JAMA article re vertical transmission - talk me down

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I'm first trimester and have been affected by birth defects before. I may have been exposed and apart from isolating I don't know what to think or do.

Previous research was encouraging so not intending to scare monger but discuss what the research says. I'm especially concerned about the IGM findings although appreciate they can be clinically unreliable.

www.google.com/amp/s/abcnews.go.com/amp/Health/Wellness/mother-baby-transmission-covid-19-ruled-study-finds/story%3fid=69821832

Sorry to bump so soon, I'm struggling with this

www.medpagetoday.com/infectiousdisease/covid19/85619

Last bump and then I'll leave you all alone

I don't know what I'm hoping for as nobody knows the answers!

All l can think to say is, worrying won't change it. And, you have to catch it first- are you following the guidance?

True.

Yes I am following the guidance. I'm worried I may already have had it and been asymptomatic (I had a sore throat for a couple of days a couple of weeks ago but nothing else) but not sure what to think

I feel for you as I was very anxious during my first pregnancy and you sound very much like I was. Obviously no one can say for definite, but I think you have to try and keep in mind the balance of probabilities. Having looked at the articles (only quickly, so apologies if anything I say isn’t exactly as it said), it was only 9% of babies affected so that’s 91% that weren’t, so the article actually says most babies aren’t affected. Plus, if the mothers were tested, it’s likely they had more severe symptoms so that could also have increased the likelihood of passing it to the baby and also the severity for the baby. All the babies pulled through as well, despite the mothers presumably being quite ill. You weren’t very ill and so even if you did have it, would probably have a much lower chance of passing it on. And you may not have had it all as there are lots of colds going round as well. I know it’s easy to say, but try not to worry too much. You may well not have had it, if you did your body did a good job of fighting it off and those antibodies would pass to the baby and help the baby to fight it. I’m hoping that helps a bit, as I know how much I worried and it isn’t easy.

You're right. I think that if I were later in pregnancy I'd be less concerned (although risk to me would be higher) as the baby would be formed.

Can't help but think of rubella and CMV for example and how damage they do in first trimester.

I just keep expecting bad news at 12 week scan again (if we make it that far) and can't believe it's happening again. Even if things appear normal this time I'll be worried something missed.

I was the same all the way through my first pregnancy. I’d had a miscarriage before that and couldn’t believe everything would go right so I worried about everything. I know it’s really hard but try and think of all the cold and flu viruses that people get when pregnant that don’t affect the baby. Many mothers in that study didn’t even pass it on to the baby and, if you’ve had it you’ve had a mild case, so keep thinking about that if you can and try to hang onto the positives.

It's hard isn't it? I had a miscarriage too and in next pregnancy we had a wonderful DC but found out at scan that they had birth defects from an unknown cause around this stage of my pregnancy.

I think I've been exposed and am so worried that it will cause developmental problems and also that we simply won't know and as before will spend the whole pregnancy wondering what will happen.

www.nytimes.com/2020/03/27/health/shielding-the-fetus-from-the-coronavirus.html

More and more articles coming out about the studies. I can't believe it. I don't know what to think and just feel utterly depressed about the pregnancy when it's such a wanted child

The NY Times article says clearly that babies aren't affected or are barely affected, OP.
Flu doesn't cause birth defects. Most viruses don't.

That's true and the article notes that.

But it also says "Still, the studies merit concern, she said, because if the virus does get through the placental barrier, it may pose a risk to the fetus earlier in gestation, when the fetal brain is most vulnerable."

It then refers to Zika as an example before concluding it's unlikely the virus falls into same category but nobody knows.

The babies in the study were already fully developed and at less risk - take rubella for example which is devastating in first trimester.

I do want to be reassured, though, so I'm not looking anymore!

Too much speculation is definitely bad for the soul.

RCOG have updated their guidance today to say that vertical transmission is probable, although they do not yet know if it causes birth defects.

I'm so frightened because I'm so early in and now I'm convinced I have a cough, though it may be psychosomatic.

@lljkk most viruses do not cross the placenta - influenza very likely doesn't. Although it's not strictly true to say it doesn't cause birth defects as it can occasionally indirectly if a mother has a high temperature in first trimester.

In most teratogenic viruses there is little effect on the baby after the early stages of pregnancy, when the baby is fully formed. They all have differing rates of transmission and variable effects.

