What Pregnant People Need to Know About COVID-19
Research on the effects of COVID-19 during pregnancy and the early postpartum period has been ongoing since the start of the pandemic, and experts know a lot more now than they did then. In fact, pregnancy and recent pregnancy are now included in the list of underlying medical conditions that can increase a person's risk of severe illness from COVID-19.
Even so, there's still a lot we don't know, and research on the impact of COVID-19 on pregnancy and pregnant people continues. What we do know is that pregnant people are at a higher risk for severe illness, hospitalization, and intensive care unit (ICU) admission due to COVID-19 compared to non-pregnant people.
We also know that COVID-19 during pregnancy can have adverse effects on the unborn baby, including increased risk of preterm birth and stillbirth. Experts are also finding evidence that the coronavirus may be able to pass from a pregnant person to their unborn baby through the placenta.
Thankfully, though, it appears that most newborns with COVID-19 recover without any complications—and evidence suggests that the breast milk from a person with COVID-19 doesn't carry the virus. Read on for more information about COVID-19 and pregnancy, including tips for reducing your risk and preventing illness.
COVID-19 and Pregnancy
It's natural for pregnant people to worry about the coronavirus. After all, they have a higher risk of contracting viral illnesses due to changes in physiology and the immune system during pregnancy, according to Jessica Madden, M.D., medical director of Aeroflow Breastpumps.
"For example, women who get influenza while pregnant are at a higher risk of developing pneumonia than women who aren't pregnant," she says. Viral illnesses like the flu are also associated with an increased risk of miscarriages, birth defects, low birth weight, and other pregnancy complications.
Preliminary research suggests that COVID-19 follows this same trend. While studying coronavirus cases from January 22, 2020 to June 7, 2020, the Centers for Disease Control and Prevention (CDC) found that pregnant women were "significantly more likely to be admitted to the intensive care unit (ICU) and receive mechanical ventilation" as a result of COVID-19 illness.
Additionally, "women with COVID-19 might also be at greater risk for pregnancy complications," says Justin Brandt, M.D., an assistant professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine at Rutgers Robert Wood Medical School in New Jersey. According to the American College of Obstetricians and Gynecologists (ACOG), those complications can include high blood pressure, heavy postpartum bleeding, and other infections.
Keep in mind that COVID-19 tends to affect older people and those with preexisting conditions more severely, according to the CDC. It makes sense, then, that those with "high-risk" pregnancies have increased odds of severe illness as well, suggests Dr. Madden. This includes pregnant people with preeclampsia, gestational diabetes, and other complications. Additionally, pregnant people of color may be at increased risk of severe illness from COVID-19 because of the health inequities they face.
Can COVID-19 Affect the Fetus?
In short, yes. Getting COVID-19 during pregnancy can affect an unborn baby.
In July 2020, doctors in France recorded COVID-19 transmission from a mother to a baby in the womb. The newborn experienced neurological symptoms, brain swelling, irritability, and body rigidity, according to The New York Times. He recovered without any complications within three weeks.
Other studies have also shown that transmission through the placenta (intrauterine vertical transmission) might be possible—although it appears to be a rare event, according to ACOG.
Some pregnant people with COVID-19 also experienced pregnancy loss, stillbirth, and miscarriage. According to a November 2020 CDC report, pregnant people may be at a higher risk of giving birth prematurely. Among 3,912 babies born to COVID-19 positive women, 12.9 percent were born before 37 weeks—higher than the national estimate of 10.2 percent.
A 2021 study published in Lancet Regional Health — Americas also supports this claim. Researchers examined women who delivered babies in California from July 2020 to January 2021. They found that those diagnosed with COVID-19 (as documented on the birth certificate) had a 60 percent increase in very preterm birth (before 32 weeks gestation). They also had a 40 percent increase in preterm birth (between 32 and 37 weeks) and a 10 percent increase in early term birth (between 37 and 38 weeks). Pregnant people with co-morbidities—like high blood pressure, obesity, and diabetes—had an even greater risk of preterm birth after COVID-19 infection.
