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What All Moms-to-Be Should Know About COVID in Pregnancy

Pregnant women are at increased risk for severe illness from COVID-19. But there are a few key steps you can take to keep yourself and baby protected.
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Updated
January 14, 2022
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Image: Tom Werner / Getty Images

Just as COVID has evolved since it first emerged in the US in January of 2020, so has experts’ understanding of the virus. And while there are still plenty of unknowns, the only thing that seems more contagious than COVID itself is the spread of information—and misinformation. While it’s nerve-wracking for everyone, that’s especially true for pregnant women, who need to keep themselves and their babies safe. Want to sort the facts from the fiction? Here is everything you need to know about COVID in pregnancy.

What Is COVID-19?

The 2019 novel coronavirus, known as COVID-19 or COVID, is a member of the coronavirus family, explains G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

There are six other known coronaviruses, four of which cause a common cold, and two of which have caused more dangerous infections in the past: SARS (Severe Acute Respiratory Syndrome) in 2002 to 2003, and MERS (Middle East Respiratory Syndrome) in 2012.

COVID is contagious and spreads easily from person to person, explains Andres Romero, MD, an infectious disease specialist and medical director at AHMC Seton Medical Center in Daly City, California. While, in theory, it could infect someone if they touch a surface with the virus on it and then touch their face without proper hand hygiene, it’s much more likely to spread through air droplets that contain the virus, according to the Centers for Disease Control and Prevention (CDC).

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What to know about the Omicron variant

The Omicron variant was first discovered in November of 2021 in South Africa, according to the World Health Organization (WHO). It was soon after identified in the US, and has been rapidly spreading since. While more research is needed, early studies have shown that Omicron is more transmissible than previous COVID-19 variants. On the other hand, this strain also appears to be less severe. While this may sound like encouraging news, the sobering reality is that COVID-19 will continue to drive hospitalizations and deaths. “Many people are still greatly impacted by Omicron, especially if unvaccinated,” says Alexa Mieses Malchuk, MD, MPH, an assistant professor at the University of North Carolina’s School of Medicine and a practicing family physician with a specialized interest in public health. “Omicron can still cause complications such as preterm birth in pregnant women, and all pregnant women should be fully vaccinated and receive a booster when eligible.” (More on that below.)

Risks of COVID in Pregnancy

Research suggests that a pregnant woman isn’t necessarily more likely to contract the virus than a nonpregnant person, Ruiz says. However, the CDC emphasizes that pregnant women are at an increased risk of severe illness if they do contract the virus.

What COVID might mean for Mom

Overall, the risk of COVID-19 to pregnant women across the board is considered low, according to the Mayo Clinic. But that doesn’t mean you shouldn’t take specific precautions. “We know that COVID [can be] particularly problematic for pregnant women,” says Geeta K. Swamy, MD, a maternal-fetal medicine specialist at Duke Health in Durham, North Carolina. “Pregnant women are at a higher risk for complications, including hospitalization, requiring a ventilator for breathing and even death during pregnancy.” Additionally, she says the risk of death from COVID for a pregnant woman can stretch into the first few weeks of the postpartum period. Finally, pregnant women with COVID are also at an increased risk of preterm birth and stillbirth, according to the CDC.

It’s still difficult for researchers to quantify exactly how much the risk of severe disease increases during pregnancy for a woman. But one study found that COVID-19 in pregnancy was associated with “consistent and substantial increases” in maternal death, severe maternal morbidity (health problems directly related to pregnancy and childbirth) and neonatal complications.

What COVID might mean for baby

Aside from the risk of preterm birth and stillbirth, contracting COVID in pregnancy doesn’t seem to pose a major risk to babies in-utero. “We aren’t seeing significant concerns where Mom is transmitting the virus to the baby, which is called vertical transmission,” says Swamy. This is not to say it never happens; some studies have proven there are instances where babies born to COVID-positive mothers tested positive themselves. Still, this seems to be the exception, not the rule. Moreover, there have been case reports of infants born to COVID-positive mothers that tested negative for the virus but had virus-specific antibodies.

Symptoms of COVID in Pregnancy

According to Swamy, there is nothing to suggest that COVID symptoms present any differently in pregnant women than anyone else. “Most [cases] start out similar to a common cold,” she says, “with a runny nose, cough, fever, body aches and headache.” Ruiz notes that some patients have also presented with fatigue, sore throat and shortness of breath.

Without a test, it’s difficult to discern whether someone with any of these symptoms has been infected with COVID, but this is especially true for expecting moms. “Pregnant women may already be feeling many of these symptoms outside of COVID,” explains Swamy, “such as being tired, having a stuffy nose or a headache.” Because of this, it’s important for pregnant women to monitor their symptoms closely and to call their doctor if symptoms last for more than a day or two or if there was any known exposure to the virus.

If you have a known exposure to COVID, keep in mind that you may not experience symptoms right away. This is because the incubation period—meaning the time between catching the virus and when symptoms set in—is between one to 14 days, and an average of five days, according to Romero.

