A pregnant person touching their stomach to represent pregnancy during COVID-19.

COVID-19 and pregnancy: Your questions answered

It’s understandable, in this time of uncertainty due to the coronavirus (COVID-19) pandemic, to feel stressed by the news and the rising number of cases. You might be feeling especially anxious if you’re pregnant, and we hope that Ovia Health is able to provide you with some of the support and advice that you need. 

What you should know about COVID-19 and pregnancy

Here’s the latest from the Ovia Health clinical team including answers to your questions, practical advice, and a call for how we can all help prevent the spread of coronavirus.

If I’m pregnant and I get COVID-19, will the infection be worse?

It’s possible. Public health experts are still collecting and reporting information about COVID-19 and pregnancy. An updated report including data from 2020 through mid-2021 from the CDC [1] indicates pregnant people and recently pregnant people (within 42 days for giving birth) are at higher risk for significant complications from COVID-19 than their non-pregnant peers. This means that while overall risk for severe illness is low, there is an increased risk of hospitalization, intubation and mechanical ventilation, and requiring intensive care. There is also an increased risk of adverse pregnancy outcomes, including preterm birth and possibly an increased risk of pregnancy loss when compared to pregnant women who did not get COVID-19. These risks are especially true for Black and Hispanic pregnant people who have an increased risk of preterm birth regardless of COVID-19. Therefore, pregnant, recently pregnant, and breastfeeding people should take extra precautions to prevent getting exposed to COVID-19. Please follow guidance from public health experts to reduce your risk.

What can I do to prevent infection?

On August 11th, the CDC announced that they recommend that pregnant people get a vaccine to protect themselves from COVID. 

This means that prevention is no different for pregnant people than it is for anyone else. Follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Avoid going to public places if you think or know you have COVID-19, to prevent spreading it to others. 

The CDC recently revised their stance on wearing masks in public if you’ve been fully vaccinated. While they had previously said those who are fully vaccinated could forgo masks indoors, the rapid spread of the Delta variant of the SARS-CoV-2 virus has changed things. The CDC now recommends that everyone in areas with substantial or widespread transmission of the virus wear masks when indoors and practice social distancing. Being vaccinated has been shown to provide protection against severe COVID-19 disease, even from the Delta variant, however, you can still get sick and pass the illness on to vulnerable people who aren’t vaccinated. 

Importantly, vaccines are now available and free for all people in the U.S. over the age of 12, and as mentioned above, recommended for pregnant people. For more information on vaccines head here.

Should I go back to the office?

If you’ve been able to work from home since the beginning of the pandemic, you may now be back in the office, or gearing up to head back to the office soon. Alternatively, some employers are continuing to offer hybrid or remote policies. If you’d like to start a conversation with your employer about accommodations at work, talk to your provider about what they would recommend based on your circumstances and the community spread in your area.

Is hand sanitizer safe in pregnancy?

Yes, Yes, YES. The CDC reports[3] that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this regular habit as well.

If I get COVID-19, will I pass it to my fetus?

Research on this topic is still emerging[4].There are a few scientific reports suggesting that COVID-19 crosses the placenta and can infect your fetus[5], although there is more evidence to suggest that COVID-19 is not transmitted to the fetus. Other similar viruses (influenza, SARS) do not infect the fetus during pregnancy. At this point, it appears that this form of transmission is not a major concern. However, studies show that people who tested positive for COVID-19 during pregnancy are more likely to have complications, such as preterm birth [6]. There is no evidence that cesarean delivery reduces the risk of infection, so this is not recommended.

What about during and after birth?

It is extremely important that you CALL your healthcare provider BEFORE you go to the hospital if you think you have COVID-19 or think you might have been exposed. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected. 

What is the risk to my baby? And what about the risk to my other children?

The good news is that children seem to be at less risk of becoming really sick with COVID-19 than adults are, and the same seems to be true of babies[7]. And current evidence suggests that babies are not likely to get COVID-19 from their mothers as long as preventative steps are taken such as wearing a mask around your baby, washing your hands for 20 seconds prior to holding your baby, and others listed here. You should still do everything you can to reduce the risk of exposure. Children with certain underlying conditions are at risk for complications from COVID-19, so it is important to keep them safe and communicate with their pediatrician.

Is breastfeeding safe if I think I have COVID-19?

