Reproductive Health and Coronavirus - PowerPoint Presentation

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Reproductive Health

and Coronavirus

Alicia Y. Christy M.D.

COL (retired) U.S. ArmyDeputy Director Reproductive HealthWomen’s Health, VHA

3/23/2021

Reproductive Health | Women’s Health Services

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Reproductive Health and CoronavirusWhat we knowCurrent Recommendations

Resources3/23/2021

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Pregnancy and BreastfeedingWhat we knowData is limited and rapidly changingLittle or no evidence:that coronavirus can be transmitted through breastmilkthat coronavirus can be transmitted from the mother to her baby before the baby is born

Spread of the virus is thought to be through direct contact and respiratory droplets.Pregnant women may be at higher risk of severe illness and death related to COVID-19 infection.

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Pregnancy and Breastfeeding 1RecommendationsIf you are pregnant you should follow routine infection control precautionsFrequent handwashing, cleaning and disinfecting surfaces

social distancing remain important.If you are pregnant and have symptoms of COVID-19, you should contact your PCP and maternity provider for advice.If you are pregnant and diagnosed with COVID-19, it is important you stay in close contact with your PCP and Maternity Provider.

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Pregnancy and Breastfeeding 2If you have a newborn, you can take the following steps to avoid passing the infection to your baby:Wash your hands before touching your baby.Wear a face mask while breastfeeding if possible.

Wash your hands before touching any breast pump or bottle parts and clean all pump and bottle parts after use. Someone who is not sick may feed your breast milk to your baby after you pump3/23/2021

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Maternity Care DeliveryWhat we knowHealthcare resources varyDepends on number of COVID-19 cases and resources available in each community/geographic areaAvailability of maternity care providers and inpatient obstetric units may change or become limited.

The number of support people/loved ones available during delivery may be reduced.Childbirth preparation classes may be canceled or offered remotely.

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Maternity Care Delivery 2RecommendationsStay in close contact with Maternity Care Coordinator at your facility

Contact your maternity care providers to find out if your visits are in person or conducted via telehealthObtain a paper copy of your prenatal record and keep it with youKnow the on-call or after-hours phone number of your maternity care providerSign up for MyHealthyVet, if you haven’t already, to access your VA providers Arrange ways to video chat with loved ones on a smartphone or tablet that can be used in the labor and delivery room

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Newly Pregnant VeteransRequirement for a positive lab pregnancy test in CPRS temporarily suspendedYou can get a maternity care consult by notifying your provider that you had a positive home pregnancy testIt is important that you contact with the Maternity Care Coordinator at your facilityThey will help coordinate your care in the community

They will make sure information about your pregnancy is in the VA medical recordYour initial visit with your PACT will likely be conducted by Telehealth or with VVC3/23/2021

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Transferring Maternity CareSome Veterans have expressed interest in transferring their maternity care due to concerns related to COVID-19.Make sure you contact your Maternity Care Coordinator at your facility before transferring care.The Office of Community Care will need to ensure that your chosen provider is “in network.” If not, VCA may be an option.Accredited birth centers are covered benefit, not all pregnant people are candidates for birth center delivery.

Planned home birth is not a covered benefit. Transferring care may cause a gap or delay in care.3/23/2021

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Questions and topics to ask your providers around COVID-19Have there been any recent changes in your clinic policies related to COVID-19?What are your COVID-19 testing procedures for me and my support people?Is cyber-support (computer, phone tablet or other device) available with my support people?Is there any COVID-19 related restrictions for my support people to be at the birth with me?

If I test positive , can I have support people during my birth?What are your policies around postpartum and nursing when COVID-19 positive?

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GynecologyWhat we knowAs is the case with pregnancy, there is limited data on how to best manage gynecologic problems during COVID 19 pandemicMany facilities have suspended non-essential office visits and elective surgery In some facilities, only emergency patients may be seen and only emergency surgery is being performed

You can check the availability of non-emergency medical care at your facility by:Checking your facility’s websiteContacting your WVPMMessaging your provider through MyHealthy Vet

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Cervical Cancer Screening/ManagementWhat we knowIt takes a very long time for cervical cancer to develop (10-30 years)

RecommendationsRoutine cervical cancer screening – delay for 6-12 monthsIf you’ve had an abnormal pap smear, your provider will let you know when you should reschedule your appointmentProbably within 3-12 months

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Contraception What we knowPreventing unplanned pregnancy is important, especially during a global pandemic In most cases your provider can help you find the right birth control for you with a phone or video appointment

Most contraceptive methods can be mailed to you Condoms provide protection against sexually transmitted infection and can be prescribed and mailed to youEmergency contraception can be useful in the case of contraceptive failure and/or unplanned sexual intercourse. It won’t harm an ongoing pregnancy and can be prescribed and mailed to you.

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Contraception 2RecommendationsIf you are using, or want to start using, a birth control method, contact your primary care providerIf you want an IUD, Depo Provera shot, or contraceptive implant, typically a clinic visit is required -- contact your provider and be aware that some of these visits are being deferred until normal operations resume

Availability of face-to-face visits varies by facility

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Gynecologic SurgeryWhat we knowNon-emergency surgeries are not being performed, this includes many common surgeries such as hysterectomy and surgery for urinary incontinence.Recommendations

Your surgeon will let you know when your surgery can be rescheduledIf you’re having severe symptoms such as heavy bleeding associated with weakness, be sure to reach out to your provider

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InfertilityWhat we knowThere is limited information about how coronavirus effects pregnancy, especially early pregnancyWe do not have information about the impact of coronavirus on infant development; information so far is reassuring Infertility treatment requires the use of masks and gloves, which are supplies that are in high demand right now

Most infertility treatments are considered elective, or non-emergency3/23/2021

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Infertility 2RecommendationsIn areas with very high number of COVID-19 cases Providers may suspend initiation of new treatment, including ovulation induction (fertility medication), intrauterine inseminations (IUIs), and in vitro fertilization (IVF)

It may be recommended that elective fertility surgeries and non-urgent diagnostic procedures be suspendedFertility providers have been asked to minimize in-person interactions and increase use of telehealth appointments

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COVID-19 Vaccination Q& A 1Q: Can the COVID 19 vaccine give me COVID?A: No. The currently available COVID-19 vaccines do not contain a live virus. The currently available vaccines work by telling your infection fighting cells to make a protein that helps protect you from COVID-19. The currently available COVID -19 vaccines do not contain ingredients that are known to be harmful to pregnant women or to the fetus.

