When the Stork Brings More than a Bundle of Joy
Posted on Sunday, June 21, 2020
By Jessica Sinclair
The time around birth is high stakes even under normal conditions, and there is concern that the current pandemic could add danger to the already complex mix. Epidemiologist Deshayne Fell and experts from across the province want to know how the novel coronavirus is playing out in the Ontario’s maternity wards and birthing centres. For that, the Associate Professor at the School of Epidemiology and Public Health is using the massive trove of data collected by Better Outcomes Registry & Network (BORN) Ontario.
Our provincial birth registry, BORN Ontario routinely gathers data surrounding the circumstances of each birth, including the mother’s health, whether the baby was born on time, and at what birth weight. In addition to data from hospitals, BORN Ontario receives information from midwives attending home births and birthing centre deliveries. When the COVID-19 pandemic struck, Dr. Fell worked with BORN Ontario to rapidly develop a data collection tool, which was put into place across the province within two weeks. This enhanced data collection will be in place for a full year, through the expected second wave of COVID-19 in the fall.
“From past infectious disease outbreaks, we know that pregnant mothers often do more poorly with viral respiratory illness compared with non-pregnant women of similar age, and it can lead to pregnancy complications, such as premature birth,” says Dr. Fell.
Pregnancy brings massive physical changes, and the pressure from an enlarged uterus alone can decrease lung capacity. Along with chemical and hormonal changes, the last two trimesters seem to make some illnesses, like influenza, more dangerous for pregnant women. Expectant mothers are also more susceptible to contracting some illnesses in the first place, as in the case of malaria.
Eleven years ago, the World Health Organization declared a new strain of swine-origin H1N1 flu a pandemic. Then working at BORN Ontario, Dr. Fell was involved in using the registry to track the effects of the swine flu on expectant mothers and their newborns. Her fears were justified: pregnant women were disproportionately affected during that pandemic. Over the course of 20 months, hundreds of thousands of people died worldwide, including a handful of pregnant women in the US and Canada. The highest hospitalization rates were in children under 5 years old.
The novel coronavirus has been bucking our expectations since it began. Health professionals initially expected that it would strike down both the very old and the very young, based on past experience from other infectious disease outbreaks. As it turns out, only the first has come to pass. The burning question in maternal health is whether or not SARS-CoV2 infection will follow the same pattern as previous influenza pandemics.
“Early Chinese studies suggest that pregnant women are not more susceptible to becoming infected with SARS-CoV-2 (the virus that causes COVID-19 illness),” says Dr. Fell. “In Ontario, we will look at the extent of diagnosed infection in pregnant mothers as well, but also whether they are more likely to end up in the hospital or ICU—or have other poor outcomes—once they get it.”
With so many unknowns, weighty questions remain about how to handle a birth when the mother has COVID-19. Should the baby be isolated from the mother immediately after birth? Should that mother be advised to breastfeed while infected? Would antibodies in breast milk confer immunity to the child? Is coronavirus transmitted vertically from mother to child in utero, through the placenta? The answers to these will be heavily consequential for young families and newborns in the first days of life.
The team at BORN Ontario plans to share some initial surveillance reports in the coming months, putting as much information as they can in the hands of the province’s COVID-19 task force, and helping to inform provincial networks of obstetrical care. BORN will also be contributing information from Ontario to the national Canadian “COVID-19 in pregnancy” collaboration.