Every 20 minutes or so, Kate Casaletto tries to think of a funny joke. If the 27-year-old mother-to-be can’t come up with one, she calls her sister or her mother to chat — one of them is bound to crack her up.
“It’s really important to laugh,” Casaletto said.
Casaletto needs humor to cope with the extraordinary anxieties of pregnancy amid a pandemic, worries that compound the usual stresses of bringing a child into the world.
Little is known about how the coronavirus affects pregnant women. Pregnancy tamps down the immune system, making women more susceptible to infections. And other respiratory viruses, such as influenza, can be devastating, leading to hospitalization or preterm labor. For these reasons, the American College of Obstetricians and Gynecologists advises that “pregnant women should be considered an at-risk population for COVID-19.”
But what is known from small studies is comforting: So far, there’s no evidence that pregnant women are more susceptible to coronavirus than others, and no evidence that women infected with the coronavirus have worse pregnancy outcomes than those who are not infected.
One study of nine women in China found that the virus did not cross the placenta or get into breast milk. The women delivered healthy babies. But a study published Thursday of 33 pregnant women with COVID-19 in China found that three delivered babies were infected with the virus, possibly transmitted in the uterus. Overall, however, “outcomes were favorable” for the 33 babies.
“This is a brand-new virus, and we don’t know what we’re dealing with,” said Dr. Maryanne C. Bombaugh, an obstetrician-gynecologist who is president of the Massachusetts Medical Society. “We don’t know exactly how it behaves in pregnant women. We are in very, very uncharted territory.”
But the risk of infection is only one of many uncertainties that pregnant women face.
What if the hospital is overrun with respiratory illnesses and there aren’t enough beds for labor and delivery? What if the mother becomes infected shortly before delivery and has to be separated from her child at birth, as is currently recommended? What if she goes into preterm labor and faces daily risks visiting her baby in the hospital?
For Lucy Huber, a 32-year-old freelance writer in Cambridge, the anxiety brings a sense of loss. At 33 weeks pregnant, she expected this stage to be a happy, exciting time. Instead, choosing a name, shopping for baby clothes, decorating the nursery — coronavirus has cast a pall over these normally joyous tasks.
“I kind of got robbed,” Huber said. “It feels like all of that got taken away and it’s replaced by fear.”
Casaletto, the woman who seeks laughter, sees the final days of her pregnancy reshaped by the social distancing requirements.
An Instagram blogger who is 33 and a half weeks pregnant, Casaletto is staying at her home on the North Shore pretty much all the time, going out only to play with her dogs in the backyard or for drives with her husband. Her parents in Somerville see her only on FaceTime.
Her obstetrician called recently to cancel her next checkup, as many doctors are doing to reduce opportunities for infection. She’ll miss the reassurances that such appointments bring.
And her birth plans have been upended. Her husband can be at her side during delivery, but no other visitors are allowed. Not her siblings, who were going to fly in from far-flung cities; not her husband’s large family, who had planned to gather in the waiting room.
The worries keep mounting.
“There are a lot of things that we just don’t know but that you have to think about,” Casaletto said.
Will there be enough formula if she needs to supplement breastfeeding? Will there be a shortage of diapers? Will all this worrying harm the baby?
Dr. Margaret Sullivan, an obstetrician-gynecologist at Tufts Medical Center, gets that last question a lot these days. She tells her patients: "Unless you’re not sleeping, not eating, and losing weight, stress is not going to be directly harmful to the fetus.”
But most questions still lack answers. Sullivan consults with colleagues three times a day.
“It’s a very fluid situation. The information changes daily,” she said.
Sullivan’s office is rescheduling less-urgent gynecological visits to reduce the traffic in the offices. Five Tufts physicians are piloting a telehealth program for low-risk pregnancies, so women can get prenatal care remotely.
Dr. Khady Diouf, a reproductive infectious disease specialist at Brigham and Women’s Hospital, said obstetricians at her hospital are offering to provide care by phone to limit unnecessary visits.
Steps also are being taken to reduce the risk that COVID-19 will spread inside the hospital. The Brigham has set aside two isolation rooms for women in labor who have COVID-19 or are suspected cases.
Only one visitor per patient is allowed on the labor floor. Patients who have hired doulas for support are encouraged to work with them by phone or video chat. The number of staff in the delivery room is kept to a minimum.
Recently, a woman who was being tested for possible COVID-19 infection delivered a baby at the Brigham, Diouf said. Following CDC guidelines, the hospital separated the baby from the mother at birth. To avoid the mother possibly infecting the baby through respiratory droplets, another caregiver fed the baby with milk the mother pumped.
Once sent home, the mother was advised that, if she did not have a healthy caregiver to feed the baby, she should wear a mask during feeding. She could begin breastfeeding if her test came back negative or 14 days had passed.
For women worried about hospital capacity, Diouf doesn’t recommend looking into home birth unless that was already in their plans. “The hospital is still equipped to take care of pregnant women who are delivering,” she said.
What about women who are thinking about getting pregnant? Should they wait till the pandemic is over?
Diouf doesn’t make a recommendation on such a personal decision, but she noted that the data from China involved women who became infected in their third trimester. It’s completely unknown what happens if a woman is infected in the first or second trimesters.
“It’s a decision that needs to be weighed carefully,” she said. “Not knowing the effects of this virus and what the future is going to look like makes it hard to plan anything.”
The American Society of Reproductive Medicine has recommended that fertility treatments stop during the crisis, in keeping with calls to eliminate elective procedures and also in recognition of how little is known about the virus.
Meanwhile, the women who are already pregnant struggle with their anxieties.
“It’s hard to be pregnant as it is,” said 34-year-old Rawan Missouri of Melrose, who is due to deliver her second child in four weeks. “You’re always worried about your baby. On top of that, you’re in a pandemic and you’re worried about whether you’re going to have a place to have a baby.”
Victoria McGrane of the Globe staff contributed to this report.