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COVID-19 Vaccination Q & A 2Q: Can I get a COVID 19 vaccine if I’m pregnant?A: Based on what is known about these vaccines, experts believe they are likely to be safe in pregnancy. But since no testing has been done with women who are pregnant, researchers do not know if there are any risks. Pfizer began studies of pregnant women Feb 18

th.Twelve obstetrics and gynecology groups published a joint statement recommending that pregnant and breastfeeding women who are eligible to receive a COVID-19 vaccine should receive it. Many women may want to discuss their decision with their maternity care provider or primary care provider, but they are not required to consult their provider before deciding to be vaccinated.

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COVID-19 Vaccination Q & A 3: Can I get a COVID 19 vaccine if I’m breastfeedingA: COVID-19 vaccines are being offered to breastfeeding women. Although there were no breastfeeding women in the trials, there is no evidence the vaccine is harmful to breastfeeding women and their babies. You do not have to delay or stop breastfeeding to get the vaccine.

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COVID-19 Vaccination Q & A 4Q: Will the COVID 19 vaccine make me or my partner infertile?A: As we collect information on the millions of individuals who have so far received the vaccine, no evidence has been found to suggest it affects fertility. The vaccines do not affect your genes or DNA. DNA contains our unique genetic code. It is like a recipe book. It holds the instructions for making all the proteins in our bodies. If you are planning or trying to get pregnant, you can get a COVID-19 vaccine. You also do not need to delay getting pregnant after you get a vaccine. The current COVID-19 vaccines will require two doses. If you find out you are pregnant after you have the first dose, you should still get the second dose.

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COVID-19 Vaccination Q & A 5Q: If I decide to get the COVID-19 vaccine what should I expect?A: It is common to feel 

side effects after getting a COVID-19 vaccine, especially after the second dose. This is a common reaction to vaccinations because the body is responding and starting to build up its own immune response. You may feel like you have the flu for a few days, body aches, fatigue, and fever. You may have pain at the injection site. This is normal. If you have a fever or other side effects after getting the vaccine, you can take acetaminophen, an over-the-counter medication that is safe during pregnancy. If you are worried about your side effects or they last more than a few days, talk with your maternity care provider or other health care professional.

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COVID-19 Vaccination 6Women Veterans are a very diverse group. Nearly 1/3 of women Veterans are African Americans. Black Americans are nearly three times more likely to die from the virus than their White counterparts Because of a long history of mistrust, Black Americans are less likely to get vaccinated than other ethnic groups

Death rates in the Hispanic community are also higher, and they are also less likely to accept the vaccine.3/23/2021

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COVID-19 Vaccination 7A team of VA researchers found Among Veteran users of VA, race and ethnicity is associated with a greater risk of testing positive for COVID-19 – but not death – within a 30-day period after hospital discharge. Black and Hispanic Veterans were twice as likely to test positive for COVID-19, even after accounting for underlying health conditions, demographic factors like education and income, and geographic location

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COVID-19 Vaccination Q& A 8Q: Why are Blacks and Hispanics more likely to get COVID-19?A: Blacks and Hispanics are more likely to work in “essential” high risk jobs that put them more at risk for contracting COVID-19. Blacks and Hispanics are less likely to have access to personal protective equipment like masks, gloves, and hand sanitizer. They are more likely to live in multigenerational households and less likely to have access to COVID-19 testing, which would allow them to avoid contact with infected people, or to avoid infecting others

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COVID-19 Vaccination Q& A 9Q: How do I know the vaccine will work in Black and Hispanic people?A: There were over 60,000 participants in the vaccine trials. Between 11 and 16% of the participants were Hispanic and 8-10% were Black.

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Resourceshttps://www.va.gov/health-care/covid-19-vaccine/Centers for Disease Control and Prevention COVID-19Vaccination Considerations for People who are Pregnant or Breastfeeding

She Wears the Boots: A Podcast for Women Veterans3/23/2021

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SWTBP

https://www.spreaker.com/user/11014928/womenshealth-covid19vaccine-cosby-christ

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Reproductive Health and COVID 19Information resourceshttps://www.cdc.gov/coronavirus/2019-ncov/index.html

Blogs.va.gov/Vantage/73421/veterans-va-covid-19-call-us/https://www.acog.org/patient-resources/faqs/pregnancy/coronavirus-pregnancy-and-breastfeedinghttps://www.asrm.org/news-and-publications/news-and-research/announcements/coping-during-the-covid-19-pandemic--messages-for-patients/Women Veteran Call Center 1-855-VA-WOMENVA Medical Center website

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In Memory of LTC Karen Wagner

We dedicated a special issue of Seminars in Reproductive Medicine

to Lieutenant Colonel Karen Wagner, a Medical Service Corp officer who was killed during the attack on the Pentagon on September 11, 2001. Her legacy remains an inspiration to everyone who knew Karen, and her contributions and sacrifice will long be remembered.Alicia Y Christy M.D.

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?QUESTIONS?

Alicia Y Christy M.D.