When to Get a COVID Test

If you’re experiencing any symptoms of COVID during pregnancy, it’s important to call your doctor for advice on next steps. “Testing is especially recommended for those who are sick with fever, cough or difficulty breathing, and who have been in close contact with a person known to have coronavirus, or live in or have recently traveled from an area with ongoing spread,” Ruiz says.

There are two categories of COVID tests, according to the CDC: Viral and antibody. Whether you are pregnant or not, there’s no difference in methodology for these tests.

Viral COVID tests are the most common, as they are used to determine whether or not someone is currently infected with the virus. They come in many forms such as PCR (polymerase chain reaction) laboratory tests, rapid antigen tests and at-home tests (which can be either rapid antigen tests that offer quick results or PCR tests that you send to a lab for results). Generally, PCR tests are considered the gold standard for accuracy, according to the Cleveland Clinic. It may take some time to get results from a PCR test, though. Regardless of the test type, they all require a sample from either the nose (which is most common) or the mouth.

Antibody tests, on the other hand, are used to determine whether or not there are COVID antibodies in your blood, not to diagnose a current infection. The presence of COVID antibodies indicates that you contracted the virus at some point in the past. While these tests can be useful in some cases, Swamy notes that they’re not reliable in predicting whether a person will be infected with the virus in the future because people with antibodies can still get infected or reinfected with the virus.

How to Treat COVID in Pregnancy

According to Ruiz, mild cases are thought to last about two weeks, though more severe cases could last longer. “Fortunately, the vast majority of cases are mild,” he says, and can be treated in the comfort of your home.

Risk for severe illness aside, getting COVID during pregnancy can feel particularly rough because your options for over-the-counter medicines are limited. “At home, supportive or symptomatic treatment of COVID is okay with things like Tylenol,” says Swamy, but anything beyond that should be approved by your doctor first. She explains that while pregnant women should generally avoid things like ibuprofen, Motrin and cough and cold medicines, in situations like this, doctors may green light their use for a couple of days to help treat symptoms.

Beyond over-the-counter medications, options for treating COVID during pregnancy are limited. There is a monoclonal antibody treatment that is administered through an IV by a medical provider; however, Swamy says that this only works if it’s administered shortly after a person has been infected with the virus. What’s more, Mieses Malchuk notes that this treatment hasn’t been studied specifically in pregnant women. “A shared decision should be made between a pregnant woman and physician about whether monoclonal antibody treatment for COVID may be beneficial,” she says. COVID treatment pills, such as Merck’s new molnupiravir option, haven’t been authorized for pregnant women.

If at-home treatment isn’t working and a pregnant patient is on the decline, Swarmy says that hospitalization may be necessary. But Mieses Malchuk emphasizes that “prevention is the best defense against COVID.”

Should Pregnant Women Get the COVID Vaccine?

The best way to protect yourself from COVID is by getting vaccinated, both with the manufacturer’s regular dose(s) as well as recommended boosters. “The CDC, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine and the American Academy of Pediatrics all strongly recommend vaccination against COVID in all adults,” says Swamy. Given the increased risk for severe illness, hospitalization and death, this is especially true for pregnant women.

Pregnant women can receive any of the three approved COVID vaccines (Pfizer-BioNTech, Moderna or Johnson & Johnson’s Janssen), but Mieses Malchuk notes that Moderna and Pfizer-BioNTech’s mRNA options have become the preferred choices in the US. What’s more, she encourages moms to get boosted as soon as they’re eligible. “If mom already received the J&J, she is eligible for a booster two months later. If fully vaccinated with Moderna or Pfizer, pregnant women should receive a COVID booster six months later,” she advises.

It’s understandable why some moms-to-be may be hesitant, but as more and more pregnant women get the vaccine, the CDC says all cumulative data and evidence suggest that the vaccine is effective and safe for Mom and baby. And while no vaccine offers 100 percent protection from a virus, the COVID vaccine does provide significant protection from serious illness, hospitalizations and death in pregnant women who are COVID-positive, says Mieses Malchuk.

Mieses Malchuk says there’s no evidence that there are any vaccine side effects specific to pregnant women. According to the CDC, the most common side effects include pain, redness and swelling at the injection site, as well as fatigue, headache, chills, muscle aches, fever and headache. You may feel uncomfortable, but these side effects are usually mild and should be gone within 24 to 48 hours.

Swamy stresses that there are no concerns for the developing baby or the woman herself in terms of the vaccine’s safety. In fact, getting vaccinated helps protect baby, since it significantly reduces Mom’s risk of complications like preterm birth and stillbirth. “The more severely ill Mom is, the more likely the pregnancy can be affected,” says Mieses Malchuk, “so the vaccine protects Mom and baby.” Also, some studies have shown that moms who are vaccinated pass those antibodies to their babies in-utero as well as through their breast milk after birth.

Can the COVID vaccine affect future pregnancy?

