you are following best hygiene practices and stay in communication with your GP and midwife.

How about Breastfeeding?

Based on the current understanding of how anti-bodies are transferred to the infant via breastfeeding - if you contract the virus during pregnancy, then the anti-bodies that you produce should in-fact protect your baby whilst you are breastfeeding.

If you have the virus during labour, then care needs to be taken to not transfer the virus to the newborn (ask your midwife for specific advice). There is no evidence that the virus itself is transferred in breast milk.

Advice*

🌸 If you are trying to conceive in NZ, then I recommend that you switch your focus to getting fertility fit for the next month or two (until we know how widespread this virus will be in NZ). This means focussing on your health (both partners), understanding your fertility, and working to create the healthiest sperm and eggs possible.

🌸 Regarding Fertility Treatment:

==> Fertility clinics in NZ are still operating (with added safety measures in place), they do not recommend deferring your treatment at this point. As the situation evolves the advice may change. They will work with you on a case by case basis to discuss the risks. If you are diagnosed with Covid-19 during treatment then your cycle will be cancelled as you will need to self-isolate. I am unsure of the financial implications of a cancelled cycle in this instance, best to raise this with your specialist.

==> The European Society of Human Reproduction and Embryology has released this statement:

"As a precautionary measure - and in line with the position of other scientific societies in reproductive medicine - we advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid becoming pregnant at this time. For those patients already having treatment, we suggest considering deferred pregnancy with oocyte or embryo freezing for later embryo transfer."

🌸 If you are in your first trimester, then consider self-isolation.

==> If you are working in an office, then speak to your manager about either working from home temporarily or moving your desk to a position that is separated from other workers. I understand that this may be a difficult conversation to have if your employer is unaware of your pregnancy or TTC journey.
==> If you are unwell monitor for fever (any temp higher than 38.5 degrees Celsius contact your midwife).
==> Avoid anyone who is sick.

🌸 If you are in your 2nd and 3rd trimester there is no evidence of risk to you or your baby. Practice physical isolation and a high level of hygiene, and continue to monitor for fever. Consider self-isolation if in the final 4 weeks. If you are a confirmed to have Covid-19 during labour, then you will be placed into isolation when arriving at hospital which may impact on your birth experience.

🌸 Take steps to protect your family with good nutrition. Support the whole family’s immune systems with an appropriate probiotic, vitamin c, and herbal preventatives. This will protect you as they will be less likely to bring colds and viruses into the home (especially in the case of toddlers in day care).

🌸 Let your midwife know of any concerns you have. Talk to them about alternative arrangements for your appointments.

🌸 If you think you have been exposed to Covid-19, self-isolate immediately and call your GP – they will advise you on how to get tested. Do not visit the GP or midwives clinic – call them. It is highly likely you will only experience mild cold and flu symptoms, monitor for fever and follow the recommendations from your midwife.

* NOTE: This is my advice as a Naturopath and Fertility Educator. We do not know what is going to happen over the next 2 months in NZ, therefore I have erred on the side of caution. If you are concerned then please contact your midwife or GP, my sources have been referenced below.