05/11/2023
COVID-19 During Pregnancy
COVID-19 (coronavirus disease 2019) is a respiratory illness that can be serious. It is caused by a newly identified virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Based on available information, the risk of getting COVID-19 seems to be similar for pregnant women and other adults.
Some evidence suggests that COVID-19 is more likely to cause severe illness in pregnant women who have symptoms of COVID-19, particularly if they have certain conditions (such as diabetes or heart disease), than in people who are not pregnant.
The risk of problems during pregnancy (such as preterm labor, birth of a premature newborn, and preeclampsia) may be increased if symptoms are moderate or severe.
Doctors suspect COVID-19 based on symptoms and the likelihood of exposure, but tests are needed to confirm the diagnosis.
The risk of a pregnant woman transmitting COVID-19 to the fetus appears to be very low. But once the baby is born, person-to-person spread is possible.
Symptoms of COVID-19 During Pregnancy
Most people with COVID-19 have mild or no symptoms, but some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. Occasionally, loss of smell or taste can be the first symptom.
Whether pregnancy increases the risk of having severe symptoms has not been established. However, some evidence suggests that COVID-19 is more likely to cause severe illness in pregnant women, particularly if they have certain conditions (such as diabetes or heart disease). Women with severe illness may require hospitalization, intensive care, and/or a ventilator.
The risk of problems during pregnancy (such as preterm labor, birth of a premature newborn, and preeclampsia) may be increased if symptoms are moderate or severe. More information is needed to confirm that this risk is increased.
Diagnosis of COVID-19 During Pregnancy
A doctor's evaluation
Tests to identify the virus
Diagnosis of COVID-19 in pregnant women is similar to diagnosis in people who have COVID-19 and are not pregnant. COVID-19 is suspected if people have a fever, a cough, sudden loss of smell or taste, and/or trouble breathing and they could have been exposed to the virus.
To confirm the diagnosis, doctors may take samples of fluids from the respiratory tract to be tested. Polymerase chain reaction (PCR) techniques can help doctors identify the virus. This tests can be used to make many copies of the virus's genetic material and thus make identification easier. If a test is not readily available or if symptoms are mild, the diagnosis may be based on symptoms and likelihood of exposure (if it can be determined).
If needed, chest x-ray and/or computed tomography (CT) is done.
Prevention of COVID-19 During Pregnancy
The best way to prevent COVID-19 is to avoid being exposed to the virus, which can be difficult because some infected people do not know they have the virus. The Centers for Disease Control and Prevention (CDC) has issued recommendations for preventing the spread of COVID-19. These recommendations apply to all people (see also Prevention of COVID-19).
In addition, pregnant women should call their health care practitioner to determine whether they can have fewer prenatal visits and visits for testing (such as for blood or urine tests or ultrasonography). Reducing the number of visits can reduce the risk of exposure to COVID-19. For example, instead of a visit, women can talk with their health care practitioner on the telephone or have an online video call (telemedicine).
If fetal monitoring is needed, practitioners can sometimes do it in a way that requires less contact between health care practitioners and the woman. For example, they can monitor the fetus from outside the examination room electronically or with Bluetooth, although they must enter the room to attach the monitor.
If a pregnant woman may be infected, separating her from her baby after delivery may be necessary until doctors determine whether the baby is infected.
COVID-19 Vaccine
The CDC recommends COVID-19 vaccination for all people 5 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy. (See also CDC: COVID-19 Vaccines While Pregnant or Breastfeeding.)
Breastfeeding
The risk of a mother transmitting the virus through breast milk is low or nonexistent. But more information is needed to determine whether an infected mother can pass the virus to the baby in breast milk. If a mother wants to breastfeed her baby, she should do the following unless the health care practitioner has determined that she is not infected:
Wash her hands before preparing to breastfeed and before touching any breast pump or bottle parts.
Express milk to be taken and fed to the infant by a caregiver who is not infected.
Clean all pump and bottle parts after use.
Clean the pumping area, including the counter top, with disinfectant wipes.
If she chooses to breastfeed directly, wear a face mask and wash her hands before each feeding.
Treatment of COVID-19 During Pregnancy
Acetaminophen to relieve fever and muscle aches
Treatment of COVID-19 in pregnant women and people who are not pregnant is similar.
Acetaminophen may be used to relieve fever and pain, such as muscle aches.
Before delivery, pregnant women with COVID-19 should notify the hospital that they have the infection. Then the hospital staff can take the needed precautions to prevent spread of the virus.
Credit: Lara A. Friel , MD, PhD, University of Texas Health Medical School at Houston, McGovern Medical School
