pregnant woman
© Shutterstock
I was on the bus the other night with my wife. There were only 3 of us not wearing masks on our public transport, which mandates mask wearing but with medical exemptions. Across the aisle was an attractive, healthy looking young woman, perhaps mid 20s wearing a mask.

She was pregnant, I'd guess in the 2nd trimester. According to the US NIOSH (National Institute for Safety and Health) there are now millions of pregnant women wearing masks — primarily because they're mandated to do so. But there doesn't appear to be any data for how long they're worn and under what circumstances, i.e. indoors, outdoors, working, exercising or whatever.

Given what I've learned about masks I had a strong urge to warn her that there were serious risks to her and I assumed the unborn baby. I assumed because I really didn't know. The problem is there are virtually no reliable studies which link mask wearing to postnatal outcomes. But as I've come to understand the lack of a specific study need not inhibit an accurate risk/benefit analysis. So let's do that.

The wearing of masks to attempt to prevent the spread of a virus has never been widespread in the general population in the Western world. (An exception to that was during the 1918 flu pandemic, masks were mandated in some cities, USA, but not others.

Subsequent studies showed no difference in infection rates or deaths between the mask wearing cities and those that chose not to.) In Asia where mask wearing is more common they are worn for a multitude of reasons including, significantly, for protection against car exhaust and industrial air pollution. Most studies everywhere have concentrated on "fit for purpose" or effectiveness analyses.

Fewer studies have looked at the effects of masks on the wearer, fewer papers still have addressed the concern that masks might be harmful to the wearers.

Here's how we can examine the risks of mask wearing on pregnant women (or others for that matter):

If we look at the science regarding the effects of wearing a mask on the people wearing them and then compare and connect those results to effects that have been shown to affect pregnancy outcomes then we should be able to draw reasonable conclusions. In a risk/benefit analysis it may not prove a potential harm but might suggest considerable caution be applied.

Never in our history has mask wearing been so ubiquitous, across so many countries and in general mostly healthy populations of all ages, past that of toddlers. Neither has mask wearing been mandated for such long periods. Servers in restaurants, school children, plant workers, transit workers, health employees don them for far longer than previously. Pre-Covid-19 they were mostly confined to operating rooms and infectious wards.

What reasons aside from mandates might a pregnant woman have for deciding to wear a mask during what is called the Covid 19 pandemic?

Foremost would be concern for her own health and the unborn baby-protection from becoming infected, sick and possible negative effects on the fetus.

Secondly she might be concerned for others, i.e. source control, that she might not pass on an infection. Those would be her hoped for benefits. She might also want to be seen to be a good person "helping to fight the virus."

Before assessing her benefits we need some context both of Covid-19 and of mask wearing.

On March 11, 2020 the World Health Organization (WHO),declared the disease Covid-19, as a result of infection with the SARS-CoV-2 virus, to be a "pandemic." 6 months in it has failed to live up to that billing. In fact the US CDC now calls it the "Covid-19 Outbreak." And Swiss Policy Research which has published a great deal of scientific information, often at odds with the hysteria the virus has generated in the media, has studied the lethality of the virus and concluded it is generally low.
"[for] most people the new coronavirus is already neutralized by antibodies on the mucous membrane (IgA) or by cellular immunity (T-cells). In most of these cases, no symptoms or only mild symptoms develop... the new coronavirus is probably much more common than previously thought and the lethality per infection is up to five times lower than previously assumed. The real lethality could thus be well below 0.1% and hence in the range of strong seasonal influenza."
Doctors, scientists, politicians, judges and hundreds of thousands of citizens have called it a fake or a hoax. Like these 640 German medical doctors and this group of 590 Belgian doctors whose website also lists other international groups of doctors speaking out. The majority here are not saying there is no infectious disease present, they are saying the threat posed is massively exaggerated. All of the dissenters present evidence that Covid-19 at worst is as dangerous as a strong flu season.

