COVID-19 and pregnancy? Expert on high-risk patients stresses common sense.
As a leading authority on high-risk obstetrics. Dr. John Barton at Baptist Health in Lexington has been fielding a lot of questions during the coronavirus pandemic about pregnancies and COVID-19.
“We’ve not had any of the seriously ill patients that I’ve been consulted on out of different states,” said Barton in late April. “I’ve published a lot on critical care and obstetrics and people call and say, ‘What do I do here or there for this situation?’ We’ve been fortunate here we’ve not seen that, although we have had patients that have tested positive.”
His advice during those consultations: Use common sense.
In fact, in conjunction with Dr. George R. Saade at the University of Texas Medical Branch in Galveston and Dr. Baha M. Sibai at the University of Texas-Houston, Barton recently had published a paper on how to manage a hypertensive disorder pregnancy to minimize the risk with COVID-19. After receiving the paper, the editor asked about the general obstetrical patient. So Barton put together guidelines that relied on common sense.
“Our biggest problem with COVID is lack of data,” said Barton, a Lexington native and graduate of the UK College of Medicine. “Simple things like vertical transmission. What is the chance the fetus will have the infection from the mother during pregnancy? We think it’s zero, but there’s some data from China that says it might be slightly higher than that. But again it’s not based on good science. So it’s difficult to provide good care when you don’t have good science to back it up.”
Why the lack of data? It’s a new virus and, said Barton, there have not been enough randomized trials to show what’s the best treatment. As a result, “I call it a rush to judgment. People are pushing things out quickly because physicians want the information to do a better job of caring for their patients.”
Not all are properly considered or vetted, said Barton. An example is the French study on Hydroxychloroquine. The study’s abstract appeared promising. Now that there are some randomized trials of the drug, however, “we’re finding out it’s not something we should be doing, certainly not for (prevention) and maybe not even for treatment.”
Barton’s paper on pregnancies and COVID was accepted in just 26 hours, no doubt a credit to his expertise and reputation. But, said the author, “you would never see that in non-COVID times. I think we did a good job writing it, but that’s remarkable to get something in the literature that quickly.”
So what is the common sense approach for pregnant women in this scary time of COVID? If a mother has significant symptoms, she should see her physician. “The one thing about obstetrics, we can’t just say, ‘Well, we’ll just see you next year. We’ll wait until the COVID is over.’ . . . We need to continue to do the right things for pregnancy.”
For normal pregnancies, the general recommendations suffice, said Barton. But for high-risk patients, ones with chronic hypertension or poorly controlled diabetes or underlying autoimmune disorders, infection is a greater risk. Any infection can be harmful for pregnant mothers, but especially respiratory infections.
“The respiratory dynamics change in pregnancy,” Barton said. “You have this growing uterus that lifts up the diaphragm. Whether it’s pneumonia, whether it’s the regular flu or it’s COVID, pregnant women just don’t tolerate respiratory infections as well as non-pregnant women.”
For example, said Barton, the H1N1 flu pandemic a decade ago was “uniquely bad” for pregnant women. Older women had some partial immunity from a Swine Flu outbreak in the 1970s. Younger women of reproductive age, the ones Barton sees, did not have partial immunity, however.
There is also the added factor that recent literature out of New York has shown that a percentage of pregnant women who have tested positive for COVID did not show any symptoms, leading doctors to believe there are a lot of people out there with the virus, and reaffirming there is much they just don’t know yet.
“The devil is in the details,” Barton said.
That’s where the quest for more and better data is so important. Doctors and hospitals are desperate for new information, especially with regard to a new virus.
“The vaccine is obviously what we want,” Barton said, adding that until then reliable and widespread testing for immunity is needed “There are a lot of people working on this and I think we’re going to come up with an answer, but it’s not going to be tomorrow. It’s going to be weeks or months.”
And yet, Barton is hopeful about what comes out of this crisis. He points to tele-medicine, which his office began doing in 2014 and is being used more today. Younger, more tech-savvy people, think nothing of it, but Barton said he’s been surprised to learn from his colleagues how well the older population has accepted the practice.
“Ultimately,” he said, “we’ll learn a lot from this.”
