What to Know About Pregnancy and COVID-19

Having a baby is one of the most exciting times in a person’s life. But it can also be nerve-racking. On top of it, being pregnant during a pandemic comes with additional concerns and challenges. 

Having COVID-19 (sometimes referred to as coronavirus) during pregnancy slightly increases your risk of severe illness and complications. However, there are ways to reduce the risk for yourself and your baby. 

Understanding expert recommendations while research is continuously changing is also challenging. This article aims to help by reviewing current information about pregnancy and COVID-19 risk, complications, treatment, and safety precautions. 

Pregnancy and COVID-19 Risk

Research suggests that pregnancy does not increase the risk of contracting the virus causing COVID-19 (SARS-CoV-2). However, it confirms that having COVID-19 while pregnant slightly increases the risk of severe infection, intensive care unit (ICU) admission, and the need for mechanical ventilation (breathing machine).

In addition to available research on COVID-19, scientists and healthcare providers also look to other, similar diseases to understand how illness affects pregnancy. For example, the original severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) show that people are more vulnerable to viral respiratory infections while pregnant. 

Increased vulnerability to infection during pregnancy is due to changes in the heart, lungs, and immune system. These changes are normal and are often mechanisms to protect the pregnancy and the baby. 

Changes to the Heart and Lungs During Pregnancy

The way the body pumps and carries blood and oxygen to the rest of the body changes slightly during pregnancy, when oxygen need and usage are greater. The heart rate goes up to meet the body’s demand for more oxygen. 

Additionally, the following changes in the respiratory (breathing) system affect how the pregnant body produces and exchanges oxygen:

• Mild swelling to the respiratory tract and lungs 
• Changes in the rib cage and a growing uterus (womb) that make it more challenging to take deep breaths or hold as much air
• More mucus being produced in the respiratory tract

Changes in the Immune System During Pregnancy

During pregnancy, the immune response decreases slightly. This is so the body doesn’t see the baby as a foreign object and rejects it. The immune system also provides protection to the baby. These changes increase the pregnant parent's vulnerability to infection. 

Additional risk factors for experiencing severe illness with COVID-19 while pregnant include: 

• Older age (over 35) while pregnant
• Obesity
• Preexisting conditions such as hypertension (high blood pressure) and diabetes (especially with multiple preexisting conditions)
• Being unvaccinated
• Gestational diabetes 

Complications of Pregnancy and COVID-19

In most but not all studies, pregnant people with COVID-19 have an increased risk of pregnancy complications, such as preterm delivery (less than 37 weeks). One study showed an 8.8% rate of preterm delivery with COVID-19 compared to 5.5% without it.

There is also a 62% higher chance of developing preeclampsia with COVID-19. The risk of complications is higher when the virus causing COVID-19 is contracted after 26 weeks of pregnancy and with critical illness from COVID-19.

COVID-19 infection rates from the birthing parent to the baby during pregnancy is 2%. However, there has only been a small sample of well-documented cases to study. 

Research does not show an increased risk of miscarriage or congenital anomalies (health conditions present at birth). As many as 95% of the newborns remain uninfected and in good condition at birth. 

Symptoms of COVID-19 tend to be the same in pregnant and nonpregnant individuals. However, some symptoms overlap with typical pregnancy symptoms, including:

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

It’s also worth noting that early symptoms can be similar to other respiratory infections, including influenza, adenovirus, respiratory syncytial virus (RSV), and pneumonia.

The following are signs and symptoms of COVID-19 and pregnancy complications such as HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, preeclampsia, and eclampsia:

• Headache
• Acute cerebrovascular (blood vessels in the brain) disease
• Seizures
• Elevated liver enzymes
• Low platelets (blood cells that help with clotting)

Acute hypertension (sudden high blood pressure) and uterine bleeding are examples of symptoms of pregnancy complications rather than COVID-19. This, along with diagnostic tests, can help healthcare providers distinguish between the two.

Pregnancy Treatments and COVID-19

Treatment of COVID-19 during pregnancy is similar to non-pregnancy treatment. Mild COVID-19 usually requires rest, hydration, and infection prevention for your loved ones. 

If you develop worsening symptoms, such as difficulty breathing, chest pain, coughing up blood, dehydration, dizziness, or confusion, treatment might include: 

• Diagnostic and imaging tests
• Hospitalization 
• Oxygen or breathing treatments
• Medications such as antivirals, steroids, blood thinners, and immunomodulators 
• Antibiotics (if there is a bacterial infection along with COVID-19)
• Intravenous (IV) fluids
• Plasma
• Proning (lying on the stomach to help with breathing)
• Mechanical ventilation (for severe cases)

While treatment is similar to treating nonpregnant people with COVID-19, the following interventions are specific to pregnancy: 

• Use of the American College of Obstetricians and Gynecologists (ACOG) algorithm to assess severity and risk
• Maternal and fetal monitoring, when appropriate 
• A team-based approach to delivery, which may include consultations with maternal-fetal, pulmonary-critical care, or infectious diseases specialists 
• Use of abdominal radiation shield when performing imaging studies with radiation 
• Checking medication safety during pregnancy (or breastfeeding)
• Possibly avoiding proning as an option

A pregnant person, even with mild COVID-19, qualifies for antiviral treatment since pregnancy is considered high risk. Therefore, treatment with antivirals, such as Paxlovid (nirmatrelvir and ritonavir), Veklury (remdesivir), or high-titer convalescent plasma (plasma from patients who have recovered from COVID-19 that contains a high level of neutralizing antibodies) may be considered.

How to Stay Safe

Decreasing your risk of exposure is one of the best things you can do for yourself and your baby. Protective measures include the following. 

Handwashing

Try to wash your hands before eating, preparing food, or touching your face. It’s also best to wash them after using the restroom, leaving a public place, coughing, and changing diapers.

Avoid Exposure

Try to limit exposure by:

• Staying 6 feet away from others in public
• Avoiding close contact with sick household members
• Avoiding poorly ventilated spaces and crowds
• Opening windows to allow in fresh air when possible
• Wearing a mask
• Avoiding unnecessary trips out

Testing and Vaccination

You and your loved ones can test often, using an over-the-counter (OTC) rapid self-test. A PCR (polymerase chain reaction) test is preferred when you have symptoms, known exposure, or a positive rapid test. 

Experts recommend the COVID-19 vaccination during pregnancy. Research shows it is safe and effective in preventing severe illness and life-threatening complications. 

One study showed that taking two doses of the vaccine during pregnancy reduces COVID-19 hospitalizations for babies less than 6 months old. This is important because newborns and infants are at the highest risk of complications. 

Summary

While pregnancy does not increase the risk of developing COVID-19, having COVID-19 during pregnancy increases the risk of severe illness and life-threatening complications. The increased risk is due to changes in the hearts, lungs, and immune system during pregnancy. 

Treatment for COVID-19 is similar to treating nonpregnant people, with a few exceptions. For pregnant people, treatment includes using the ACOG algorithm, maternal and fetal monitoring, medication safety, team-based delivery planning, and abdominal shielding with imaging studies that use radiation. 

Prevention of COVID-19 includes handwashing, avoiding exposure, testing, and vaccination. 

A Word From Verywell

Making a decision about pregnancy or becoming pregnant during the COVID-19 pandemic can be overwhelming. For those who are pregnant or may become pregnant, follow guidelines from health officials to decrease your risk of getting COVID-19. Experts recommend vaccination for those who are pregnant. Research shows it is safe and effective in preventing severe illness and life-threatening complications.  

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.