Regardless, even some government spokespersons are now admitting it is not and was not as lethal as first announced. Officials such as Chris Whitty, the UK's Chief Medical Health Officer have downplayed the seriousness of Covid-19 as it affects the general population. He told a press conference on May 11th, when Covid-19 was already past its peak, that it was not a concern for most people.
[T]he great majority of people will not die from this...Most people, a significant proportion of people, will not get this virus at all [...] Of those who do, some of them will get the virus without even knowing it, they will have the virus with no symptoms at all, asymptomatic carriage [...] Of those who get symptoms, the great majority, probably 80%, will have a mild or moderate disease...not bad enough for them to have to go to the doctor. An unfortunate minority will have to go as far as hospital, but the majority of those will just need oxygen and will then leave hospital.

- Chris Whitty, quoted in Off-Guardian, May 15, 2020
Now consider the lethality of Covid-19 as it would apply to a pregnant woman.

The mean age of all births appears to be between 30 and 33. The ages of the birth mother will be with minor exceptions between 15 and 45 years.

According to Worldometer the percentage of deaths at the peak of the outbreak under the age of 45 was less than 5%. The hardest hit age group accounting for almost 50% of all mortality to date were 75+ years old. And most of the deaths, over 90%, had several comorbidities, a status not impossible but unlikely in pregnant women.

In fact Stanford Professor John Ioannidis, one of the most acclaimed scientists in medicine, says that for those under 45 the infection/fatality rate is essentially zero.

Understanding the above we can safely say a pregnant woman's risk of death absent serious comorbidity, such as terminal cancer, is essentially zero.

But what about a non-fatal Covid-19 infection resulting in harm to the fetus?

The odds are against it. Most importantly because 80% of Covid infections are either asymptomatic or have only mild symptoms. And over 95% have only moderate symptoms. The biggest risk to the fetus would apparently be if she got a fever from Covid-19, as it's been reported that fever can result in congenital birth defects in the child. However, even here that is not a fear that is borne out by science.

First only 30% of Covid-19 infections result in fever. Second and most important, fever in pregnancy has not been found to result in congenital birth defects according to a recent, 2017, study with a very large cohort of pregnant women.

And what about her risk of hospitalization should she be infected? In her age category it would be in the 1% to 3% range, not of the whole population, just of those hospitalized. This is very low as a risk but it may still be a concern for the very risk averse.

But as with everything Covid the elderly take the heaviest hit and men are more susceptible than women. So a conservative guess for pregnant women (who are after all a small subset of all women at any given time) would be in the range of considerably less than 1%.

And importantly, the benefits of wearing masks would only pertain if they do what is claimed they do by authorities mandating their wear-i.e. are effective at stopping the coronavirus.

Does the wearing of masks prevent or reduce the chances of a Covid-19 infection?

Two of the most often cited studies in favour of wearing masks in healthcare and the community are from the prestigious British medical journal The Lancet. Despite their stature, they've had major missteps during the pandemic. The Lancet was forced to withdraw a paper critical of hydroxychloroquine, HCL, as a Covid-19 treatment because it was based on fraudulent data.

Both their reports on face masks were based on meta-analysis of other studies all of which were observational studies as opposed to randomized control trials, RCTs which are far more reliable. RCTs are considered the gold standard in medical studies. Here is a story of how observational studies led to women being prescribed hormone treatments to protect their hearts. An RCT raised a red flag, finding that not only were there no benefits derived from the treatment but that it actually causes heart problems.

The conclusions of both Lancet papers 1 & 2 were that the benefits were slight and that the "certainty of evidence was low" Sometimes, it was suggested, the benefits were more psychological than physical.
"One advantage of universal use of face masks is that it prevents discrimination of individuals who wear masks when unwell because everybody is wearing a mask."
And this quote from the Lancet's most recent study:
"Face coverings and masks might protect both healthcare workers and the general public against infection with COVID-19, and protective eye covering may also provide additional benefit-although the certainty of the evidence is low for both forms of protection."
Note the use of language here, hardly reassuring if it's protection you're looking for: "might protect" "may also provide additional benefit." But then they go on to say the "certainty of the evidence is low" for both forms of protection. In medical studies saying the certainty of evidence is low is tantamount to saying it's untrustworthy.