We just don't know with this one but it's rare for a virus to act in this way (if indeed it does cross placenta) and so is concerning.

I don't want to cause panic but feel absolutely terrified and surprised it's not on UK news yet, now RCOG have updated their advice.

I guess we will not know for a year or more if it likely causes effects, by which time our baby will hopefully be born if the pregnancy continues. It's very frightening.

I understand totally how frightening this is. I found out yesterday I was pregnant. Very wanted baby but would definitely have timed things differently had I known covid-19 was on the horizon.

Seeing RCOG update it’s guidance made it feel quite real didn’t it as usually they are the only source I would look at.

If you put together the more encouraging studies with the newer less encouraging ones the most you could conclude is that yes, vertical transmission is probable, but clearly it’s not very common. If vertical transmission does occur then it doesn’t mean that it will effect the majority of foetus’ (even Zika didn’t effect most babies of mothers carrying it!) and of those foetus’ exposed it doesn’t mean that birth defects will occur. There is still so much unknown that we mustn’t jump to the worst case scenario. Especially as other coronavirus (like SARS and MERS) that we know about have had no impact on foetal development at all in the first trimester.

Essentially this is out of our control. What is in our control is limited our chances of catching it. I hope you are able to work from home etc :) What will be will be and there is every chance you and your baby will be absolutely fine x

@ForeverBaffled congratulations on your pregnancy! Thank you for your reassuring reply too. We feel the same - much wanted but we wouldn't be trying right now.

What you say is very true. And, in some infections, the transmission rate greatly increases further through the pregnancy but at that stage has a very limited effect. Perhaps that may be the case here and as you say even then the transmission rate appears low.

I think part of my worry is based on experience of a pregnancy where we knew something was wrong but not what, and were waiting until the birth to see if our child was healthy (she does have some problems but is very happy and healthy and we are very optimistic about surgery)

I know I'd always have worried but this feels like an extra dimension of anxiety!

I'd been reading the latest guidance RCOG link but their women and family info has been updated and says:

"Given current evidence, it is considered unlikely that if you have the virus it would cause problems with the baby’s development, and none have been observed currently."

So that's encouraging for us!

It’s so unfair that you have this dimension of worry after everything you’ve been through. Remember that so much of what you are feeling is that re-triggered anxiety from your first pregnancy and not reality. I mean that kindly. As someone who struggles with health anxiety I have to remind myself of that all the time.

In the RCOG article offering occupational health advice (published 26th March) it mentioned lack of abnormal anomaly scans from Asia which is also encouraging.

Right now your baby is fine. You may have had the virus but sounds mild and therefore your viral load will have been extremely low in your system. The women in these studies had full blown pneumonia which the vast majority of us won’t have if and when we get it.

The chances are we won’t get any definitive answers either way until long after our pregnancies are over so we will just have to hold our nerve and hope for the best. Most of the evidence implies that everything will be okay :)

OP I’m pregnant too, almost at the end of my pregnancy so perhaps a little different situation, but just sharing my experience in case it helps you. My doctor has been far more concerned about me getting it because ‘it’ll be not nice for me’ because I have a depleted immune system due to the pregnancy. She hasn’t been at all concerned for the baby, and she’s really been keeping on top of the progress of the virus so I trust her. So far I’ve had two lots of flu jabs and she’s reassured me that they are safe for the baby so it makes me feel that exposure to this virus should be similar fo4 the baby. Now as we’re getting near the end, she just doesn’t want me to catch it and then be quarantined around the time of the birth. She really hasn’t seemed at all concerned for the baby in this, and the baby is normally her main focus at all times! I agree with the others, try not to stress, whilst none of us really know as it’s a new virus, keeping calm and stress free is really important. Just protect yourself as much as you can and that’s all we can all do. I was reassured by reading that in China, babies have been born to mothers who have contracted the virus, and those babies haven’t caught it. Good luck for the rest of your pregnancy, take lots of deep breaths.

Thanks so much for these replies, they've made me feel so much better and able to keep things in perspective.

I find it so much more helpful when worries are understood and acknowledged - in my first pregnancy they were largely dismissed by friends and family when we'd been told by medical professionals there was a very real risk of finding a problem.

I know with any pregnancy there's a background risk but I can't quite believe this is happening now. I do however feel much, much better now so thank you.

Response to the new evidence which I found reassuring:

jamanetwork.com/journals/jama/fullarticle/2763851