What to Know About Pregnancy and COVID-19

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Researchers are still learning how COVID-19—the disease caused by the SARS-CoV-2 infection—affects pregnant people. Current reports suggest that pregnant people have a higher risk for more severe illness from COVID-19 than nonpregnant people. Pregnancy can make you more susceptible to certain infections and may also make these infections more severe.

Some underlying medical conditions, and other factors—such as age or occupation—can further increase a pregnant person’s risk for developing severe illness from COVID-19.

Pregnant people with COVID-19 might also be at increased risk for other poor outcomes, such as preterm birth (delivering the baby earlier than 37 weeks).

Read on to learn about how COVID-19 might affect pregnant people, including risk factors, symptoms to look out for, when to see your doctor, and more.

Portrait of a pregnant afro hair woman in the city wearing a cloth protective mask during Covid-19 coronavirus pandemic

LeoPatrizi / Getty Images

Pregnancy and COVID-19 Risk

When talking about pregnancy and COVID-19 risk, it’s important to separate the question into two topics:

  • Susceptibility: Is someone who is pregnant more likely to contract COVID-19 when exposed to the virus?
  • Outcomes: Is someone who is pregnant and develops COVID-19 more likely to have bad outcomes, such as hospitalization, intensive care admission, the need to be intubated, or death?

Susceptibility

Whether being pregnant increases the risk of becoming infected with COVID-19 when exposed is still unclear, but we do know that due to changes in your body and immune system, pregnant people can be badly affected by some respiratory infections. Given the growing evidence, the Centers for Disease Control and Prevention (CDC) now includes pregnant people in its “increased risk” category for COVID-19 illness. 

The H1N1 influenza A pandemic of 2009 was a reminder that certain infections may disproportionately affect pregnant people, with those who were pregnant having an increased risk for severe disease. In the United States, 5% of all deaths from pandemic influenza were among pregnant people, although pregnant people represent only about 1% of the U.S. population.

Many studies have been carried out to identify those more susceptible to COVID-19. A systematic review and meta-analysis of 192 studies, published in the British Medical Journal, found that the following risk factors were associated with severe COVID-19 in pregnancy:

Conditions in the places where pregnant people live, learn, and work may also affect health risks and outcomes. For example, people who are pregnant and work in places where they cannot distance themselves from people who may be sick—like healthcare providers—are at increased risk for getting sick and developing severe illness from COVID-19.

COVID-19 and Frontline Workers

Research published in The Lancet noted that between March 24 and April 23, 2020, frontline healthcare workers had at least a threefold increased risk of reporting a positive COVID-19 test and predicted COVID-19 infection, compared with the general community.

Post-hoc analyses showed that Black, Asian, and minority ethnic healthcare workers are at especially high risk of COVID-19 infection, with at least a fivefold increased risk of COVID-19 compared with the non-Hispanic White general community.

Outcomes

In a report from the CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team that included over 23,000 pregnant persons and over 386,000 nonpregnant females of reproductive age with confirmed COVID-19 infection, pregnant patients had a higher risk of:

  • ICU admission (10.5 vs. 3.9 per 1,000 cases)
  • Receiving invasive ventilation (2.9 vs. 1.1 per 1,000 cases)
  • Receiving extracorporeal membrane oxygenation (ECMO) (0.7 vs. 0.3 per 1,000 cases)
  • Death (1.5 vs. 1.2 per 1,000 cases)

The risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Pregnant people with COVID-19 might also be at increased risk for other poor outcomes related to pregnancy, such as preterm birth (delivering the baby earlier than 37 weeks).

Complications of Pregnancy and COVID-19

During pregnancy, your body goes through a number of physiological changes which have a significant impact on the immune system, respiratory system, and cardiovascular function. In general, pregnant people are more susceptible to illness than nonpregnant people, as pregnancy decreases your immune system response.

It’s worth noting that some of the clinical manifestations of COVID-19 overlap with symptoms of normal pregnancy such as:

  • Fatigue
  • Shortness of breath
  • Nasal congestion
  • Nausea and/or vomiting

The recent meta-analysis published in the British Medical Journal found that 40% of pregnant people with COVID-19 experienced common symptoms such as fever and cough. Other COVID-19 symptoms, like respiratory issues and the development of pneumonia, seemed more likely to occur in those who are pregnant, according to the review.

This could, in part, help explain why an increased number of pregnant people need ICU support either during or immediately after pregnancy.

Pregnant people with COVID-19 were also found to be more likely to give birth prematurely. The findings also show that one in four of all babies born to people with COVID-19, were admitted to a neonatal unit, but data on causes of preterm births or reasons for admission to neonatal units among these babies are lacking. Stillbirth and newborn death rates, however, were low.

At present, the extent to which mother-to-child transmission of COVID-19 occurs, either in utero, during birth, or in the early postnatal period, is unclear.

Long-Haul Symptoms and Pregnancy

Long-haulers are still being studied.

