Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection

COVID pregnant

The INTERCOVID Multinational Cohort Study

Key Points

Question  To what extent does COVID-19 in pregnancy alter the risks of adverse maternal and neonatal outcomes compared with pregnant individuals without COVID-19?COVID pregnant

Findings  In this multinational cohort study of 2130 pregnant women in 18 countries, women with COVID-19 diagnosis were at increased risk of a composite maternal morbidity and mortality index. Newborns of women with COVID-19 diagnosis had significantly higher severe neonatal morbidity index and severe perinatal morbidity and mortality index compared with newborns of women without COVID-19 diagnosis.

Meaning  This study indicates a consistent association between pregnant individuals with COVID-19 diagnosis and higher rates of adverse outcomes, including maternal mortality, preeclampsia, and preterm birth compared with pregnant individuals without COVID-19 diagnosis.

Abstract

Importance  Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed.

Objective  To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals.

Design, Setting, and Participants  In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge.

Exposures  COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms.

Main Outcomes and Measures  The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity.

Results  A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity.

Conclusions and Relevance  In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.

The post Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection appeared first on Time For Families.


Source: Time for Families

President Biden Issues Most Substantive, Wide-Ranging LGBTQ Executive Order In U.S. History

Biden Executive Order

Today, the Human Rights Campaign responded to the release of an executive order that implements the U.S. Supreme Court’s ruling in the consolidated cases Bostock v. Clayton County, Altitude Express v. Zarda and R.G. & G.R. Harris Funeral Homes v. EEOC.

The Order is included in a series of Day One Executive Orders that also includes executive actions launching a “whole-of-government” response to address racial equity, improving response to the COVID-19 pandemic and reducing its economic impact on the vulnerable, and combating climate change.legal surrogacy in New York

“Biden’s Executive Order is the most substantive, wide-ranging executive order concerning sexual orientation and gender identity ever issued by a United States president. Today, millions of Americans can breathe a sigh of relief knowing that their President and their government believe discrimination based on sexual orientation and gender identity is not only intolerable but illegal. By fully implementing the Supreme Court’s historic ruling in Bostock, the federal government will enforce federal law to protect LGBTQ people from discrimination in employment, health care, housing, and education, and other key areas of life. While detailed implementation across the federal government will take time, this Executive Order will begin to immediately change the lives of the millions of LGBTQ people seeking to be treated equally under the law. The full slate of Day One Executive Orders mark a welcome shift from the politics of xenophobia and discrimination to an administration that embraces our world, its people and its dreamers. We look forward to continuing to engage with the White House, Department of Justice, and other agencies to ensure that Bostock is properly implemented across the federal government.”

Alphonso David, President, Human Right Campaign

On June 15, in a landmark ruling in the consolidated cases of Bostock v. Clayton County, Altitude Express v. Zarda and R.G. & G.R. Harris Funeral Homes v. EEOC, the Supreme Court of the United States affirmed that discrimination on the basis of sexual orientation and gender identity is a form of prohibited sex discrimination. In July 2020, HRC spearheaded a letter along with other leading LGBTQ rights organizations to call on the Department of Justice to not delay the application of the law and fully enforce the Supreme Court’s Bostock decision. However, the Trump Justice Department failed to adequately instruct the federal government to implement the ruling, leading to dangerous misinterpretations like the one the Department of Education released last week and that issued by the Department of Justice Civil Rights Division on Sunday.

HRC.org, January 20, 2021

Click here to read the entire statement.

The post President Biden Issues Most Substantive, Wide-Ranging LGBTQ Executive Order In U.S. History appeared first on Time For Families.


