A virus has quickly, and very seriously, presented itself as a threat to all that we hold dear — taking lives, impacting our liberty and surely stealing our happiness. The big disease with the tiny name, COVID-19, is caused by a corona virus, of which there are four types based on protein composition — alpha, beta, delta, and gamma. COVID-19 is a beta coronavirus, which impacts both humans and animals, and it has managed to spread across the globe.
While many human infections appear to be mild, two distant relatives of COVID-19, SERS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) have been responsible for significant outbreaks of lethal pneumonias. Although the overall mortality rate of COVID-19 is lower when compared to SERS and MERS, rates of infectivity are higher. This means that patients with co-morbidities are likely to contract more severe diseases, and subsequently, have a higher risk of mortality.
For the women who are pregnant during the COVID-19 pandemic, the typical feelings of joy and giddy anticipation have been quickly replaced with anxiety and concern. There are several questions expecting mothers are asking about the virus’s effect on fetal developmental sequelae, if vertical transmission in utero or during delivery occurs, or if the virus is excreted into breast milk — potentially infecting the neonates. These are all very valid concerns, which no health provider has a definitive answer to.
For women with high risk conditions such as Lupus, hypertension, or diabetes, the dread is palpable. It has been noted across all media that those with co-morbid conditions have poorer outcomes when diagnosed with COVID-19. Particularly for diabetics, the proof is resounding – the virus attaching to its host like a moth to a flame. The effects of diabetes on the body, particularly if poorly controlled, are many—but the main derangement reflects an increase in inflammation/oxidative stress, a decrease in immunological competency, and a derangement of clotting factors. This increases the risk of clot formation in the body, which has as a triple additive effect. Diabetes mellitus, as a distinctive co-morbidity, is associated with more severe disease, acute respiratory distress syndrome and increased mortality.
This particular cohort of patients is one that extreme oversight need be paid if COVID-19 infection occurs. Especially because pregnancy in and of itself creates a circumstance of vulnerability for women.
- The immunologic status of a pregnant woman is depressed. During pregnancy, the fetus is identified as a foreign organism, and in response, the feto-placental unit produces chemicals that depresses the mother’s immune system. This allows the fetus to maintain its existence in the womb and grow unharmed.
- The growth of the uterus displaces the lungs upward in the body, thus comprising a change in both their function and capacity.
- Hormones from the placenta induce a diabetic state.
- Pregnancy increases the propensity for abnormal clotting. COVID-19 appears to induce abnormal clotting—thus promoting an additive effect in pregnancy.
It’s also important to note that preterm labor has remained one of the most enigmatic challenges in the field of perinatal medicine. Globally, preterm birth impacts 1.3 million people. In the United States, it complicates roughly 9% of all births, and in some urban demographics, this figure approaches 18%. While research has focused on many aspects of the preterm labor puzzle, environment and vitamin deficiencies — particularly of vitamin D — still remain in a rudimentary phase. Vitamin D is involved in a number of bodily processes for both mother and fetus–such as bone metabolism, muscle maintenance, respiratory function, brain development, mood stabilization, immunologic and cardiovascular function.
Preliminary research from a small study out of South Carolina has also revealed that a deficiency of this vitamin may play a factor in preterm birth. Pregnant African American and Hispanic women, noted to be deficient in vitamin D, were given supplementation of the vitamin. These same women, once their levels reached a particular therapeutic level, were noted to have a 62% lower rate of premature delivery as compared to their cohorts.
So how can pregnant women empower themselves and reduce their risks of contracting COVID-19, in spite of increased risks associated with pregnancy and additional compounding risk factors like diabetes?
First, focus on reducing anxiety and developing an action plan. To mitigate the risk of contracting COVID-19, pregnant women should drive or have someone drive them to their appointments. If relying on public transportation, it’s essential to maintain social distancing; keep hands sanitized during and after travel; and refrain from rubbing your eyes or touching your face. Pregnant women need to stay informed, be prepared and set limitations on who can visit during and after delivery as well. Remaining flexible and utilizing all on-line resources, like your Doctor’s Patient Portal, is pertinent to staying healthy and reducing your risk.
