COVID While Pregnant

What happens if you’re pregnant and get COVID-19?

If you’re pregnant and get COVID-19 (SARS-CoV-2), you’re more likely to get seriously ill from COVID-19 than people who aren’t pregnant.

Medicine has come a long way since the COVID-19 pandemic. But getting a positive COVID test while you’re pregnant can still cause you stress and worry. It might help to remind yourself that healthcare providers know more about the virus than they once did. And they’re learning more every day.

It’s important to contact your pregnancy care provider if you think you have symptoms of COVID-19 or get a positive at-home COVID test. They can best help you manage your symptoms and determine if you need emergency care.

What are the risks of being pregnant with COVID-19?

If you’re pregnant, you’re at risk for complications from COVID-19. This is because your immune system, heart and lungs change during pregnancy. This can raise your risk of getting very sick from respiratory viruses like COVID-19.

Your immune system works to protect both you and the fetus from illness. Some parts of your immune system get weaker because it’s giving some of your protection to the fetus. This can make you more susceptible to certain infections. Changes to your respiratory system, like your diaphragm shifting upward, can also lead to shortness of breath.

Most pregnant people have mild symptoms of COVID. But studies suggest that if you have moderate or severe COVID-19, your risk of the following complications may increase:

• Blood clotting disorders
• Fetal growth restriction (the fetus isn’t growing at the average growth rate for its age)
• Gestational diabetes
• Heavy bleeding right after giving birth (postpartum hemorrhage)
• Low birth weight (delivering a baby weighing less than 5 pounds, 8 ounces or 2.5 kilograms)
• Preeclampsia
• Preterm birth (delivering a baby before 37 weeks)
• Stillbirth (researchers are still determining the exact risk)

The risk for complications tends to be highest in the third trimester (beginning at 29 weeks). This is likely due to maximum lung compression in this stage of pregnancy. But the actual overall chance of having a severe complication during pregnancy due to COVID is still quite low.

What are other risk factors for severe illness from COVID while pregnant?

You may be at a higher risk for severe illness due to COVID if you’re pregnant and:

• Have a medical condition like diabetes, high blood pressure or heart disease
• Have overweight or obesity
• Have limited or no access to medical care

Can COVID cross the placenta?

A study published in 2024 found that small proteins from the COVID-19 virus can pass through the placenta. The findings suggest that the spreading of the virus from a pregnant person to the fetus is more common than researchers once estimated. This is called vertical transmission.

The study also found that a pregnant person’s immune system response to a COVID-19 infection may affect the fetus. More specifically, it may cause inflammatory responses in the developing fetus. This can happen even if there’s no evidence that the fetus has a COVID-19 infection.

Studies from the National Institutes of Health (NIH) show that only a handful of babies have COVID-19 at birth. Healthcare providers don’t know if they got the virus before, during or just after birth.

Are the symptoms of COVID-19 the same during pregnancy?

Yes, the symptoms are the same. Most symptoms start as mild and flu-like. But they can become severe.

Mild symptoms of COVID-19 during pregnancy could include:

• Fever
• Chills
• Cough and nasal congestion
• Headache and body aches
• Tiredness
• New loss of taste or smell

Seek emergency medical attention if you have any of the following severe symptoms:

• Trouble breathing
• Pain or pressure in your chest
• Confusion
• Inability to wake up or stay awake

What causes COVID-19?

A virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. Coronaviruses are a family of viruses that can cause respiratory illness in humans. You get it from a person who already has the virus. This can happen if:

• You breathe in respiratory droplets from someone who has the virus — for example, a person coughs or sneezes near you and you breathe in those particles
• You’re in close contact (touching, shaking hands) with an infected person and then touch your face

How is COVID diagnosed during pregnancy?

A COVID-19 diagnosis in pregnancy is the same process as the diagnosis when you’re not pregnant. Your healthcare provider may diagnose COVID based on symptoms and likelihood of exposure to the virus. A laboratory test that involves swabbing your nasal fluid is the only way to definitively diagnose COVID-19.

What should I do if I test positive for COVID while pregnant?

If you took an at-home COVID-19 test, the first thing you should do is contact your healthcare provider. Let them know what symptoms you have. Your provider may diagnose COVID based on your symptoms and the result of the at-home test. In some cases, they may order a laboratory test to confirm the diagnosis.