If masks work to reduce even some of the risk of infection for a pregnant woman there could be an argument for wearing them to move even further into a safe zone of infection avoidance. Much of the decision hinges on the evidence for effectiveness of masks in this area, including our gold standard, the randomized control trials, RCTs. As it turns out there are abundant studies of mask efficacy including respirators like the N95, medical or surgical masks and cloth masks.

One of the most recent was this May 2020, Hong Kong study published by the US CDC (Italics mine).
In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks.

In this review, we did not find evidence to support a protective effect of personal protective measures or environmental measures in reducing influenza transmission. Although these measures have mechanistic support based on our knowledge of how influenza is transmitted from person to person, randomized trials of hand hygiene and face masks have not demonstrated protection against laboratory-confirmed influenza, with 1 exception (18). We identified only 2 RCTs on environmental cleaning and no RCTs on cough etiquette.
What of the argument about being a good person and wearing a mask to protect others, so-called source control? If a pregnant woman becomes infected with Covid-19, she can do as people have always done and stay home until she's better. Otherwise, as a healthy person she will infect no one. Even if she's "asymptomatic" there is no real risk of infecting others. Dr. Maria Van Kerhove, Technical Lead Covid-19 at the World Health Organization, WHO, clearly states that asymptomatic transmission is "rare."

Her statement first went viral and then was overwhelmed by the pushback led by Dr. Anthony Fauci and others who appeared to be threatened by her statement. The evidence since then seems to validate what she said.

One of the most vocal critics of mask wearing is Dr. Denis Rancourt, a retired professor of physics at the University of Ottawa and currently a researcher with the Ontario Civil Liberties Association, OCLA. Significantly Rancourt also has considerable expertise in biology and published in that arena. He published a paper entitled Masks Don't Work.

After surveying all of the RCT literature he found literally no evidence that masks of any type succeed in blocking viruses. And he uses both physics and biology to demolish the "droplet" argument. Rancourt as a physicist, has been criticized for "stepping out of his field" however he has done an immense amount of cross-disciplinary work which actually makes him highly qualified to weigh in on this debate.

Here is a link in which he details his extensive and recognized scientific background. Finally, most people would be surprised to learn that even in the operating room there are significant studies showing that masks are ineffective for preventing infection. Masks may be more medical lore than actual science.

My own view of the "controversy" around mask efficacy is that governments are now widely demanding compliance with mandatory mask wearing, even in the home, saying that it's based on "the science." Many scientists, who most often depend on government licensing, funding and cooperation will do a study that does not actually support mask wearing but then weakly conclude that "masks should work, even minimally, so yes, go ahead and wear them." Not a very powerful argument but one that is made nonetheless.

But why not? Supposing it helps even a little and after all one is showing support for fighting the pandemic? It won't hurt. But how sure are we of that last statement? I've seen healthcare workers on social media say they've worn masks for years and they're fine, so what's the problem? The problem might well be long term. For instance the health consequences of smoking were debated for literally decades because the harm wasn't immediately apparent. There were even advertisements for cigarette brands endorsed by doctors and most doctors at the time smoked.

As it turns out there is considerable direct and some indirect evidence of the harm that mask wearing may, and probably does, do to anyone wearing them. As one would expect healthy young people are least at risk while others, with immune deficiencies already, are more likely in harm's way. Pregnant women are a special case because what they do can affect their unborn child. Children, because their development is still ongoing are also in a higher risk category.

Masks pose a direct threat to the health of the mother and an indirect threat to the unborn child. The most serious threat to both is probably the oxygen depletion caused by having your mouth and nose covered. In addition you will breathe in more carbon dioxide as when you exhale some is trapped in the mask and you rebreath it. These effects have many variables such as general health, age, how long masks are worn and what if any activity is being undertaken.

