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t m c p u l s e | j u ly 2 02 0 29 initial gloomy picture that we saw from China and maybe from New York regarding pregnancy has not been replicated in experiences elsewhere," Saade said. "Now, that's not to say that pregnant women can't get very sick— we've seen cases here and there where pregnant women were intubated or ventilated and even some died—but I think it's not as dire as we thought it would be. We're seeing a lot more pregnant women who are asymptomatic, who don't show any signs or symptoms or may have some mild symptoms, and they're positive and they do very well." These observed outcomes are at odds with what was seen during the H1N1 pandemic and with influenza outbreaks, he added, all of which resulted in more sickness and mortality in women who were pregnant. But, if COVID- 19 ends up being less of a respiratory virus and affects the vasculature or immune response more—something experts are currently hypothesizing— then Saade said he could see pregnancy offering some protection from COVID-19. "If it's not a lung function issue, if it's a vascular and immune response, maybe pregnancy actually protects against this," Saade said. "We know preg- nancy is an immune-tolerant state, because the body doesn't want to reject the fetus. Whether that makes the pregnant woman have less of a cytokine storm with an infection or not, that is still to be determined. We also know that the vessels of pregnant women respond less to constricting agents, and whether that protects the pregnant woman from the consequences of the virus, that's also to be determined." Still, with so many unknowns surrounding COVID-19 and pregnancy, both Saade and Aagaard urged expecting mothers to take recommended precau- tions while also maintaining routine prenatal care. "What I tell [my patients] is exactly this: I wish I could give you all the answers. I wish I could give you a number and make you feel better, make you feel less alarmed, but I can't—and I wouldn't be doing my job if I did. I have to tell you the hardest thing to say, which is 'I don't know,'" Aagaard said. "In the absence of really good, strong evidence suggesting the contrary, I would urge you to heed carefully the CDC recommendations. Err on the side of caution, practice common sense, wash your hands, stay out of risky situations and the moment you're not feeling well, with a chronic dry cough, a fever, chills, call us. We're here and we're ready to take care of you."