Brandi Jones MSN-Ed, RN-BC is a board-certified registered nurse who owns Brandi Jones LLC, where she writes health and wellness blogs, articles, and education. She lives with her husband and springer spaniel and enjoys camping and tapping into her creativity in her downtime.
Geetika Gupta, MD, is a board-certified internist working in primary care with a focus on the outpatient care of 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.
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).
Because COVID-19 is still a fairly new disease, research is ongoing and results are sometimes conflicting. Some data is from the initial stages of the pandemic or the delta variant, and the sample size is small.
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.
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:
When an illness such as COVID-19 develops, it causes more swelling and mucus in the respiratory system. It becomes more difficult for the pregnant body to move oxygen in and out of the lungs. The heart responds by pumping harder. If this continues for an extended period, the body cannot pump enough blood or oxygen, causing life-threatening illness.
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:
The United States documented 198,598 pregnant people with COVID-19 from January 22, 2020, to April 11, 2022. Hospitalization data were available for 160,857 cases. The following information is from that data:
Another sample of research studies showed the following statistics:
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.
Much of the research on this is from the time of the delta variant (July through September of 2021, before omicron). Early findings show the delta variant causes a 2.7% risk of having a stillborn infant compared to the 0.63% in the non-COVID-19 group.
This was especially true for pregnant parents with multiple preexisting health conditions, multiple babies (twins, triplets, etc.), or severe illnesses.
Symptoms of COVID-19 tend to be the same in pregnant and nonpregnant individuals. However, some symptoms overlap with typical pregnancy symptoms, including:
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:
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.
The long-term consequences of COVID-19 during pregnancy are still being researched. On November 2, 2021, the National Institutes of Health (NIH) announced that it was conducting a four-year study for 1,500 patients and their children.
The NIH study will gather data to see if pregnancy increases the risk for long COVID. Long COVID is when someone with COVID-19 has lingering symptoms for weeks or months after recovery. It is referred to as post-acute sequelae SARS-CoV-2 infection (PASC) and the people with this complication are called long-haulers.
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:
While treatment is similar to treating nonpregnant people with COVID-19, the following interventions are specific to pregnancy:
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 monoclonal antibodies, 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.
Decreasing your risk of exposure is one of the best things you can do for yourself and your baby. Protective measures include the following.
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.
Try to limit exposure by:
While it’s important to decrease your risk of exposure to COVID-19, it is also vital to receive prenatal care during pregnancy. Many healthcare providers use the following methods to keep patients from coming to a healthcare facility too often:
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.
Check online for PCR tests offered through telehealth visits. If you do have symptoms or test positive, notify your healthcare provider.
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.
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.
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.
Yes, the COVID-19 vaccination is recommended during pregnancy. Research shows it is safe and effective in preventing severe illness and life-threatening complications.
Yes, COVID-19 can be more dangerous for pregnant women, especially those who are unvaccinated. This is due to changes in the lungs, heart, and immune system during pregnancy.
Pregnant people, especially those who are unvaccinated, have a higher risk of severe disease, complications, and delivering before full term.
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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