The pregnant lady on the bus was at rest but supposing she was going to the gym later where they require masks to work out? Or perhaps she's going to work where she's physically active.

This is where calculating harm and finding evidence comes in. This article by prominent retired neurosurgeon Dr. Russel Blaylock, a highly regarded MD and author, lays out a whole minefield of risk from wearing face masks. Regarding oxygen he says this:
"While most agree that the N95 mask can cause significant hypoxia and hypercapnia, another study of surgical masks found significant reductions in blood oxygen as well. In this study, researchers examined the blood oxygen levels in 53 surgeons using an oximeter. They measured blood oxygenation before surgery as well as at the end of surgeries.4 The researchers found that the mask reduced the blood oxygen levels (pa02) significantly. The longer the duration of wearing the mask, the greater the fall in blood oxygen levels."
If blood oxygen saturation is lowered by wearing a mask, then we ask what harm could that do to a pregnant woman? For most healthy young people the harm is probably mild such as a headache that goes away after full breathing is restored. But if the mother's oxygen saturation is lowered then so is that of the fetus and here things get frankly frightening. A 2012 Arizona State University shows how oxygen deprivation at birth has been shown to result in long term adverse effects such as birth defects and a higher risk for other diseases such as cancer and cardiovascular problems.
They show how hypoxia, or a period of low oxygen during pregnancy, combined with a genetic risk factor of having only one functioning copy of a gene, dramatically increases the chances of a baby being born with congenital scoliosis, a malformation of the spine that affects around 1 in 1,000.'

[...]

'We've long suspected that it is genes or our environment that cause birth defects, but up until now, the majority of these have been largely unknown," says Dunwoodie. "This is the first time anyone in the world has shown that both 'nature' and 'nurture', in combination, are molecularly responsible for causing many birth defects."
But in recent prenatal and postnatal studies oxygen deprivation even if mild and of short duration tends towards the same high risk health outcomes. The 2019 study at the University of Cork says:
"Hypoxia or lack of oxygen to the brain at birth affects almost 200 babies in Ireland each year and results in death or disability in over two million infants each year globally. Even a very mild lack of oxygen at birth can have serious long-term effects with significant costs for the affected children, and their families."
Note they are talking here about oxygen deprivation during birth. However, the results strongly suggest that reduced oxygen at any point before or during birth would produce the same effects.

Some of the evidence is indirect but nonetheless pertinent. Example, studies have shown that babies born at high altitudes to mother's for whom it is not their natural environment have a higher incidence of low birth weight, birth defects and higher risk of congenital disease. This is presumed to be as a result of less oxygen at higher levels. People native to high altitudes appear to have evolutionarily adjusted to the effects.

Thus clearly we have evidence that masks deplete oxygen and there are several studies linking even mild hypoxia to adverse postnatal outcomes. That is one very real risk for pregnant women wearing masks.

An additional risk of masks depleting oxygen and increasing carbon dioxide in the blood is that both of these effects compromise the immune system's function. A pregnant woman's immune system works to protect her and her unborn child up until the 14th week of pregnancy when the fetus develops its own. After week 14 the prenatal child's immune system will still be affected by the mother's.

Pregnant women make all of their choices from the onset of pregnancy for 2, themselves and their unborn child. For instance, most women give up or restrict drinking alcohol during pregnancy because of the well-studied effects of drinking on postnatal health outcomes.

The problems of oxygen concentration in the blood is not the only danger mask wearers face. Bacterial and viral infections from microbial buildup on the inner surfaces of masks and even brain infection from viruses travelling from the mask up the olfactory (nasal) nerves to the brain are also risks.

After a short period wearing a face mask the inside of the mask gets moist and warm, the perfect medium for growing microbes. Like a petri dish tied to your face. Viruses and bacteria that you're breathing out and microbes that have landed on the outside of the mask or were transported there when you touched it, are now being breathed back into your nasal passages, throat and lungs. Now, with widespread mask usage there are additional safety concerns with people using non-medical, non-respirator type, cloth masks.