There are many benefits to breastfeeding for parents and babies. It appears unlikely that COVID-19 can be transmitted through breast milk. Most studies have shown no infectious virus components in breast milk, though there have been rare cases of viral RNA samples reported [8]. Based on this information, we’re more concerned that your baby could become infected through droplet exposure (cough, sneeze, etc.) while breastfeeding. It’s not yet clear whether it’s safer to wear a mask while breastfeeding or to pump and have a healthy caregiver bottle-feed (with breast milk) your baby if you think you may have COVID-19[9]. This is a topic to discuss with your healthcare provider and baby’s pediatrician. Either way, hand-washing and use of masks is recommended.

We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. While preliminary research shows that antibodies to COVID-19 have been found in breast milk, more research is needed [10].

How do I do my part to prevent the spread of COVID-19 to others?

If you have a cough, a fever, a cold, or other respiratory symptoms, OR if you think you might have been exposed to COVID-19, please CALL your healthcare provider or the hospital BEFORE you show up for an appointment or to the emergency room. This way, your healthcare provider will be ready to take great care of you without exposing others. In general, if you have these symptoms or think you might have been exposed to COVID-19, make sure to do your part and practice social distancing: staying six feet away from others, not going to crowded spaces, and paying particular attention to stay away from the elderly, those with compromised immune systems, and yes, other pregnant people. (Obviously, you can’t stay six feet away from your child, as every parent of a sick kid knows, so just do your best and don’t worry too much if “best,” isn’t “perfect.”)

The CDC states those who are fully vaccinated but exposed to a known case of COVID-19 should get tested for COVID 3-5 days after exposure and wear a mask when indoors until 14 days after their exposure, or until they have a negative COVID test.

What about my prenatal visits? Should I still attend all of my visits?

The short answer is yes, particularly for visits that involve an ultrasound, fetal testing, or are in the third trimester. For other visits, the answer is maybe, and depends on your health status and your provider’s practice. When in doubt, call your healthcare provider and ask, and consider asking them if it would be reasonable to do your prenatal visit by video or telephone. If you go, remember to wear a mask and handwash/sanitize after touching all of those doors/chairs/surfaces.

Though you may be nervous about going into the hospital, it’s important to reach out to your provider if something is not feeling right.

What if I’m trying to conceive and not yet pregnant?

There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.

Should pregnant people get the COVID-19 vaccine?

Deciding whether or not to get a vaccine is a personal choice. All people who are eligible to receive the vaccine at this time should be able to get it, if they so wish. Multiple, well-respected clinical organizations including the CDC and ACOG (the American College of Obstetricians and Gynecologists) ACNM (American College of Nurse-Midwives) recommend the vaccine to people who are trying to conceive, pregnant, and breastfeeding [11]. If you’re in the process of making this decision and are looking for more information, head here

There are some things to consider. The first clinical trials for the COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson did not include participants who were known to be pregnant or breastfeeding. This is typical for pharmaceutical research and studies involving pregnant and breastfeeding individuals are currently underway. Early reports have found no increased risk to the mother or the fetus and in those  breastfeeding, antibodies have been identified in breastmilk. The potential for this to protect baby while nursing needs to be studied further. 

What we do know is that none of these COVID-19 vaccines contain “live” virus. This means you cannot get COVID-19 from the vaccines. In general, vaccines that do not contain “live” viruses are safe during pregnancy and do not have increased risks for infertility, miscarriage, fetal anomalies, or stillbirth. Side effects for the COVID-19 vaccines include pain at the site of injection, fever, fatigue, and chills. These typically go away after a couple of days. These side effects are normal and expected and are indicators of your immune system doing its job to learn to protect you from the virus. There have been very rare reports of unexpected, adverse reactions from the vaccines. A severe allergic reaction called anaphylaxis can happen in very rare cases and the Johnson & Johnson vaccine has been linked with rare cases of dangerous blood clots [5]. The incidences of these adverse events is so low, getting vaccinated remains safer than potentially getting infected with COVID-19. [12]. The CDC recommends women under 50 be aware of this risk and know that mRNA vaccine options exist that do not carry this same risk.

The CDC is also recommending pregnant people reach out to the experts at Mother to Baby for more information: https://mothertobaby.org/. Your midwife, doctor, or other healthcare professional is also a great resource for more information about the COVID-19 vaccine. Ultimately, you are the one who knows what is best for your body and your family.

Learn more about the coronavirus

Reviewed by the Ovia Health Clinical Team
Updated August 30, 2021

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