Source: Time for Families

The Poly-Parent Households Are Coming

Poly-Parent Households

The Poly-Parent Households Are Coming

The Poly-Parent Households Are Coming.  Consider the following scenario: Anna and Nicole, 36 and 39 years old, have been close friends since college. They each dated various men throughout their twenties and thirties, and had a smattering of romantic relationships that didn’t quite work out. But now, as they approach midlife, both women have grown weary of the merry-go-round of online dating and of searching for men who might — or might not — make appropriate fathers for the babies they don’t yet have. Both Anna and Nicole want children. They want to raise those children in a stable, nurturing environment, and to continue the legacy of their own parents and grandparents. And so they decide to have a baby — a baby that is genetically their own — together.Poly-Parent Households

Such an idea may sound fantastical. But technologies that could enable two women (or two men, or four unrelated people of any sex) to conceive a child together are already under development. If these technologies move eventually from the laboratory into clinical use, and the history of assisted fertility suggests they can and they will, then couples — or rather, co-parents — like Anna and Nicole are likely to reshape some of our most fundamental ideas about what it takes to make a baby, and a family.

To date, most major advances in assisted reproduction have been tweaks on the basic process of sexual reproduction. Artificial insemination brought sperm toward egg through a different, nonsexual channel. I.V.F. mixed them together outside the woman’s body. Little things, really, in the broader sweep of life.

And yet even these have had profound consequences. Humans are reproducing in ways that would have been truly unimaginable just several decades ago: Two men and a surrogate. Two women and a sperm donor. An older woman using genetic material from a much younger egg.

Each turn of the technological screw has been generated by the same profound impulse — to allow people to conceive babies they desperately want, and to build families with those they love. Each development has, in many ways, been deeply conservative, intended to extend or re-create life’s most basic process of production. But as these technologies have expanded and evolved, their impact has become far more revolutionary; they’ve forced us to reconceptualize just what a family means, and what it can be.

For most of human history, after all, families across the Western world were defined in largely biblical terms: one man, one woman, with children conceived through sex and sanctified by marriage. Everyone else was just a bastard.

NYTimes.com, August 12, 2020 by Debra L. Spar

Click here to read the entire article.

The post The Poly-Parent Households Are Coming appeared first on Time For Families.


Source: Time for Families

No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

Frozen Embryo v. Fresh Embryo viability

No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

No significant difference was found in Frozen Embryo v. Fresh Embryo viability.  Sacha Stormlund, M.D., Ph.D., from Hvidovre University Hospital in Copenhagen, Denmark, and colleagues compared the ongoing pregnancy rate between women randomly assigned to assisted reproductive technology treatment with a freeze-all strategy with gonadotropin releasing hormone agonist triggering or a fresh transfer strategy with human chorionic gonadotropin triggering. The 460 women (aged 18 to 39 years) had regular menstrual cycles and were treated at one of eight outpatient fertility clinics in Denmark, Sweden, and Spain.No Significant Difference in Frozen Embryo v. Fresh Embryo Viability

The researchers found that the ongoing pregnancy rate did not differ significantly between the freeze-all and fresh transfer groups (27.8 versus 29.6 percent; risk ratio, 0.98; 95 percent confidence interval, 0.87 to 1.10; P = 0.76). There were also no significant differences between the groups for the live birth rate (risk ratio, 0.98; 95 percent confidence interval, 0.87 to 1.10; P = 0.83). From The BMJ:

Abstract

Objective To compare the ongoing pregnancy rate between a freeze-all strategy and a fresh transfer strategy in assisted reproductive technology treatment.

Design Multicentre, randomised controlled superiority trial.

Setting Outpatient fertility clinics at eight public hospitals in Denmark, Sweden, and Spain.

Participants 460 women aged 18-39 years with regular menstrual cycles starting their first, second, or third treatment cycle of in vitro fertilisation or intracytoplasmic sperm injection.

Interventions Women were randomised at baseline on cycle day 2 or 3 to one of two treatment groups: the freeze-all group (elective freezing of all embryos) who received gonadotropin releasing hormone agonist triggering and single frozen-thawed blastocyst transfer in a subsequent modified natural cycle; or the fresh transfer group who received human chorionic gonadotropin triggering and single blastocyst transfer in the fresh cycle. Women in the fresh transfer group with more than 18 follicles larger than 11 mm on the day of triggering had elective freezing of all embryos and postponement of transfer as a safety measure.

Main outcome measures The primary outcome was the ongoing pregnancy rate defined as a detectable fetal heart beat after eight weeks of gestation. Secondary outcomes were live birth rate, positive human chorionic gonadotropin rate, time to pregnancy, and pregnancy related, obstetric, and neonatal complications. The primary analysis was performed according to the intention-to-treat principle.