In the largest study to date of COVID-19 among nonhospitalized pregnant people, researchers analyzed the clinical course and outcomes of 594 pregnant people who tested positive for the virus during pregnancy. They found that half of the participants still had symptoms after three weeks and 25% had symptoms after eight weeks.

Pregnancy Treatments and COVID-19

If you’re pregnant, you may wonder whether your medications could affect your risk of COVID-19. And if you should develop COVID-19, would your treatment differ from someone who is not pregnant?

Pregnancy Treatments During the COVID-19 Pandemic

It is important to continue getting the health care you need to stay healthy, even while COVID-19 is spreading. Most pregnant people who are due for screenings, tests, or other care from any healthcare professionals can go ahead with these appointments, with appropriate safety measures in place at the healthcare office.

Two vaccines are recommended for pregnant people during each and every pregnancy: the flu shot and Tdap. Maternal immunizations continue to be an essential component of prenatal care during the COVID-19 pandemic.

Currently, there is no evidence to suggest that taking any specific medications, like blood pressure medication, leads to more severe illness from COVID-19.

Continue to take your medications and follow your treatment plan as prescribed by your healthcare provider.

COVID-19 Treatments During Pregnancy

To date, most of the data generated about the epidemiology, clinical course, prevention, and treatment of COVID-19 have come from studies of nonpregnant adults. More information is urgently needed regarding COVID-19 in other patient populations, such as pregnant individuals.

The National Institutes of Health guidance indicates:

  • Pregnant people should be counseled about the potential for severe disease from SARS-CoV-2 infection and the recommended measures to take to protect themselves and their families from infection.
  • If hospitalization for COVID-19 is indicated in a pregnant person, care should be provided in a facility that can conduct maternal and fetal monitoring, when appropriate.
  • Potentially effective treatment for COVID-19 should not be withheld from pregnant people because of theoretical concerns related to the safety of therapeutic agents in pregnancy.

Frequently Asked Questions

The CDC covers many frequently asked questions about COVID-19. The most common among people who are pregnant are:

Should I get the vaccine if I’m pregnant?

Yes. If you are pregnant, you can receive a COVID-19 vaccine. While studies to evaluate the safety of COVID-19 vaccines in pregnancy are still ongoing, the vaccine is likely to protect you from severe illness, which could help both you and your fetus. You may want to discuss the pros and cons of the vaccination process with your healthcare provider, although it is not required prior to vaccination.

According to the CDC, there is no evidence that antibodies formed from the COVID-19 vaccination cause any problem with pregnancy, including the development of the placenta.

There is evidence that protective antibodies are passed to the fetus.

How can COVID-19 affect my baby?

COVID-19 research is evolving daily, and some researchers are looking specifically at COVID-19 and its possible effects on babies. While much is still unknown about the risks of COVID-19 to newborns of mothers with COVID-19, we do know that:

  • COVID-19 is uncommon in newborns of mothers who had COVID-19 during pregnancy.
  • Some newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth.
  • Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered.

What will happen during labor if I have COVID-19?

While you are in the hospital or birth center, you should wear a mask if you have COVID-19. But when you are pushing during labor, wearing a mask may be difficult. For this reason, your healthcare team should wear personal protective equipment (PPE). They also may take other steps to reduce the risk of spreading the virus, including wearing goggles or face shields.

In most cases, the timing and method of delivery (vaginal birth or cesarean birth) do not need to be changed due to COVID-19.

Where will my baby stay after delivery if I have COVID-19?

There are many benefits to having your baby stay in the same room as you after delivery, even if you have COVID-19. For example, rooming together may help you bond with your baby and help you start breastfeeding if desired. Staying in a separate room may be encouraged if you are very sick or your baby is at a high risk of getting very sick.

How to Stay Safe

The same COVID-19 preventive rules and recommendations that apply to the population at large apply to people who are pregnant.

You should:

  • Stay at least six feet away from other people and avoid crowds if you need to go out.
  • Avoid contact with other people in places that do not offer fresh air from the outdoors (open windows and doors when possible).
  • Wash hands often with soap and water for at least 20 seconds.
  • Clean hands with a hand sanitizer that contains at least 60% alcohol if you can’t wash them (rub until your hands feel dry).
  • Avoid touching your eyes, nose, and mouth.
  • Have a good stock of essential supplies, including at least 30 days of any medications (so you don’t have to go out as often).
  • Talk with an OB-GYN or other healthcare professional if you have any questions about your health or COVID-19.
  • Call 911 or go to the hospital right away if you need emergency health care.

Summary

While more research is needed, COVID-19 is thought to be a greater risk to pregnant people. If you are pregnant, make sure to keep your distance from people outside of your immediate family and consider getting the COVID-19 vaccine.

A Word From Verywell

It can be alarming to read headlines about how pregnancy can potentially lead to more serious COVID-19 outcomes. While there is no way to have zero risk of infection, it is still important to know how to be as safe as possible.

Ensure you and the people who live with you are taking steps to protect themselves.

If you’re really worried or unsure about how to protect yourself and others from COVID-19 at this time, make sure to always raise concerns about your health and wellbeing with your doctor.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

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