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COVID-19 and Your Placenta

Your Placenta and Viruses

The placenta is one of the most important aspects in a healthy pregnancy. Your placenta will carry oxygen, nutrients, hormones and blood to your growing baby. The unwanted waste will also be flushed out through the placenta. Another major role is protecting your baby from sicknesses. The placenta is the life giving connection between you and your baby!

There are still unknowns about the placenta however. One of them is how viruses interact with it and what exactly is happening when those viruses cause problems. The outcomes of similar viral infections are known though and can include, miscarriage, preterm labor, stillbirth, fetal disease, seizures, mental disabilities and delays, and disease later in life like diabetes (Annual Review of Virology).

The Placenta and COVID-19

Reports of miscarriages, fetal distress and stillborn babies are being linked to COVID-19. According to CNBC obstetricians are reporting a rise in miscarriages since the pandemic started. They are unable to officially link this to the virus but view it as related. This is not surprising. The Journal of the American Medical Association (JAMA) reports that 40% of pregnant people with cases of MERS and SARS (both types of coronavirus) resulted in a miscarriage or effected growth.

Learning from the past and similar situations is a great way to keep ourselves safe and knowledgeable. In an article published in the Elsevier Public Health Emergency Collection, data from the 2002-2003 outbreak of SARS and MERS illustrates what can happen when infected with a virus. In pregnant SARS patients: 57% had a miscarriage in the 1st trimester, 40% had fetal growth restriction and 80% had a preterm birth, 25% died during pregnancy. In pregnant MERS patients: 91% presented with adverse outcomes, 44% of neonates required admission to the ICU, and 27% died.

Data is emerging for the new COVID-19 and its effects on pregnancy. Time will reveal more. The CDC states on their website, “A small number of other problems, such as preterm (early) birth and other problems with pregnancy and birth, have been reported in babies born to mothers who tested positive for COVID-19. We do not know if these problems were related to the virus.”

A study at Northwestern found placental injury, blood clots and abnormal blood flow in the placenta of people testing positive for COVID-19. One of the assistant professors of pathology at Northwestern says, “There’s an emerging consensus that problems with blood clotting and circulatory problems are a feature of the coronavirus, and I think our work shows there might be something clot-forming about coronavirus, and it’s happening in the placenta.”

In an article published by JAMA the details of one miscarriage related to COVID-19 are explained. A pregnant woman in her 2nd trimester with COVID symptoms took herself to the hospital. She was given acetaminophen and sent home. Two days later her symptoms did not stop and she started to experience severe contractions and a high fever. Her baby was unfortunately stillborn. The baby was not found to be infected with COVID, neither was the amniotic fluid. But when the placenta was biopsied the virus was found. The doctors could find no other reason for the stillbirth. The virus was then found in the woman’s nasopharyngeal swab.

What Can You Do?

Unfortunately the thing we keep hearing over and over is, more research needs to be done. It is understandably hard to collect data from large numbers of pregnant women, especially ones that are infected. On top of that we don’t know exactly how the virus works or how viruses in general interact with the placenta. 

Taking precautions is the very best thing you can do right now. Sanitizing, limiting social interactions, social distancing, wearing protective equipment and just all around being mindful is your best course of action.

Posted on

COVID-19 and Your Placenta

Your Placenta and Viruses

The placenta is one of the most important aspects in a healthy pregnancy. Your placenta will carry oxygen, nutrients, hormones and blood to your growing baby. The unwanted waste will also be flushed out through the placenta. Another major role is protecting your baby from sicknesses. The placenta is the life giving connection between you and your baby!

There are still unknowns about the placenta however. One of them is how viruses interact with it and what exactly is happening when those viruses cause problems. The outcomes of similar viral infections are known though and can include, miscarriage, preterm labor, stillbirth, fetal disease, seizures, mental disabilities and delays, and disease later in life like diabetes (Annual Review of Virology).

The Placenta and COVID-19

Reports of miscarriages, fetal distress and stillborn babies are being linked to COVID-19. According to CNBC obstetricians are reporting a rise in miscarriages since the pandemic started. They are unable to officially link this to the virus but view it as related. This is not surprising. The Journal of the American Medical Association (JAMA) reports that 40% of pregnant people with cases of MERS and SARS (both types of coronavirus) resulted in a miscarriage or effected growth.

Learning from the past and similar situations is a great way to keep ourselves safe and knowledgeable. In an article published in the Elsevier Public Health Emergency Collection, data from the 2002-2003 outbreak of SARS and MERS illustrates what can happen when infected with a virus. In pregnant SARS patients: 57% had a miscarriage in the 1st trimester, 40% had fetal growth restriction and 80% had a preterm birth, 25% died during pregnancy. In pregnant MERS patients: 91% presented with adverse outcomes, 44% of neonates required admission to the ICU, and 27% died.

Data is emerging for the new COVID-19 and its effects on pregnancy. Time will reveal more. The CDC states on their website, “A small number of other problems, such as preterm (early) birth and other problems with pregnancy and birth, have been reported in babies born to mothers who tested positive for COVID-19. We do not know if these problems were related to the virus.”