Results Ongoing pregnancy rate did not differ significantly between the freeze-all and fresh transfer groups (27.8% (62/223) v 29.6% (68/230); risk ratio 0.98, 95% confidence interval 0.87 to 1.10, P=0.76). Additionally, no significant difference was found in the live birth rate (27.4% (61/223) for the freeze-all group and 28.7% (66/230) for the fresh transfer group; risk ratio 0.98, 95% confidence interval 0.87 to 1.10, P=0.83). No significant differences between groups were observed for positive human chorionic gonadotropin rate or pregnancy loss, and none of the women had severe ovarian hyperstimulation syndrome; only one hospital admission related to this condition occurred in the fresh transfer group. The risks of pregnancy related, obstetric, and neonatal complications did not differ between the two groups except for a higher mean birth weight after frozen blastocyst transfer and an increased risk of prematurity after fresh blastocyst transfer. Time to pregnancy was longer in the freeze-all group.

Conclusions In women with regular menstrual cycles, a freeze-all strategy with gonadotropin releasing hormone agonist triggering for final oocyte maturation did not result in higher ongoing pregnancy and live birth rates than a fresh transfer strategy. The findings warrant caution in the indiscriminate application of a freeze-all strategy when no apparent risk of ovarian hyperstimulation syndrome is present.

August 6, 2020 – DoctorsLounge.com

The post No Significant Difference in Frozen Embryo v. Fresh Embryo Viability appeared first on Time For Families.


Source: Time for Families

Baby Was Infected With Covid-19 in Utero, Study Reports

Covid-19 in utero

Researchers said the case strongly suggests that Covid-19 can be transmitted in utero. Both the mother and baby have recovered.

Researchers on Tuesday reported strong evidence that the Covid-19 can be transmitted from a pregnant woman to a fetus in utero.Covid-19 in utero

A baby born in a Paris hospital in March to a mother with Covid-19 tested positive for the virus and developed symptoms of inflammation in his brain, said Dr. Daniele De Luca, who led the research team and is chief of the division of pediatrics and neonatal critical care at Paris-Saclay University Hospitals. The baby, now more than 3 months old, recovered without treatment and is “very much improved, almost clinically normal,” Dr. De Luca said, adding that the mother, who needed oxygen during the delivery, is healthy.

Dr. De Luca said the virus appeared to have been transmitted through the placenta of the 23-year-old mother.

Since the pandemic began, there have been isolated cases of newborns who have tested positive for the coronavirus, but there has not been enough evidence to rule out the possibility that the infants became infected by the mother after they were born, experts said. A recently published case in Texas, of a newborn who tested positive for Covid-19 and had mild respiratory symptoms, provided more convincing evidence that transmission of the virus during pregnancy can occur.

In the Paris case, Dr. De Luca said, the team was able to test the placenta, amniotic fluid, cord blood, and the mother’s and baby’s blood.

The testing indicated that “the virus reaches the placenta and replicates there,” Dr. De Luca said. It can then be transmitted to a fetus, which “can get infected and have symptoms similar to adult Covid-19 patients.”

A study of the case was published on Tuesday in the journal Nature Communications.

Dr. Yoel Sadovsky, executive director of Magee-Womens Research Institute at the University of Pittsburgh, who was not involved in the study, said he thought the claim of placental transmission was “fairly convincing.” He said the relatively high levels of the coronavirus found in the placenta and the rising levels of virus in the baby and the evidence of placental inflammation, along with the baby’s symptoms, “are all consistent with SARS-CoV-2 infection.”

Still, Dr. Sadovsky said, it is important to note that cases of possible coronavirus transmission in utero appear to be extremely rare. With other viruses, including Zika and rubella, placental infection and transmission is much more common, he said. With the coronavirus, he said, “we are trying to understand the opposite — what underlies the relative protection of the fetus and the placenta?”

NYTimes.com, July 16, 2020 by Pam Belluck

Click here to read the entire article.

