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Is the Preterm Birth Rate Actually Declining in COVID?



My response to the article in the New York Times about the preterm birth rate during COVID and quarantine.


To continue the conversation, head over to instagram.com/healthy.highriskpregnancy





Video Transcript:


Hello. Welcome. My name is Parijat Deshpande. I am a high-risk pregnancy specialist and somatic trauma professional. I work with women during pregnancy to help them reregulate their nervous system in order to improve their pregnancy outcomes and reduce their risk of preterm delivery. So you can imagine that when I saw that New York Times article about the preterm birth rate declining during COVID and during lockdown, I was very intrigued and I knew I had to say something.


So first, just from the beginning, I want to say, I am very excited to see what the research is going to be like coming out over this next year. I think it's going to be really interesting to see what this entire lifestyle shift is going to be like and how it's going to impact pregnancy outcomes, and especially as it pertains to preterm delivery, but there were a couple of things that I wanted to address to make sure that we're on the same page about what these terms actually mean and what the physiology actually is with regards to pregnancy and preterm delivery.


So primarily, I want to start with this idea that could it be stress and that maybe women are less stressed right now? And I want to say, even without touching that question, stress doesn't work that fast. We do know that according to the research around stress physiology in pregnancy, that when a nervous system is in survival mode and fight or flight mode, when you're experiencing pregnancy in that mode, that it does have a cascading effect on the endocrine system and the immune system, which can shift the balance of those three and put you at risk for pregnancy complications, including preterm delivery. We know that. The research is documented in my book, Pregnancy Brain, if you want to know more about that.


But what we are also not considering is that those shifts have different meanings depending on when those shifts happen during pregnancy. First trimester versus second trimester, versus third trimester. And given that, I don't think we have enough information because there hasn't been enough time yet. If you look at the studies that have been done, they were done in such a short window that we'd have to parse out exactly where the woman was during pregnancy and what we know about how stress physiology impacts pregnancy in that particular point of pregnancy.


And there are just so many variables, but the biggest one is we don't know enough. It hasn't been long enough. And stress doesn't work that fast. It's not like there is an extremely stressful event, and then within hours or days, see the preterm delivery. Usually, that's not the case. There's a cascading effect of the shift in the nervous system, which shifts the endocrine system and the immune system. We see a change in the hormones that are produced by the placenta to increase what we call the placental clock to then set the stage for preterm delivery. But all of that is not an instantaneous reaction.


So I think that's one thing to keep in mind. So that means that we're not saying stress doesn't play a role, it's that I don't think we've had a wide enough window in order to see how it's impacting pregnancy complications and preterm delivery, given the context of this article.


The other piece of it that's tied to that is then the article quoted some medical professionals, suggesting that rest could be playing a role, that maybe women are resting more because they're at home and they're not commuting and some women maybe aren't even working anymore, and that might be playing a role in helping women stay pregnant longer.


Now here's what we know about rest. You can be on your sofa, watching Netflix all day long, physically still, and not still be resting. So the idea that the solution is to rest more is actually an incomplete solution. What we know is that when the nervous system is in that survival mode, whether you are standing or sitting or lying down, it doesn't matter, the same chain reaction happens to put you at risk for pregnancy complications, including preterm delivery.


But what we also know is that when you can reregulate that nervous system, we can see the impact of that as well on the endocrine system and the immune system, extending the length of pregnancy. And so the question really is it's not the rest that is doing it, it's not really that rest. And I think a lot of women can resonate that there's not a lot of rest happening right now. So it's not the solution to just put your feet up and hope for the best. The solution is to find a way to start feeling safe. And maybe that could be what's happening, as women are choosing to stay at home and not go out and risk of exposure to, as the article said, "Viruses including COVID," that risk-averse behavior could be perpetuating a sense of safety, and we know that safety is what is required to have a regulated nervous system and thus impact on the other two systems as well, that we know impact pregnancy outcomes.


The other piece that came to mind too, was that doing prenatal appointments virtually may also be supporting women who are living with medical trauma, who have experienced medical trauma, and avoiding the exam rooms where the sights, the sounds, the smells, and all the interventions are constantly retriggering that trauma are no longer present. And by being safe at home, they may be experiencing that reregulation, that downregulation of the nervous system to keep a sense of safety. Now, again, that safety is possible even when we are out and about working. It's not necessarily tied to being on lockdown, it's just that the circumstances of lockdown are maybe making that a little bit more accessible to some people.


Now, I will say that we do know for certain populations, the preterm birth rate is tied to being on your feet. Nurses, doctors, surgeons, shift workers, where the day-to-day schedule is quite strenuous. And in those cases, sure, getting off of your feet, putting your feet up might be making a difference. But I don't want to forget the entire rest of the population where it's not just about that. It is about the internal experience of living in a body that is in survival mode. So given that, I think really the best conclusion to take away from this is it's interesting, but I don't think we can make any conclusions about this because we don't have enough information yet. There are too many factors that are unaccounted for in the studies that they cited and in the anecdotal evidence that's being presented.


If you talk to NICU nurses and neonatologists and OBs around the country, and sometimes around the world, we are hearing that they're not seeing that downregulation or that down-dip of preemies that the article cited. So it is not a universal experience, and I think when we take a trauma-informed lens and we look at the physiology of stress and the physiology of pregnancy as it pertains to stress, I think it makes a lot of sense. And I'll be very curious to see over these next six months, the next year, what this data actually looks like. But I think, for now, it is way too soon to say that lockdown is what is going to reduce preterm delivery and that resting by putting your feet up is going to be the answer.


We know from a physiological perspective that putting your feet up is not enough, that we do need to do the deep inner work to reregulate the nervous system. And when we do that, which is possible when we're on lockdown and when we're not, that's when we see an improvement to pregnancy outcomes. And I think that's really important because that research has been out there for 70 plus years. It's in my book, Pregnancy Brain. I talk about it all the time, but it doesn't get enough of the attention that it deserves. We keep hearing this narrative, we've been trying to reduce the risk of preterm delivery and we haven't made any progress yet, and I really do believe this is the piece of the puzzle that's been missing.


So while this particular article may not be highlighting a trend yet, I think it's a really important stepping stone in getting us to step back and think, how can we help pregnant women feel safe? Because it is in that safety that we are going to start to see a long-term shift in patterns when it comes to pregnancy outcomes and preterm delivery. And I think that outcome and those changes in those patterns, we should be able to see across the board, given the different communities that we want to be serving in this world.


So that is my initial take. I have so much to say on this topic, if you want to know more, come follow me on Instagram, @healthy.highriskpregnancy. If you'd like a copy of my book, or you would like to work with me directly on how to reregulate your nervous system to improve your pregnancy complications, visit me on my website at parijatdeshpande.com. Thanks so much.



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