A study at Northwestern found placental injury, blood clots and abnormal blood flow in the placenta of people testing positive for COVID-19. One of the assistant professors of pathology at Northwestern says, “There’s an emerging consensus that problems with blood clotting and circulatory problems are a feature of the coronavirus, and I think our work shows there might be something clot-forming about coronavirus, and it’s happening in the placenta.”

In an article published by JAMA the details of one miscarriage related to COVID-19 are explained. A pregnant woman in her 2nd trimester with COVID symptoms took herself to the hospital. She was given acetaminophen and sent home. Two days later her symptoms did not stop and she started to experience severe contractions and a high fever. Her baby was unfortunately stillborn. The baby was not found to be infected with COVID, neither was the amniotic fluid. But when the placenta was biopsied the virus was found. The doctors could find no other reason for the stillbirth. The virus was then found in the woman’s nasopharyngeal swab.

What Can You Do?

Unfortunately the thing we keep hearing over and over is, more research needs to be done. It is understandably hard to collect data from large numbers of pregnant women, especially ones that are infected. On top of that we don’t know exactly how the virus works or how viruses in general interact with the placenta. 

Taking precautions is the very best thing you can do right now. Sanitizing, limiting social interactions, social distancing, wearing protective equipment and just all around being mindful is your best course of action.

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Fecal Transmission of COVID-19

Fecal Transmission of COVID-19

 

The outbreak of COVID-19 has everyone covering their faces, washing their hands and practicing social distancing. Those that are pregnant are even more cautious. This is wise because pregnancy weakens the immune system making you more vulnerable to sickness. One of the most concerning parts of our situation is that so little is known about the virus. This makes every precaution worth while, especially when it comes to the health of your baby.

The World Health Organization states that COVID-19 is transmitted through respiratory droplets containing the virus or the virus being suspended in the air. This is why staying away from people, facemasks and sanitising are so important. But exposure to COVID-19 isn’t limited to the routes everyone is talking about.

COVID-19 – Not Just Respiratory

 

Some patient results listed in Nature Reviews Gastroenterology & Hepatology found that

those that are no longer testing positive for Coronavirus in their respiratory system are consistently still testing positive in rectal swabs. 

A study in the American Journal of Gastroenterology found that 99/204 patients stated digestive problems as their main issue (diarrhea, vomiting, nausea) resulting from their COVID-19 infection. There have even been patients that did not exhibit signs of respiratory problems that have tested positive in their rectal swab. Not all patients experience the discomfort in their stomachs either. Unfortunately that means even if you aren’t having trouble breathing or having stomach issues, you could still have the virus.

Researchers say that the virus could stay around longer in the digestive system than in the respiratory system. The City University’s Department of Architecture and Civil Engineering published that toilets can spread left behind bacteria far into the air and the surrounding objects through droplets from flushing. 

How COVID-19 reacts with the gastrointestinal tract and is spread through fecal matter and even in water are still some of the unknowns.

Pregnancy and Stomach Problems

 

The issues a normal person might face if they contract the virus are horrible. If you are pregnant, the worry of course increases. Gastrointestinal issues and pregnancy are of concern when it comes to pregnancy. A study published in the Open Forum for Infectious Diseases found that in a sample of 527 pregnant women experiencing diarrhea, a small gestational age was increased by approximately 20%.

Dehydration from diarrhea can lead to serious health complications and even be fatal for both mother and baby. Dehydration can affect how nutrients are carried throughout the body and negatively impact breast milk production. Dehydration can also lead to low levels of amniotic fluid. Amniotic fluid is essential to your baby’s development and can increase the chance for preterm labor. 

The Bottom Line

 

Nobody knows all of the facts about COVID-19. The new research being done on the virus and fecal matter illustrates that taking more safety measures is better right now. In addition to your respiratory defenses you should also be taking care in the bathroom.

  • Don’t use public restrooms

  • Wash your hands thoroughly after the bathroom

  • Put your toilet seat down when flushing

  • Clean and disinfect your bathroom and toilet often

  • Don’t hug the toilet if you’re experiencing morning sickness

 

 

 

 

References:⁣

https://www.familyeducation.com/immune-system-pregnancy-step-step-guide⁣

CDC Recommendations/Higher risk of respiratory infections: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fpregnancy-breastfeeding.html⁣

https://www.healthline.com/health/pregnancy/dehydration#What-causes-dehydration?-⁣

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161079/⁣

https://www.nature.com/articles/s41575-020-0295-7⁣

https://pubmed.ncbi.nlm.nih.gov/32284613/?dopt=Abstract⁣

https://www.scmp.com/news/hong-kong/health-environment/article/3050502/coronavirus-hong-kong-study-shows-pathogens-can⁣

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Prescription Opioids

These painkillers are prescribed to new mamas for anything from perineal tears to C-section incisions. The potential for developing a habit is huge and spikes every day you use them. Abuse, addiction, and even death are all part of the opioid epidemic that is spreading worldwide. According to the National Institute on Drug Abuse (NIDA), more than 130 people die in the United States every day from an overdose of opioids. These issues don’t seem like they belong in the same place as a beautiful new family with their whole lives in front of them. Unfortunately, that’s where they are found all too often.