The post Baby Was Infected With Covid-19 in Utero, Study Reports appeared first on Time For Families.


Source: Time for Families

Overlooked No More: Karl Heinrich Ulrichs, Pioneering Gay Activist

overlooked

Overlooked is a series of obituaries about remarkable people whose deaths, beginning in 1851, went unreported in The Times.

Before the word “homosexuality” existed, he argued that same-sex attraction was innate, and that those who experienced it should be treated the same as anyone else.Overlooked

By the time the overlooked lawyer and writer Karl Heinrich Ulrichs took the podium at a meeting of the Association of German Jurists in 1867, rumors about his same-sex love affairs — and the subsequent threat of arrest and prosecution — had already cost him his legal career and forced him to flee his homeland.

Standing in Munich before more than 500 lawyers, officials and academics — many of whom jeered as he spoke — Ulrichs argued for the repeal of sodomy laws that criminalized sex between men in several of the German-speaking kingdoms and duchies that existed in the years before the creation of a unified German state.

“Gentlemen, my proposal is directed toward a revision of the current penal law,” he said, according to the historian Robert Beachy in the 2014 book “Gay Berlin: Birthplace of a Modern Identity.”

Ulrichs described a “class of persons” who faced persecution simply because “nature has planted in them a sexual nature that is opposite of that which is usual.”

Same-sex attraction was a deeply taboo topic at the time; the word “homosexuality” would not even exist for another two years, when it was coined by the Austro-Hungarian writer Karl-Maria Kertbeny. So the ideas in Ulrichs’s speech — that such attraction was innate, and that those who experienced it should be treated the same as anyone else — were revolutionary.

His remarks preceded by more than 100 years the Stonewall riots in New York in 1969, which are widely seen as the start of the modern L.G.B.T.Q. rights movement.

They helped inspire the rise of the world’s first gay rights movement, 30 years later in Berlin.

They foreshadowed the imposition of a sodomy law across the German Empire that would later be used by the Nazis to target gay men, thousands of whom were killed in concentration camps.

Although overlooked they made history: Ulrichs is believed to have been the first person to publicly “come out,” in the modern sense of the term.

“I think it is reasonable to describe him as the first gay person to publicly out himself,” Robert Beachy said in an interview. “There is nothing comparable in the historical record. There is just nothing else like this out there.”

His speech was also deeply unwelcome at the 1867 meeting, where the audience erupted in shouts of “Stop!” and “Crucify!” that ultimately forced Ulrichs off the stage.

For much of Ulrichs’s life, same-sex relations were widely seen as a pathology or as a sin to which any person could succumb if seized by wickedness. These views still exist in some parts of the world.

Ulrichs helped forge the concepts of gay people as a distinct group and of sexual identity as an innate human characteristic in a series of pamphlets he wrote from 1864 to 1879 — at first under a pseudonym, but under his own name after he gave his speech at the 1867 conference.

“By publishing these writings I have initiated a scientific discussion based on facts,” he wrote in a letter published in 1864 in Deutsche Allgemeine, a pan-German newspaper.

NYTimes.com by Liam Stack, July 1, 2020

Click here to read the entire article.

The post Overlooked No More: Karl Heinrich Ulrichs, Pioneering Gay Activist appeared first on Time For Families.


Source: Time for Families

The Hidden Costs Of Starting A Family When Queer

hidden costs queer

The Hidden Costs Of Starting A Family When Queer

The Hidden Costs Of Starting A Family When Queer – Jac Ciardella sat at his kitchen table in New Jersey and inserted a syringe into a navel orange. His hand flexed as he squeezed the plunger, pushing water into the fruit’s rind. He needed the practice. He was about to inject fertility drugs into his wife, Candice Ciardella, and he wanted to get it exactly right. He knew how painful it could be. gay money
 
Just a year earlier, in February, 2017, the spouses’ positions were swapped: Candice, now 37, was administering the shot for Jac, who’s 40. Jac is a transgender man, and both he and his wife have undergone in vitro fertilization (IVF) in order to have a child.
The couple’s fertility journey started in 2015. The original plan had been to use donor sperm to impregnate Candice. But after six unsuccessful attempts at intrauterine insemination (IUI), they decided to try IVF on Jacwith the idea that Candice could carry one of his fertilized eggs. Candice began giving her husband shots of the hormone human chorionic gonadotropin (hCG), to make him produce extra eggs. 
 
