Covid-19 in pregnancy: a New Zealand response

Covid-19 is changing the way healthcare is delivered, and maternity care is no exception. Fortunately New Zealand’s community-based approach is providing a strong foundation for doing things differently. “It’s about limiting hospital and clinic attendance to that which is strictly necessary”, says obstetrician and associate professor at the Liggins Institute Dr Katie Groom. Where possible, this means carrying out antenatal appointments by telephone or video call, which is a good thing in terms of reducing the risk of Covid-19 transmission, but it needs to be done safely. “Certain things like blood pressure monitoring, urine checks, and measuring tummies can’t be done by telephone – so we’re working out the best systems for doing that.”

And what about women with higher risk pregnancies? Groom is a maternal-fetal medicine specialist at Auckland Hospital, where women with scheduled appointments are still encouraged to come in. “It’s about getting the balance right between what’s really essential and what’s causing women more anxiety by not being seen,” says Groom.

As one of only three fetal medicine clinics in the country, Groom and the team are also trying to reduce the need for women to travel to Auckland by offering virtual consults and working from ultrasound images that have been taken locally. But it can be difficult not being face to face. Even for those women attending hospital visits things are harder. “Often we’re providing a lot of information and it’s not always good news, so our national and hospital guidance on physical distancing and no visitors is really tough for women and their families”. The reality of this is one-on-one conversations conducted at a distance with the woman’s support person joining by video or phone.

Women are also, understandably, worried about getting Covid-19. Groom is at pains to reassure women that the risk of this is extremely low. Staff are trained in when and how to use PPE to keep both women and hospital staff safe. Like many parts of the health workforce, the maternal-fetal medicine team has been split into two, with only one team in the hospital at a time. This means that if someone in one team was exposed to the virus, the other team should be able to step in and maintain the service.

To date there is very limited information about how many pregnant women have contracted Covid-19 and how it has affected them and their babies. Case reports from China and the United States suggest pregnant women are no more likely to contract Covid-19, but for those who become unwell, caesarean section and early birth seems more likely. There’s also little information to suggest there is any risk of vertical transmission (transmission across the placenta from mother to baby), but the risk of horizontal transmission (once baby is born) through breastfeeding and close contact is unknown.

These knowledge gaps are the reason why Groom and her colleagues are working hard to set up a national registry to report on cases of Covid-19 in pregnancy in New Zealand. Collecting data from those already affected will provide valuable information about how the virus affects women and whether it can be transferred to the baby. It will help plan maternity services over the coming months and give pregnant women a clearer idea of what to expect.

Having a New Zealand specific registry is important because of our unique community-based model of maternity care, ethnic diversity, and the impact of an early lock down. Data recorded will include demographics, health and previous obstetric health, what happens during the pregnancy and birth, breastfeeding and outcomes for newborn babies.

While the data will partly be used for research, more importantly it will provide real-time, publically accessible information about the rate of infection in pregnancy in New Zealand and what the outcomes might be. “It will give us information about how we manage the pandemic right now, but also be a valuable resource for the future should anything like this happen again”, says Groom.