Meryl Pataky spent the early part of last year bending neon tubes into droopy floral arrangements drizzled with tar. The art pieces were for a series and solo show called “Not Long for This World.” It was a reflection on Pataky’s longing for motherhood in a world that appeared to be fraying at its ozone edges.
Pataky has been trying to get pregnant for over a year now. She’s had two miscarriages in that time, the second one at the beginning of California’s pandemic lockdown in March. “My husband and I are back to drawing board, having very deep philosophical conversations about what it means to bring a child into this world,” she told me in July.
While many are delaying pregnancy because of COVID-19 and its economic fallout, Pataky, 37, is trying to conceive despite the risks, knowing she might not being able to if she waits. “Everyday we have different anxieties,” she says. “Surprisingly, I feel calm and steadfast about it.”
Since January, 15,735 pregnant people have contracted COVID-19 and 37 have died from complications related to the disease. But because COVID-19 is so new, there is limited research on the effects that it has on pregnant people or their babies. The published studies can be alarming and are often incomplete. Researchers are most concerned that pregnant people may be more prone to COVID-19’s worst symptoms than the general population. For that reason, the CDC has advised women not to skip prenatal visits. But as the pandemic rages on, it’s become more difficult for people on the road to pregnancy to access the prenatal and preconception care they need.
COVID-19’s impact on pregnant women
A person’s immune system is suppressed during pregnancy to insure it doesn’t attack the fetus. As such, pregnant people are susceptible to a host of illness, including respiratory infections. Still, early research on COVID-19 and pregnancy can feel foggy for those considering conceiving. In June, the CDC conducted a large analysis of pregnant American women with COVID-19 and found they were more likely to be hospitalized and entered into intensive care than nonpregnant women. In particular, it found that Black and Hispanic pregnant women were more likely to contract COVID-19 than their white counterparts. However, it did not specify whether hospitalizations were because of COVID-19 symptoms or because of the pregnancy or delivery.
In a study out of Paris, roughly half of a cohort of 100 pregnant women with COVID-19 were hospitalized for close monitoring or oxygen. Of those, only 10% had severe symptoms and required intensive care. The remaining women were observed remotely with daily calls from their obstetrician. But the study was small and researchers acknowledge the obstetric units they were observing tended to have higher risk pregnancies.
Another study out of London indicated there were more still births during the pandemic between February and June than there were in a pre-pandemic period between October 2019 and January 2020. However, the study had several limitations: For one, the women who had stillbirths had no symptoms of COVID-19 and there was no other evidence that they might have had the virus. The study, which was done in retrospect, only considers births from a single center, and does not consider the reason for the still births. But it does mention an alternative that could present mothers-to-be with reason for concern: the incidence of still birth may have been related to fewer prenatal visits, a result of pandemic-related restraints.
For women who are choosing to get pregnant amid waves of COVID-19, prenatal care, preconception care, and frequent contact with their doctor have become even more important than before. While prenatal care has long been established as necessary, preconception care has not always gotten the same level of respect. At a minimum, preconception care includes taking a folic acid supplement and getting up to date on certain vaccinations. But preconception care can involve a much more robust health assessment that factors in one’s diet, exercise regimen, and preexisting health conditions.
Even in normal times, preconception care isn’t common—a 2015 study found that only 14% of American women received preconception care between 2009 and 2010, up from 9% between 1998 and 2000. It may seem unnecessary at first glance, but experts argue that preparing the body for pregnancy is actually quite important in cutting down on birth defects. In the 2015 study, the researchers noted that 50% to 70% of leading birth defects could be mitigated if mothers took folic acid in the months preceding their pregnancy.
Telehealth for preconception care
During the COVID-19 pandemic, healthcare providers have alternatively closed their practices, stopped taking new clients, pivoted to online appointments, or implemented strict rules around in-person visits. This new environment and the fear of COVID-19 itself is making it difficult for women to access sexual reproductive care, including preconception care. Still, doctors are making accommodations to see patients any way they can. Kindbody, a fertility clinic in several major cities, takes temperatures on arrival and requires all patients to wear masks. Partners must dial in remotely over FaceTime if they’d like to be present. No one is allowed to wait in the lobby. For first timers, Kindbody is taking consultations online.
Last month, Maven Clinic, a company focused on connecting women to fertility and maternal health services, launched online preconception services. Through its app, members can speak with obstetricians, gynecologists, endocrinologists, fitness experts, nutritionists, therapists, and relationship coaches. A series of videos and articles provide tips on how to get pregnant (or stay not pregnant). Maven Clinic CEO Kate Ryder says that the new service is intended to help women understand their own ovulation cycles, overall health, and how to best prepare their bodies for pregnancy.
“There’s so much biology that women are just not taught. A lot of our content teaches that,” she says.
Maven Clinic disseminates its services through member employers and certain health plans, like state health insurance MassHealth. The preconception product was planned before COVID-19, but has an opportunity to engage women who are isolated at home and pondering pregnancy. However, the product’s target audience may be dwindling.
Erik Lumer, Chief Product Officer at Maven Clinic, says that economic and health uncertainties are causing many women to delay their pregnancies. Still, he sees an opportunity for the platform to help women navigate a change of course—from pursuing pregnancy to exploring birth control again. “For people that are not delaying, just what does it mean to manage in the best possible way?” he says.
Overall, the product’s goal is to connect women with care in advance of a pregnancy, even if they are not planning to get pregnant for a few years. “We try to map out what their specific issues are: emotional support, cycle management, nutrition—the link between stress and their physical health.”
After Pataky’s miscarriage in March, she says she hasn’t been working out or eating well.
“It’s an incredible amount of stress living through a pandemic. On top of that, trying to become a mother over and over again and failing—it’s a lot to deal with,” she says. Sometimes she would just end up sitting in bed all day. “I just felt—subconsciously —like my body had betrayed me,” she says. Perhaps unintentionally, she was forcing herself to rest and as a result to take a break from preparing for a baby.
Recently, she’s started to work out again, and she says she feels like she’s turning a corner. She and her husband are also starting the process of trying to get pregnant again. For now, they’re going the natural route. Her doctor recommended her to a fertility specialist, but they weren’t seeing any new patients because of COVID-19. “I guess we’ll just navigate it on our own,” she says.