Between 2008 and 2016 Jama Network Open studied 300,000 women that were prescribed opioids after childbirth. Of those 300,000 new moms, 6,000 of them showed “persistent” opioid use by refilling their prescriptions beyond the average time a woman recovers from most postpartum pains. (what is the time period?) 

Misuse and addiction aside, opioids can cause a person to feel drowsy, delirious, dizzy and nauseous… all of these things are distracting and can take away from the ability to care for a baby.

(I would also add a section on how the opioids impact the baby)

INCREASED RISK

New mothers that are prescribed opioids may have never been exposed to their dangers. It’s easy to accept whatever a medical professional tells you to do. (maybe say something like they have the best intentions to manage your pain and may not be aware of safer alternatives. Also. the drug companies have been telling doctors and patients for decades that opioids are safe and non-addictive, so really the fault lies with them and not your well meaning provider) This can make things like heavy pain medication seem absolutely normal and enjoyable.

Postpartum women are especially vulnerable to misusing their pain meds. The prevalence of postpartum depression and even the “baby blues” increases the chances of substance abuse. Turning to drugs to lessen feelings of sadness or loneliness is extremely common. Developing an addiction and not dealing with mental health issues in a proper way can set a person up for a lifetime of problems. (Talk about how this crosses educational, racial and socioeconomic lines) 

Substance abuse can also come on by accident. A new mom is already tired and it sometimes can feel like the days blend together those first weeks postpartum. How easy would it be to forget how much you took or when you took it? (good point!)

MANAGING PAIN

Knowing that you will be dealing with pain postpartum can be scary. Setting up a plan to manage that pain is necessary and will set your mind at ease. Talking with your doctor about options and their risks and benefits is always a good idea. We want every mama to be as comfortable as possible after birth and that comfort doesn’t necessarily have to come from a prescription bottle. The world of sports technology has long been using pain relief approaches that do not require medication to treat athletes. Compression, support, icing, and heating are beloved methods used by professionals… so we applied this to postpartum care! Every mama’s journey is different so we encourage you to listen to your body and talk to your doctor if anything is not working for you. 

Our dream is to make every new mama happy, healthy and feeling her best – our dream is to raise the standard of postpartum care.

(Be more informative about soft tissue swelling management and how important support/compression and ice are to managing tissue trauma. I would also talk about how everyone thinks about supporting the stomach but they often forget about the most important part…the pelvic floor. Every new mama has some level of pelvic floor dysfunction, even if she had a c-section. Like how common incontinence is here in women childbearing age and older. Maybe make a comment about how young the models are in the Depends ads today. They are trying to “Normalize” it and we are trying to prevent it.

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A Rainbow After Loss

Rainbows remind us that there is hope and beauty after a storm. It is no wonder why the term rainbow baby is used for babies born after a miscarriage, stillbirth or infant loss. It is fitting that meteorologist Dylan Dreyer publicly announce that her recent pregnancy is going to give her a lovely rainbow baby!

The pain and grief that comes with her loss took another emotional toll when she had to hide it. Dylan reveals, “I’m devastated, and I have to go to work on the ‘Today’ show and be happy and smiling and pretend like nothing’s wrong.”

Researchers at Albert Einstein College of Medicine of Yeshiva University and Montefiore Health System, found that feelings of guilt and shame are prevalent with men and women that have experienced this type of loss. Out of 1,000 US adults surveyed, 47% reported feeling guilty, 41% felt they had done something wrong, 41% reported feeling alone and 28% reported feeling ashamed. Only 45% felt they had received enough emotional support from the medical community.

We applaud Dylan for acknowledging this devastating event and speaking to the fact that everyone’s situation and feelings are valid and can coexist. She says, “My sadness doesn’t take away from anyone else’s happiness and my sadness isn’t minimized because someone else has a sadder situation.”

28% of those surveyed that had suffered a miscarriage said that celebrities’ speaking about their loss had lessened their feelings of isolation, 46% said they weren’t as lonely when friends told them about their own miscarriages.

“…miscarriage is very common but rarely discussed, many women and couples feel very isolated and alone after suffering a miscarriage. We need to better educate people about miscarriage, which could help reduce the shame and stigma associated with it,” said Dr. Williams. “We want people who experience miscarriage to know that they’re not alone—that miscarriages are all too common and that tests are available to help them learn what caused their miscarriage and hopefully to help them in subsequent pregnancies.”

A storm leaves droplets of water that act like tiny prisms to reflect pieces of light into something magnificent. Your unique story of pain is like those millions of raindrops that can refract a brilliant light in the world – no matter if you are creating your own rainbow or easing the effects of the storm for someone else.

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