What can I do to treat COVID-19 if I’m pregnant?

Your healthcare provider may prescribe medication to help treat COVID-19 during pregnancy. Currently, the preferred treatment option for pregnant people with COVID-19 is ritonavir-boosted nirmatrelvir (Paxlovid®). It’s an antiviral medication that involves taking a combination of pills. Your provider will give you specific instructions on taking them.

If your symptoms are mild, your pregnancy care provider may recommend:

• Resting
• Drinking extra fluids
• Taking acetaminophen for pain relief (don’t take ibuprofen)
• Using a humidifier to relieve congestion
• Taking over-the-counter medication containing dextromethorphan to reduce coughing

Ask your provider if they recommend using a pulse oximeter (pulse ox) and/or a blood pressure monitor at home. They can let you know what symptoms are serious and what to do if you experience them.

If your symptoms become severe, your provider may recommend treatment in a hospital. This way, you can receive extra care. Your chances of hospitalization are low. But your risk of hospitalization is higher than a person who isn’t pregnant. Your provider is acting out of caution to protect you and the fetus.

What can I do to avoid getting COVID while pregnant?

You can take the same steps during pregnancy as you normally would to avoid getting COVID-19.

Getting the COVID-19 vaccine is the most effective way to protect yourself from the virus. Vaccination is safe and effective during pregnancy. Get the flu vaccine (and other vaccines your provider recommends), too.

Some other actions you can take include:

• Washing your hands frequently
• Avoiding contact with sick people
• Maintaining distance from people at crowded, indoor events or avoiding large events
• Wearing a mask when in indoor public spaces and crowded outdoor spaces
• Avoiding touching your eyes, nose and mouth unless you know your hands are clean
• Disinfecting doorknobs, electronic devices, counters and other high-touch surfaces frequently

It’s also important to go to your prenatal appointments. Your provider can check on your health and the fetus’s growth. They’ll guide you in managing the health risks of your pregnancy.

Having a high fever during pregnancy (especially in the first 12 weeks) increases your risk of pregnancy complications. That’s why it’s important to protect yourself from all illnesses during pregnancy, not just COVID-19.

Should I be worried about COVID-19 during pregnancy?

You might feel worried if you get COVID during pregnancy. On top of the usual pregnancy changes, you’re likely feeling sick and wondering if COVID will affect your delivery.

There are risks. But it’s important to know that most pregnant people who get COVID-19 experience mild symptoms and fully recover.

Be sure to communicate with your healthcare provider and follow their advice. They can assess your symptoms and let you know if you need immediate medical attention.

Remember, taking care of yourself is your top concern. Be sure to get plenty of rest and drink a lot of water. If you live with others, try to isolate yourself until you feel better.

Can COVID during pregnancy cause birth defects?

Research is still ongoing about the effects of COVID-19 on a fetus. But most studies show that birth defects (congenital disorders) due to COVID-19 are rare.

When should I see my healthcare provider?

Talk to your healthcare provider if symptoms of COVID-19 don’t improve after several days. Most cases of COVID are mild, and symptoms go away slowly with time and lots of rest. Ask your provider what symptoms to watch out for or what to do if you don’t feel better.

When should I go to the ER?

Go to the nearest ER if you have any of the following symptoms:

• Severe fever (higher than 103 degrees Fahrenheit or 39 degrees Celsius)
• Diarrhea and vomiting
• Trouble breathing
• Chest pains
• Disorientation or confusion
• Blue-, gray- or white-tinged lips (cyanosis)
• Confusion, lethargy or having trouble staying awake

What questions should I ask my healthcare provider?

Finding out you have COVID while pregnant can be scary. It’s natural to have lots of questions. Some of the questions you may want to ask your pregnancy care provider are:

• Is my baby at risk for getting COVID because I have it while pregnant?
• What symptoms are considered severe?
• How can I tell the difference between normal shortness of breath during pregnancy and severe shortness of breath?
• What symptoms mean I should go to the ER?
• What are the potential complications of having COVID while pregnant?
• Do I have to quarantine or stay away from other family members?
• Will my birth plan be affected by having COVID?