There are a lot of rumors about the vaccine’s effect on fertility, but that’s all they are—rumors. “There’s no research whatsoever to suggest or support that the vaccine impacts your ability to get or stay pregnant in the future,” says Mieses Malchuk. The CDC also recommends the vaccine for women who are actively trying to conceive or plan to start trying in the near future.

How to Prevent COVID in Pregnancy

Again, the most important step a woman can take to protect herself and her baby is to get the COVID vaccine during pregnancy (this includes booster shots). Beyond that, Romero stresses the importance of avoiding exposure to the virus in general. That means social distancing, not touching your face with your hands and washing your hands frequently with soap and water for at least 20 seconds, he says. Regular use of alcohol-based hand sanitizer is also helpful in killing off any nasty germs. Additionally, the CDC recommends that people wear well-fitted, multi-layer masks indoors in public settings.

Finally, be careful where you’re getting your information, Ruiz cautions. Make sure the recommendations you’re following are coming from a doctor or medical professional, the CDC or your local public health office. “There’s a lot of misinformation spread through social media, which may try to sell you unproven cures or treatments, or materials that won’t protect you from getting the illness,” Ruiz says. “Above all, stay calm, stay informed (from reliable sources) and stay prepared by exercising the infection precautions.”

How COVID Policies May Affect Your Birth

Between a pregnant woman’s increased risk of severe illness from COVID, how easily the virus is transmitted and the very weak immune systems of newborns, the vast majorities of hospitals and birthing centers have implemented policies on what is and isn’t allowed in labor and delivery, postpartum recovery and neonatal intensive care units (NICU). Of course, every facility is different, so specific policies will vary, but some of the guidelines the CDC recommends include:

  • If you’ve tested positive for COVID, you should notify your doctor or midwife of your infection; they will then alert your hospital/birthing center so that all infection control personnel are prepared.

  • If you’re symptomatic, you should be tested for COVID; it’s recommended that asymptomatic patients are tested as well.

  • Personnel should be wearing personal protective equipment around anyone who is COVID-positive; masks should be worn at all times around all patients.

  • Your visitors should be limited to people who are essential to your well-being and care (emotional support persons). They should be screened for COVID symptoms and shouldn’t be allowed into labor and delivery if they have any symptoms.

  • If you’re COVID-positive, you and baby will be isolated from healthy moms and babies in postpartum care. (Swamy notes that if you are COVID-positive and doing well, you shouldn’t have to isolate and separate from your baby.)

Again, these are guidelines, not absolute rules, so your personal experience will depend on what policies your hospital/birthing center have put in place. The good news is that “according to the CDC, the risk of Mom passing COVID on to baby is low,” says Mieses Malchuk. “But it’s not impossible.” While staying together after birth has many benefits to both Mom and baby, she acknowledges that parents may have different levels of risk tolerance. “If Mom chooses to stay with her newborn, she should still wear a mask and practice all of the other infection control measures we know can lower COVID transmission risk.” What’s more, she stresses that “breastfeeding while COVID-positive is safe,” and that a new mom who’s planning to nurse “shouldn’t delay breastfeeding her newborn.”

How to Plan for Postpartum Support

Since a newborn’s immune system isn’t fully developed, it’s understandable why you’d be nervous about keeping baby safe from COVID. The first (and best) thing you can do, according to Mieses Malchuk, is to get vaccinated while you’re pregnant. “Mom’s immunity will get passed to the baby and will be especially present in the baby’s first few months of life,” she says.

Additionally, Mieses Malchuk explains how important it is for helpers and visitors who interact with baby to get their COVID shots and booster (as well as their flu and Tdap shots). Parents can also ask visitors and helpers to wear masks around the baby for even more protection. Finally, anyone with known exposure to the virus or who shows symptoms of any kind should isolate away from baby until they get a negative COVID test.

All of the unknowns of COVID can be very scary during pregnancy, especially since you’re at a higher risk for severe illness. The best thing you can do? Get vaccinated and boosted, wear a mask in public settings and take all of the precautionary steps to prevent exposure to the virus.

About the experts:

Alexa Mieses Malchuk, MD, MPH, is an assistant professor in the department of family medicine at the University of North Carolina’s School of Medicine. She also practices family medicine at UNC and has a special interest in public health. She earned her medical degree and master of public health degree at the Icahn School of Medicine at Mount Sinai and completed her residency at Duke University Medical Center.

G. Thomas Ruiz, MD, is the lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California. He earned his medical degree from UC Irvine School of Medicine and has been practicing medicine in Orange County since 1993.

Andres Romero, MD, is an infectious disease specialist and medical director at AHMC Seton Medical Center in Daly City, California. He received his medical degree from Greater College of Our Lady of the Rosary in 2009.

Geeta K. Swamy, MD, is a maternal-fetal medicine specialist at the Duke Perinatal Consultants of Durham and Fetal Diagnostic Center in Durham, North Carolina. She earned her medical degree from the University of North Carolina and completed her ob-gyn residency at the Magee-Womens Hospital in Pennsylvania.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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