While these risks are worth taking seriously, it's important to note that if despite your best efforts, you do get COVID-19 while pregnant, you and your health care provider can manage the infection and the related risks for you and your baby together.
COVID-19 During and After Birth
The next question soon-to-be parents have is how COVID-19 might affect them and their baby after birth. Babies born to people who have an active COVID-19 infection will be closely monitored for the development of viral symptoms after birth, says Dr. Madden. But they will not necessarily be separated from their birthing parent after delivery. ACOG maintains that there are many benefits to parents and babies rooming together—with some extra precautions—even if you have COVID-19.
The good news is that while newborn babies exposed to COVID-19 can get sick, most have mild symptoms and recover without complications—although there are reports of severe illness and death.
According to ACOG, babies born to people who had COVID-19 during pregnancy may have an increased chance of needing care in the neonatal intensive care unit (NICU). This is not surprising given their increased risk of premature birth, which is among the most common causes of NICU stays.
When it comes to breastfeeding after baby comes, evidence suggests that birthing parents with COVID-19 are not likely to spread the virus through their breast milk. In fact, some research suggests that parents who have COVID-19 can pass virus-neutralizing antibodies to their infant through breast milk, possibly providing their baby with passive immunity. If you have COVID-19 and choose to breastfeed, the CDC just recommends wearing a mask and washing your hands thoroughly before nursing or expressing breast milk.
Experts also acknowledge that birthing parents continue to be at increased risk of severe illness from COVID-19 compared to non-pregnant people for about 42 days following delivery. So it's important to continue to take extra precautions to avoid illness for at least the first several weeks after birth both for you and your baby.
How to Prevent Coronavirus Transmission
If you're pregnant or a new parent, avoid crowded indoor spaces and don't interact with anyone who's had potential exposure to the coronavirus. What's more, "basic practices encouraged for protection against any respiratory infection remain valid," says Charles Bailey, M.D., medical director for infection prevention at St. Joseph Hospital in Orange County, California. "Stay home if you're ill (and encourage others to do the same), cover your cough or sneeze, use disposable tissues and throw them away immediately after use, and get a flu shot."
The CDC also recommends the use of well-fitting face masks when indoors in public spaces, especially in areas of high virus transmission.
Dr. Bailey suggests frequently washing your hands with soap and water for at least 20 seconds. The CDC says hand sanitizer with at least 60 percent alcohol also works in a pinch. Washing your hands is especially important before eating or touching your face.
Finally, if you haven't already, get a COVID-19 vaccine. Experts and medical organizations—including the CDC, American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), American College of Nurse-Midwives, and more—recommend getting vaccinated against COVID-19 while pregnant.
Not only does getting vaccinated protect you, but it also protects your baby. By reducing your own risk of severe illness while you're pregnant, you also reduce the risk to your baby during pregnancy—and potentially after birth. In fact, research suggests that COVID-19-neutralizing antibodies spurred by parental vaccination can be effectively transferred to the fetus through the placenta, potentially providing the baby some level of immunity, though more research is needed.
I'm Pregnant and Think I Have COVID-19—Now What?
If you're showing symptoms of COVID-19 (such as cough, fever, or shortness of breath), get tested and consult your obstetrician, midwife, or physician right away. Respiratory symptoms should be taken seriously, since they may have negative consequences for you and your pregnancy. If you are diagnosed with COVID-19, your health care provider will decide on a course of treatment.
If you're near your due date or at risk of going into labor prematurely, you and your health care provider should discuss your birth plan. "It's important for pregnant women with coronavirus to plan for a hospital birth due to their risk of developing complications from the virus (like pneumonia)," says Dr. Madden. ACOG notes that in most cases, however, the timing and method of delivery (vaginal or cesarean) do not need to be changed, and having COVID-19 is not a reason in and of itself to require a cesarean over a vaginal birth.