COVID-19 and Pregnancy
Pregnant women do not appear to be at higher likelihood to acquire the coronavirus than non-pregnant women, but the disease course of COVID-19 may be more severe. For this reason, take extra care in preventing virus exposure. More than 50% of women who get ill from the coronavirus got it from someone who did not have symptoms at the time. You have to do more than just “avoid sick people”! Understandably, the omicron variant is extremely contagious, and despite your best efforts infections are bound to happen to vaccinated and unvaccinated women. Still, vaccination is your best defense against severe disease, hospitalization, prenatal complications, and death.
If you have COVID-19 symptoms or you are concerned that you may have been exposed to COVID-19, please get tested. We cannot see patients with symptoms of Covid, or test patients for Covid, due to our OSHA compliance categorization. Your primary care provider may do testing in their office. Also, the North Carolina COVID-19 information hotline is 866-462-3821, and is for questions about the virus and for testing locations. In general, if you are experiencing fever, cough or shortness of breath, we request you call the office to postpone your appointment. See our main Covid Updates page for re-scheduling guidance.
Covid Antigen at-home tests are available for purchase at local retailers. There is limited supply in the community, so use this site to find in-stock BINAXNOW SELF-TESTS. Or, visit the NC DHHS website for testing locations, Due to the unique presentation of omicron variant, consider swabbing your throat in addition to nasal passage.
If you do acquire COVID-19, it is likely due to the omicron variant and >90% will only have mild disease (no shortness of breath) and can remain at home. Notify our office if you have COVID-19. We will have regular telephone contact with you, assessing for worsening of your illness and the need for hospital care. We will also reschedule your prenatal appointments to accommodate your isolation.
IF YOU GET COVID DISEASE WHILE PREGNANT…
Please notify our office if you get Covid. We like to keep track of your progressing course, give you practical health advice, and assist in rescheduling
You should isolate yourself from others, to reduce the risk of infection (although, most already transmit the virus several days before a positive test).
The omicron variant domintates our community at this time. Fortunately, instead of pneumonia, omicron symptoms are mainly sore throat and nasal congestion. Fatigue, headache, and a brief fever are common too. Make sure that you are really good about hydration. You may take any of the cold preparations on our safe-medications list
. Call the office or seek emergency room care if you experience worsening breathing ability, unremitting fever >102°F despite appropriate use of acetaminophen, inability to tolerate oral hydration and medications, persistant chest pain with deep breaths, confusion, or obstetric complications (e.g., preterm contractions, vaginal bleeding, rupture of membranes, decreased fetal activity). Presistant respiratory rate ≥20 to 24 breaths/minute and/or heart rate >100 beats per minute are also signs of worsening disease. Those in the third trimester should perform fetal kick counts and report decreased fetal movement.
Pregnancy itself increases your risk for severe disease, hospitalization, and death. There is some limited evidence that it may also increase the likelihood of preterm birth and stillbirth in unvaccinated women. Therapeutics do not improve symptoms, but they do reduce hospitalization and death by 89 percent! Therapeutics include oral anti-viral pills and monoclonal antibody intravenous infusions. These therapuetics are appropriate for all pregnant women, and can be especially important for women who have other risk factors (hypertension, kidney disease, asthma, diabetes, obesity, weak immune system, and others).
- Paxlovid (nirmatrelvir/ritonavir) is an oral antiviral pill combination. The medication has received an Emergency Use Athorization in the United States, including for pregnant patients. In a trial in adult outpatients with at least one risk factor for severe disease, nirmatrelvir-ritonavir, administered within three days of symptom onset, reduced the risk of hospitalization or death. The Society for Maternal Fetal Medicine issued a statement supporting the use of Paxlovid in pregnancy. Although only minimal reproductive safety data from animal studies are available for nimatrelvir (eg, reduced fetal body weights in rabbits when exposed to doses 10-fold higher than authorized human maternal doses), extensive data are available for ritonavir in patients with HIV and no increased risk of overall teratogenic effects has been observed following first-trimester exposure. There are no data on the presence of nirmatrelvir in breast milk, the effects on the breastfed infant, or the effects on milk production. Limited data suggest that ritonavir is present in breast milk, but no information is available on the effects on the breastfed infant or the effects on milk production. Lactation is not a contraindication to use, but interruption of breast feeding during maternal treatment may be prudent.