Next, consider changing dietary practices to include foods rich in both vitamins that are known to naturally boost immunological function. Onions, garlic, turmeric, citrus fruits, salmon, sardines, kale, collards, yellow/green/red peppers, and eggs are all wonderful choices—particularly in conjunction with prenatal vitamins containing omega-3.
Most important is to maximize immune function by focusing on supplementation. In addition to adhering to the advice of public health officials (e.g. avoiding crowds and washing your hands), pregnant women should evaluate their dietary supplement regimen and get their vitamin D levels tested. Vitamin D is made in the skin in conjunction with sunlight. Getting vitamin D is especially important now as evidence is mounting that vitamin D has a direct correlation to reducing complications with COVID-19. Research also shows that the risk of premature birth decreases by 60% when pregnant women have vitamin D blood serum levels of 40 ng/ml or higher. There is also published research demonstrating that higher vitamin D levels of 50 ng/ml appear to protect against viral respiratory infection. If you are newly pregnant or trying to get pregnant, you can even test your vitamin D levels in the comfort of your own home by ordering a vitamin D testing kit, or test both vitamin D and omega-3 with a combined at-home test kit. Once you know your levels you can use a free vitamin D calculator at: www.nutrientpower.org to make sure you are supplementing with the correct amount of vitamin D in order to get your levels to the desired level needed for best health outcomes. The combined work of GrassrootsHealth and Organic and Natural Health Association is making this information accessible and accountable to pregnant women. While GrassrootsHealth has focused on the research aspect of validating the importance of vitamin D testing and supplementation, including a first-of-its kind study for pregnant women at MUSC, Organic & Natural Health has made a petition to the Food and Drug Administration to permit dietary supplements containing vitamin D to provide a health claim concerning the association between vitamin D and a preterm birth. The petition was based on numerous studies mentioned above showing an association between higher serum vitamin D levels in pregnant women and a reduced risk of preterm births. The FDA opted to reject the petition based on their decision that although vitamin D is a food source, serum levels of vitamin D are not considered food or components of food, therefore cannot be characterized as a substance to decrease the risk of preterm births. Their conclusion offers an interesting opportunity for manufacturers of vitamin D supplements to include language on their labels that supports healthy pregnancies and promotes full-term births as a structure/function claim instead. Simply GOODFATS Vitamin D3 label is the first product to run with this and you’ll find on its label, “supports full-term birth” and “supports a healthy pregnancy” along with, “Pregnant women who have higher serum vitamin D levels have a decreased risk of preterm birth. Vitamin D is by far one of the most inexpensive solutions to reducing preterm births. If just 50% of preterm births could be prevented each year in the United States, hundreds of thousands of families would be spared this heartache and trauma. In the final analysis, vitamin D offers a host of benefits for both baby and mother—developmental benefits for baby – metabolic and immunologic protection for mother—and with the additive benefit of reducing preterm birth. So, begin your day with a boost of sun and “dose of D”—vitamin D!
Biography: Dr. Kecia Gaither, MD, is a double board-certified physician in OB-GYN and Maternal Fetal Medicine. She is Director of Perinatal Services at NYC Health + Hospitals/Lincoln in the Bronx, New York. Since October 2015, Gaither has served as liaison to the Association of Black Cardiologists, in which she promotes critical perinatal initiatives and continues her work of ensuring exemplary prenatal care is available to all women. In 2011, she served as an appointee of New York City Mayor Michael Bloomberg to the HIV Planning Council of New York. For multiple years, Gaither has been named America’s Top Obstetrician and Gynecologist by the Consumer Research Council. She received her Bachelor of Science degree in biology from Barnard College and her medical degree from SUNY Health Science Center in Syracuse and her Masters of Public Health degree in Health Policy and Management from Columbia University. With more than 20 years of professional experience, driven by her mission to provide exemplary prenatal care to all women regardless of circumstance, Gaither positively impacts the lives of thousands of women by delivering valuable information on a spectrum of women’s health issues through media appearances, seminars and her work as scientific adviser for Organic & Natural Health Association. Additionally, she has been published by multiple scientific journals and is a reviewer for WebMD. Gaither is based in New York and is a New York native. https://keciagaither.com/