“For years, needles were just part of the routine for us,” Candice says. “I think we had more empathy for one another because we both knew what it felt like. When it comes to the shots and the appointments, not many spouses can say: ‘I know exactly what you’re going through.’ We can.”
 
The process was emotionally taxing for both of them, but especially for Jac. “Someone’s head is between your legs, and it’s awkward for anyone — but, being transgender, it’s extra awkward,” Jac says. “Mentally, I’m feeling like I’m not supposed to be in that position. For me to feel comfortable going through IVF while still keeping my sanity and my integrity was huge.” 
 
Three cycles of IVF weren’t successful, and testing revealed no clear issues that would cause infertility. So in 2018, the Ciardellas decided to try IVF again, on Candice this time. 
 
“It was emotionally defeating. If you can survive IVF and infertility, your marriage should be able to survive just about anything else,” Jac says.  “It’s humbling and debilitating and cruel.” Adding to their stress was the financial strain. The Ciardellas were acutely aware that each failed cycle of IVF and IUI was costing them — big time. “You’re talking about tens of thousands of dollars going out the door,” he says. “It takes toughness.”
Jac and Candice’s story is unique, but the financial burden they faced is not. Most LGBTQ+ couples who want children have to confront the fact that starting a family will be expensive. Adoption, fertility treatments, and surrogates are all costly, often lengthy processes.
 
The Ciardellas say their insurance only covered their testing for issues that could cause infertility, such as blocked fallopian tubes. They had no financial help with the sperm, the IUIs, or the rounds of IVF. All told, over the course of three years, the couple would spend about $120,000 on four IVF cycles, $20,000 on fertility drugs, plus over $10,000 on IUI. “I got those numbers imprinted on my brain,” Jac says. “We always knew that to be parents, we’d need to be cutting into a good chunk of change — but we didn’t expect it to be quite that much.” 
 
Sandy Chuan, MD, a fertility specialist at San Diego Fertility Center, confirms that the costs of conceiving via fertility treatments can be shockingly high for LGBTQ+ couples. 
 
She says sperm samples can cost $600 to $900 per vial. One IUI attempt without insurance costs about $700 to $1,000, plus the donor sperm. “I usually tell my clients to ballpark around $1,500, but they might need to do three to six rounds,” Dr. Chuan explains. If IUI is unsuccessful, the next step is IVF, which Dr. Chuan says can cost as much as $15,000, plus $4,000 to $5,000 for medications to stimulate egg production. The price point for procedures can vary by state and market.
 
Refinery29.com, by Molly Longman, June 15, 2020
 
Click here to read the entire article.

The post The Hidden Costs Of Starting A Family When Queer appeared first on Time For Families.


Source: Time for Families

Better fertility treatments can mean much older parents. But how does this affect their offspring?

Older parents

For nearly 40 years, fertility treatment has grown ever more advanced and so entrenched that it’s not uncommon for couples to begin their families in their late 30s, 40s or even 50s, producing much older parents.

Much older parents…  But even as questions about the technology to extend fertility have been answered — yes, children born through in vitro fertilization are healthy; yes, freezing embryos appears to be safe; yes, mothers can generally deliver babies safely well beyond the classic childbearing years — another important question is emerging: How old is too old for their offspring?

Offspring like Hayley, the 10-year-old daughter of a 58-year-old, Ann Skye.

“I knew that she was going to really need to build her own support system in life, or potentially would need to,” said Skye, who lives in North Carolina and works in public health. “I think that has really impacted the way we parented her. We were strong proponents of letting her cry [herself] to sleep for that same reason: She needs to be able to self-soothe.”