Cloth masks are widely urged on the public as workable alternatives to medical masks or respirators. According to Robert Kennedy Jr.'s Children's Health Defense:
"Available evidence shows that (cloth masks)... may even increase the risk of infection due to moisture, liquid diffusion and retention of the virus. Penetration of particles through cloth is reported to be high." "Altogether, common fabric cloth masks are not considered protective against respiratory viruses and their use should not be encouraged."

Textile materials (that can be used for cloth masks) can contain harmful chemicals and dyes (i.e. formaldehyde). There is no research available regarding the safety of breathing through such materials but formaldehyde is a gas that can irritate a person's eyes, nose, throat and lungs, or trigger an asthma attack, even at low concentrations. Prolonged exposure to formaldehyde can cause cancer.
There have been numerous anecdotal reports of staph and streptococcus infections from mask wearing. Maskne (acne caused by mask wearing) is belittled by some masking advocates on social media, "You do get that acne is not a real problem don't you?" is one quote I saw.

But as FDA medical officer Dr.Jane Leidtka says from her 15 years of treating acne,
"Acne is not usually a serious health condition. But it can cause significant emotional distress, as well as permanent scarring of skin tissue,"
But as is reported here, the maskne reveals a more serious problem: verification of microbial buildup on the inside of the mask.

Upper East Side dermatologist Dr. Whitney Bowe. [says]
"If left untreated, the mask, 'which is a breeding ground for yeast and bacteria...could lead to infections that then require a prescription medication to clear it up."
(Note: while acne or maskne may not present a serious medical condition (although that's arguable) it demonstrates something very important: and that is that wearing a mask can lead to infections. That is sobering information because those infections may not all be as relatively benign as acne.)

And as noted above one of those infections might be in the brain - resulting from wearing a mask. Would you consider that a real problem?

Dr. Blaylock referenced the olfactory nerve as a route into the brain in a recent article in Technology News & Trends. Citing a 1989 study in the journal Virology titled Spread of a neurotropic murine coronavirus into the [central nervous system] via the trigeminal and olfactory nerves" Dr. Blaylock wrote:
"In most instances it enters the brain by way of the olfactory nerves (smell nerves), which connect directly with the area of the brain dealing with recent memory and memory consolidation. By wearing a mask, the exhaled viruses will not be able to escape and will concentrate in the nasal passages, enter the olfactory nerves and travel into the brain." [10]
Dr. Blaylock was ridiculed for that last suggestion but look at this Jun 4, 2020 quote from John Hopkins Medicine's website regarding the reported number of brain infections in Covid-19 patients:
"The first possible way is that the virus may have the capacity to enter the brain and cause a severe and sudden infection. ...The loss of smell that occurs in some patients with COVID-19 could indicate that the virus entered through the olfactory bulb, which is located right above the nose and communicates information about smell to the brain.
And a 2015 study in the journal Brain said this:
"The study listed viruses that can use the olfactory nerve as a "shortcut" into the brain. Viruses that enter the body through the nose include influenza A virus, herpesviruses [and many others].
And if the above seems unlikely to you consider that a number of studies have reported brain infections as a complication of Cv19. John Hopkins doesn't suggest the infection could have come from a mask. But the etiology suggested by Blaylock is clearly plausible.

As serious as the potential physiological health effects are there is another dimension that is important to consider and that is the emotional well-being and mental health of the expectant mother.

Most prospective mothers probably aim for a holistic, healthy state of mind and body. A cheerful relaxed disposition helps bathe the baby with natural hormonal health promoting chemicals. Masks create the opposite. They are arguably the chief symbol of the pandemic with connotations of infection and dying. In short they are a symbol of fear. Wearing one says I fear infection more than I dislike the discomfort and inconvenience of wearing this appliance on my face. You may not even consciously be aware of this fear or general sense of anxiety.

