Welcome to the weekly ZIP - your Zenith Informed Pregnancy!
Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research.
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This week's top pregnancy questions:
1️⃣ What are the risks for my baby if I get COVID while I’m pregnant?
2️⃣ Can I use retinol creams?
3️⃣ My doctor’s recommending an induction - how do I know it’s the best thing for me?
What are the risks of getting COVID while I’m pregnant? Could it cause autism for my child?
Last week, a new study was published looking at mothers who were diagnosed with COVID-19 and the rates of neurodevelopmental disorders by age 3 in their children. Understandably, the headlines and news about this study have been anxiety-inducing, particularly as we move into later fall and winter where respiratory viruses are more common. Here’s a breakdown on the evidence we have today, and what the new research tells us.
📚The tl;dr from the evidence: In general, contracting COVID (or any other infections) during pregnancy can lead to increased risk on known outcomes like preterm birth and the baby’s birth weight, especially as the weakened immune system during pregnancy can result in a higher risk of severe illness and/or hospitalization from COVID. More research is needed to understand if the relationship is causal.
“Neurodevelopmental Outcomes of 3-Year-Old Children Exposed to Maternal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Utero,” published last week, looks retrospectively at over 18,000 moms in a Boston-area health system. Researchers found that children born to mothers with COVID infection during pregnancy were at increased risk of neurodevelopmental diagnoses by age 3, which is consistent with prior studies (including some looking at other types of infections). There's a biologically plausible causal pathway behind this (maternal immune activation during pregnancy), but still a ton of unknowns, so this isn’t yet conclusive.
While this study is an important and interesting development in the research, like many observational studies, it has limitations – largely that the mothers who had COVID and those who didn’t differed on other characteristics besides infection with COVID – variables that might are sometimes independently linked to neurodevelopmental disorder risk, like socioeconomic factors or health history. Additionally, since the study looked at data from early on in the pandemic (March 2020 – May 2021), many of the participants were unvaccinated against COVID and ‘immunologically naïve’ – meaning we might see different results in the future, if some of the effect is related to a person’s first infection/exposure.
So with this new research, what can you practically do about it today? The best evidence-based intervention we have today is the COVID vaccine, to protect against COVID infection. And while the risk is possibly increased for mothers who contract COVID, the absolute risk is still low – most babies exposed to COVID in utero develop normally.
👀 Read Penny’s full summary of the evidence for more on COVID infection during pregnancy
Can I use retinol creams?
If you’ve ever seen the packaging for Accutane (covered in tiny icons of a pregnant woman with a big red X), it’s easy to understand the uncertainty and fear around retinoid use in pregnancy. But retinoids come in different forms – do we have the same level of data on all forms, and what does that mean for moms who swear by their over-the-counter retinol as part of their skincare routine?
📚The tl;dr from the evidence: Oral retinoids (like isotretinoin, commonly known as Accutane) have conclusive evidence showing that they are not safe for use in pregnancy, due to the meaningful increased risk of birth defects. This has led (reasonably so) to a stance defaulting to caution: most guidelines suggest avoiding all forms of retinoids, including topical retinoids (think prescription tretinoin, or over the counter retinol creams). However, there are differences in the risk level between oral and topical retinoids, due to how it is absorbed in the bloodstream – topical absorption through the skin is much lower than through an oral pill, although it is not zero.
The data is limited, and most studies look at prescription-strength topicals rather than OTC creams that you might buy from a skincare or beauty brand. The data that does exist is reassuring, especially for women who’ve used topicals unintentionally or before knowing they were pregnant. Most research has not shown a major increase in the risk of birth defects or other adverse outcomes, and while there are a few case reports of birth defects following topical use, they are neither consistent nor conclusive. Given the known risks of oral retinoids, topicals haven’t been studied in randomized controlled trials or at very broad scale.
👀 Read Penny’s full summary of the evidence for more on topical retinol
My doctor’s recommending an induction - how do I know it’s the best thing for me?
Induction is one of the hottest topics for third trimester moms - how quickly will it go, what are the best methods to induce labor, will it work better for my second baby, what are the reasons I’d need to be induced - there are endless questions that moms have. Today we cover one of the most basic, but important questions: weighing the pros and cons of induction for your own personal situation, when your doctor has suggested it but you’re still feeling unsure or anxious.
📚The tl;dr from the evidence: There are 2 general types of induction: medical and elective. Both use similar methods to start labor; medical inductions are recommended when there are clear health risks for you or your baby to continuing the pregnancy, such as preeclampsia, diabetes, amniotic fluid levels, or other complications, whereas elective inductions are often considered after 39 weeks in healthy or low-risk pregnancies but may be chosen due to personal preference, comfort, or convenience.
Benefits can include reducing the risk of complications (including very serious ones, like preeclampsia or stillbirth) and decreasing the change of C-section in otherwise healthy pregnancies, particularly for moms who have other medical conditions or are past their due date. Risks can include the potential for longer labor or the increased need for interventions during delivery like medications or assisted delivery.
So it’s important to know why your provider is suggesting this - is it due to medical risk factors for your or your baby’s health, or their perception of your preference? Make sure that your provider explains not only the reasons for the recommendation, but the risks and benefits for your situation, an overview of what methods would be used, and what you can expect throughout the process.
Deciding whether or not to have an induction, and preparing, is a moment of shared decision making with your provider – and an important moment to have an open dialogue about your preferences, questions, and concerns.
👀 Read Penny’s full summary of the evidence for more on weighing the pros and cons of an induction
🤓 Zenith's top read of the week
Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!
Mom’s voice boosts language-center development in preemies’ brains, study finds (Erin Digitale, Stanford Medicine) - We love science that is both impactful and heartwarming! 💖 Stanford researchers recently published on a randomized trial studying the impact of a premature baby hearing their mother’s voice, and uncovered the first causal evidence that a speech experience can contribute to brain development at such a young age.
The researchers recorded each mother reading a chapter of Paddington Bear, and then these recordings were played for their preemies for 10-minute periods, for a total of 160 minutes each night. The babies then had brain MRI scans at the end of the study before being discharged, and researchers observed a significant difference in the maturity of the key language processing pathway in the babies who’d been exposed to their mother’s voice recordings, compared to the babies who were not.
The power of motherhood can never be underestimated!
Key excerpt:
“This is a potentially transformative way of thinking about how to approach neonatal care for promoting better language outcomes in children born prematurely.”