In December, two prominent psychologists and two reproductive endocrinologists published an opinion paper in the Journal of Assisted Reproduction and Genetics questioning whether it was time to establish age restrictions in the field. They wrote that research has shown that children often experience social awkwardness if their parents are a half-century older than them and face greater risk of autism and psychopathologies. These children are also more likely to serve in a caregiving role and experience bereavement as adolescents or teens compared with their peers whose parents gave birth in their 20s and 30s, they wrote.

Do those risks constitute the potential for “great harm” to the child and outweigh a person’s right to “reproduce without limitation or interference” at any age, the authors asked.

“It is a self-perpetuating issue; the more older patients that seek [fertility] treatment, the more people feel that it is reasonable to seek treatment, especially in an age where sensational births are widely celebrated as positive events in the media,” they wrote.

In the United States, the number of live births to mothers ages 45 to 49 increased from 3,045 in 1996 to 8,257 in 2016, and the number to mothers ages 50 to 54 increased from 144 births to 786 births over the same time period, according to the National Center for Health Statistics. The average age of women becoming mothers in the United States is now 26, up from 23 in 1994, according to the Pew Research Center.

WashingtonPost.com, May 30, 2020 by Eric Berger

Click here to read the entire article.

The post Better fertility treatments can mean much older parents. But how does this affect their offspring? appeared first on Time For Families.


Source: Time for Families

How Coronavirus Is Affecting Surrogacy, Foster Care and Adoption

How Coronavirus Is Affecting Surrogacy

How Coronavirus Is Affecting Surrogacy – The pandemic is not just impacting parents and pregnant people — all prospective parents are facing new challenges.

How Coronavirus Is Affecting Surrogacy – Covid-19, the disease caused by the novel coronavirus, has upended life for those who are or hope to become pregnant in the United States. Fertility doctors have indefinitely postponed all advanced fertility treatments, and some major hospitals in hard-hit areas are trying to ban partners and doulas from delivery rooms.

But the pandemic is affecting expectant parents forming families through surrogacy, foster care and adoption as well.

Global travel restrictions have left surrogacy agencies in the United States scrambling for exemptions for their international clients — particularly for those whose surrogates are scheduled to give birth in the next month or two.How Coronavirus Is Affecting Surrogacy

Circle Surrogacy, an agency based in Boston, has 15 international clients with due dates before May 1. “We’ve had our legal team prepare letters for each of these families, which has gotten many of them into the country despite travel bans,” said Sam Hyde, the agency’s president. Still, he said, his foreign clients were at the mercy of individual immigration officials. “Some have been sympathetic to the plight of our clients, others have not — it’s really been a case-by-case basis.”

 

Some intended parents, as clients of surrogacy agencies are known, who are currently struggling to gain entry into the United States are hoping to do so after completing a 14-day quarantine in a country with less severe travel restrictions.

Last week, for instance, Johnny and Patty — a Chinese couple working with a surrogate living in South Carolina — traveled from Shanghai to Phnom Penh, Cambodia, to begin two weeks in isolation at a local hotel. The couple, who work for an international company and use these westernized names, asked that their last name be withheld since surrogacy is still relatively uncommon in China. They hope to complete their quarantine in time to witness the birth of their daughter, who is due in mid-April, and claim guardianship over her.

But with travel restrictions tightening seemingly daily, they worry their effort may still be in vain. “First we bought plane tickets to travel through Thailand, but now travel is restricted there,” Johnny said in an interview from their hotel on the second day of his quarantine. “Then we tried Dubai, but that is now also restricted.” Traveling via Cambodia, he said, was the couple’s “last hope” to reach the United States in time for their daughter’s birth.

Though they would be disappointed to miss the delivery, the couple said they were even more concerned, in that scenario, about the baby’s well-being in the ensuing days before they are allowed to travel. “Who will take care of our baby if we can’t arrive before she’s born?” Patty said.

Will Halm, a managing partner at International Reproductive Law Group, said surrogacy agencies were creating contingency plans for clients living abroad who may be prohibited from entering the United States over the next few months. “Plan A is absolutely to have parents in the U.S., joyfully watching their child being born,” he said. “If they can’t get into the country in time, that’s when we look to plans B, C and D.”