In a 2007 study the Journal of Maternal and Neonatal Medicine concluded as follows:
"Enhanced levels of depression and anxiety symptoms during pregnancy contribute independently of other biomedical risk factors to adverse obstetric, fetal and neonatal outcome[s]."
Fear is a mechanism for lowering your body's natural immunity. Fear and stress tell the body to spend its resources elsewhere than the immune system until the danger is gone. But as the masks mandates appear to be in place for an indefinite time, that might be a long while.
"...when people live in constant fear, whether from physical dangers in their environment or threats they perceive, they can become incapacitated."
"The surgical mask communicates risk" imagine just how much more risk and thus fear is communication by mass, worldwide mandatory mask wearing.

Before leaving the subject of masks it is illuminating to consider an example of what the mainstream is telling pregnant women about their effect. Google "is mask wearing safe" and you'll get hundreds of answers saying they are. BabyGaGa.com, a site directed at expectant parents, gives their advice on masks: How Safe are Masks During Pregnancy: Here's What Experts Say. One would expect from the title that there would be a comprehensive list of citations and evidence from diverse experts.

But no, all of their advice is based on one study and this study compared 16 pregnant women with 16 not pregnant women, all healthy, young non-smokers. Then, it consisted of 1 hour of sitting, standing and mild exercise on a stationary bicycle while the participants were monitored. They concluded that there was no significant difference in the "health effects" in the 2 groups.

It doesn't take a scientist to see what's wrong here.

It was not randomized in any way, it was a very small sample, studied over a very short time frame with no control group. The masks used were only the N95 respirator and not the differently problematic surgical or cloth masks. Literally none of the risks enumerated above would show up in such a study. It would be like concluding that tobacco is safe based on 32 young women each smoking one cigarette over one hour.

Despite this they did report finding:
"[that] both pregnant and non-pregnant women wearing the respirator mask had a mild — but significant — increase in the heart's resting, or diastolic, blood pressure.
It is clear from the evidence that there is no real medical benefit for wearing the mask. There are serious risks that might not befall every pregnant woman wearing a mask. But would she want to live with the uncertainty that sometime in the future her child might suffer greatly from a choice she made?

If mask wearing is unhealthy for unborn children and the mother, it is, for most of the same reasons, unhealthy for all of us especially children. It is distressing to see jurisdictions all over the world mandating wearing masks in schools. Active development as guided by our DNA from birth through adolescence is mostly complete by age 19. But during this period humans continue the process of gene expression that began in the womb.

Environmental factors such as light and oxygen have been proven to have an impact on this process and that includes oxygen depletion.

In conclusion, in deciding to wear a mask or not, especially if you're pregnant, I would say go with the weight of evidence.

First will the mask work to protect you from viral infection? The weight of evidence says it will not because there are no (gold standard) randomized control trials that conclude they do. The science that says they do more often, on closer examination, says, "they should." And that is based on mechanistic arguments that suggest "you're blocking droplets, so you should be preventing infection." However that has not been demonstrated in studies. So you would have to rate the protection of masks as "low certainty." (Which is how most of the science itself has framed it.)

Second, is there a risk to an expectant mother or an unborn child from wearing a mask. Here we have a high certainty that there is. Many studies have demonstrated risks in mask wearing. Studies that say they are safe by and large rate their certainty as low. Simply put there is a risk and that risk because it entails a long term developmental danger to the child of birth defects or congenital disease, is not worth taking.

Let's finally ask a question that needs to be addressed because it is a likely reason many people wear the mask; fear of social isolation or condemnation for not wearing one. That is not an insignificant concern.

I was yelled at in a store for not wearing a mask, I was kicked out of a lineup for breakfast at a hotel because I was maskless. I have a medical exemption but are you going to stand in front of a group of people hating on you and explain it? Not likely.

It's hard but for a pregnant woman - it's perhaps just the first time in her life she'll have to advocate for herself and her child, and take a stand. That is truly worth it. Take off the mask. Take a deep breath and share it with your unborn child.