- Paxlovid is now our preferred therapeutic for pregnant women. It has the equivalent effect as monoclonal antibody treatment, but is more available and requires fewer resources. Side-effects are very rare (<1%) and include diarrhea, altered taste, hypertension, and muscle aches.
> The typical dose is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) — with all three tablets taken together, twice daily for 5 days (30 pills in total).
- Paxlovid is in very short supply, and pharmacies receive sporadic shipments. If you are an established UNC Health pateint, then contact the UNC Health Virtual Practice provider team. Only prescriptions written by a Virtual Practice provider will allow access to supply carried at select UNC Health outpatient pharmacies.
- If you would like Arbor ObGyn to prescribe the antiviral pill treatment, we ask you to locate a nearby pharmacy with Paxlovid in-stock. One search option is to use the US government’s website with real-time locations of Paxlovid distribution. To narrow your search to Wake County, enter WAKE in the “Find in this dataset” on on the right side of the window. Then use the sort feature of the Order Label column, to further consolidate Paxlovid shipments. Contact the pharmacy directly to confirm Paxlovid availability. Call us or send a portal message indicating your desire to take Paxlovid, and you pharmacy location.
- Please review the UNC Health Paxlovid Infosheet, and emergency use Patient Fact Sheet. Also, view a useful video from UNC Health on Paxlovid therapuetic pills.
- Xevudy (sotrovimab) is a humanized monoclonal antibody option for nonhospitalized COVID-19 patients. It is the preferred monoclonal antibody in areas where Omicron is the prevalent circulating variant..
- The drug combination should not be withheld from pregnant patients who are deemed to be at high risk for progression to severe disease if they would otherwise qualify for its use, after a discussion of the potential benefits and theoretic risks. Placental transfer may be expected since human immunoglobulin G1 (IgG1) antibodies are known to cross the placental barrier. Nonclinical reproductive toxicity studies have not been performed, and there is no information regarding whether the potential transfer of these drugs provides any treatment benefit or risk to the developing fetus. Use is not authorized for patients who are hospitalized or require new or increased oxygen therapy due to COVID-19. Typical admistration is intravenous 500 mg as a single dose; administer as soon as possible after a positive SARS-CoV-2 test and within 10 days of symptom onset. We do not administer soltrovimab in our office.
- Soltrovimab is in short supply. If you are an established UNC Health pateint, then contact the UNC Health Virtual Practice provider team or 984-974-0019. Otherwise, we have been referring our patients to Starmed Healthcare. Starmed has infusion sites in Charlotte, Fayetteville, and Jacksonville. Criteria for infusions are very strict, and they are not taking vaccinated-boosted patients right now. You may try a pre-screen survey on their website.
In general, your care after recovering from COVID-19 will not differ from your original prental care plan, except for the addition of an ultrasound in the third trimester. Some leaders think that Covid infection can be associated with low amniotic fluid levels and/or limits on the baby’s growth. Therefore, we will check a growth/fluid ultrasound for your baby around 34-36 weeks (or at least 14 days from symptom resolution). Additional fetal testing such as non-stress tests or biophysical profiles are not recommended.
Ideally, birth will occur sometime after recovery. Induction of labor and cesarean birth are not recommended as a treatment plan for a history of asymptomatic or nonsevere prental Covid infection.
ABOUT THE COVID-19 VACCINE
Should pregnant women get the Covid-19 Vaccine?
Yes. Pregnant women who are eligible recipients should get the vaccine (updated guidance 01/26/22).