 

In one of the better scenarios, agencies hope friends or family members living in the United States can temporarily assume guardianship of the baby until the intended parents are granted entry into the country. As a backup, however, caseworkers are also preparing strangers — health care professionals, child care providers and even surrogates themselves — to care for the newborns until travel restrictions are eased.

“These babies will not be abandoned,” said Dr. Kim Bergman, founder of Growing Generations, a surrogacy agency with dozens of international clients who may be impacted by travel bans in the coming months. “We have an army of former surrogates who are ready and eager to act as helpers and guardians for as long as necessary.”

The ongoing crisis has created an uncertain environment for foster care parents and children as well. “Basically, everything is on pause until things are back to normal,” said Trey Rabun, who works as a services supervisor at Amara, a foster care agency based in Seattle, Wash. — one of a growing number of states ordering its citizens to work from home.

Amara, whose staff members are included in the state’s proclamation, has been able to continue some aspects of the licensing process for foster parents online, such as initial interviews. But other critical components, like home inspections, need to be done in person, Rabun said.

As a result, the number of foster homes, already all too scarce in Washington before the crisis hit, will remain static for the state’s over 10,000 foster care children until the pandemic subsides and business returns to normal, Rabun said. Of bigger concern to him, and other foster care professionals throughout the country, is the impact that “stay at home” orders may have on children not yet accounted for in the system.

“We know abuse and neglect happen more in high-stress situations,” Rabun said. But the people who would normally notice and report these sorts of problem, like teachers and doctors, will be unable to do so in the days and weeks ahead. “No one has eyes on them,” he said.

With courts and other government offices closed in many states, parents who had hoped to finalize adoptions within the next couple of months are also now navigating a drastically changed landscape — particularly for parents completing adoptions abroad.

 

Early in the year, when the coronavirus was barely registering as a news story outside of Asia, Holt International — an agency that facilitates adoption placements between Chinese orphanages and adoptive parents in the United States — was already closely monitoring and responding to the outbreak.

NYTimes.com, by David Dodge, April 1, 2020

Click here to read the entire article.

The post How Coronavirus Is Affecting Surrogacy, Foster Care and Adoption appeared first on Time For Families.


Source: Time for Families

Shielding the Fetus From the Coronavirus

coronavirus fetus

New studies suggest the Coronavirus can cross the placenta to the fetus, but newborns have been mildly affected if at all.

Newborns and babies have so far seemed to be largely unaffected by the coronavirus, but three new studies suggest that the virus may reach the fetus in utero.coronavirus fetus

Even in these studies, the newborns seemed only mildly affected, if at all — which is reassuring, experts said. And the studies are small and inconclusive on whether the virus does truly breach the placenta.

“I don’t look at this and think coronaviruses must cross across the placenta,” said Dr. Carolyn Coyne of the University of Pittsburgh, who studies the placenta as a barrier to viruses. She was not involved in the new work.

Still, the studies merit concern, she said, because if the virus does get through the placental barrier, it may pose a risk to the fetus earlier in gestation, when the fetal brain is most vulnerable.

Pregnant women are often more susceptible to respiratory infections such as influenza and to having more complications for themselves and their babies as a result. It’s still unclear whether pregnant women are more likely to contract the new coronavirus, said Dr. Christina Chambers, a perinatal epidemiologist at the University of California in San Diego.

“We don’t have any knowledge of that at all — that is a complete open question at this point,” she said. It’s also unclear what effect the virus has on the fetus, she added.

The placenta usually blocks harmful viruses and bacteria from reaching the fetus. And it allows in helpful antibodies from the mother that can keep the fetus safe from any germs, before and after birth.

Still, a few viruses do get through to the fetus and can wreak havoc. The most recent example is Zika, which can cause microcephaly and profound neurological damage, especially if contracted in the first and second trimesters.

Neither the new coronavirus, nor its more familiar cousins, has seemed to belong to this more dangerous category. If so, “we would be seeing higher levels of miscarriage and preterm delivery,” Dr. Coyne said.

NYTimes.com by Apoorva MAndavilli, March 27, 2020
 
Click here to read the entire article.

The post Shielding the Fetus From the Coronavirus appeared first on Time For Families.


Source: Time for Families