How COVID-19 can impact pregnancy

Maternal-fetal medicine specialists Joana Lopes Perdigao, MD, and Sarosh Rana, MD, MPH, answer common questions about coronavirus (COVID-19) and pregnancy.

Are pregnant people at higher risk for COVID-19?

Pregnancy causes many changes in the body and has a strong effect on the immune system. While we are still learning about SARS-CoV-2, the novel coronavirus that caused the COVID-19 disease, we have started to learn some important things about how it affects pregnant people.

While we don’t yet know if pregnant people are more likely to contract COVID-19 after they are exposed to the virus, we do know that pregnant people are more likely to experience severe illness if they do get sick. That means that they have an increased risk of hospitalization, ICU admission, the need for a ventilator and death.

Physicians have also found that contracting COVID-19 leads to an increased risk of pregnancy complications, such as preterm birth. There is also data indicating that experiencing a severe case of COVID-19 increases the risk of complications such as cesarean delivery, hypertensive disorders of pregnancy such as preeclampsia, and postpartum hemorrhage. These risks are of even more concern for individuals who have additional health risk factors, such as being overweight or obese, having high blood pressure or diabetes, or being part of a minority group that may experience more severe outcomes.

The delta variant of SARS-CoV-2 is even more contagious than previous strains of the virus, which makes it more likely for an individual to contract the virus and get sick if they are exposed. Because it is so contagious, the delta variant is circulating at high rates in the community, and the risk of being exposed continues to go up. It is not yet clear whether or not the delta variant causes more serious illness than previous virus strains, but more research is needed. It is also possible that as the virus continues to spread and mutate, strains such as the mu variant or other new strains may evolve that are more or less contagious or cause more or less severe illness.

What can I do to reduce my risk of catching COVID-19 and/or preventing severe illness?

The number one thing you can do to protect yourself from COVID-19 is get vaccinated.

The number one thing you can do to protect yourself from COVID-19 is get vaccinated. The COVID-19 vaccines currently available have been found to be safe and highly effective for individuals over the age of 12, including those who are pregnant. On August 23, 2021, the Comirnaty vaccine (previously called the Pfizer-BioNTech mRNA vaccine) was given full FDA approval for individuals age 16 and up. CDC data indicate that the vaccine presents no safety concerns for pregnant people or their babies. Data looking at pregnancy outcomes in nearly 2500 pregnant people who received an mRNA vaccine (Comirnaty or Moderna) before 20 weeks of pregnancy found no increase in the risk of miscarriage, and there is no evidence that the vaccine impacts future fertility or breastfeeding.

However, no vaccine is perfect. Even though the vaccines are highly effective at preventing COVID-19, and are especially effective at preventing severe illness and death, it is still possible to contract the virus after being vaccinated. In addition to getting vaccinated, we recommend that our patients follow all currently recommended public health guidelines, which include avoiding large crowds, wearing masks in public, frequent handwashing and social distancing.

COVID-19 vaccines and pregnancy: What to know if you're pregnant, trying to conceive or breastfeeding

If I’m pregnant and have been vaccinated, are there any additional precautions I should be taking?

We would advise that pregnant people behave more cautiously than if they were not pregnant.

While the COVID-19 vaccines are highly effective, no vaccine is perfect; and with the spread of the delta variant, we are seeing an increase in the number of vaccinated people testing positive for the virus. We would advise that pregnant people behave more cautiously than if they were not pregnant. Pregnant people should avoid high-risk situations such as traveling in an airplane or attending indoor gatherings with people outside of their own household — especially large groups of people. You should wear a mask when indoors with people outside of your household and if you are in crowded outdoor areas. In general, settings that are outdoors and uncrowded (where social distancing is possible) are relatively safe, as are settings where everyone is masked.

If you received one of the mRNA vaccines, you should speak with your physician about whether or not you are eligible for a third or booster dose of the vaccine, and if so, when you should schedule your shot.

As a pregnant person, what should I do if I have symptoms?

Call your doctor, but do not come in for treatment right away, unless you are experiencing severe, life-threatening symptoms, such as struggling to breathe or a very high fever. After a series of questions, your doctor will help you decipher whether you need to come to the hospital or stay at home. If possible, you should get tested for COVID-19. Your doctor may ask you to quarantine and rest at home. If you stay at home, stay away from others as much as possible. You should remain in a specific “sick room” and away from other people and any pets.

If you are a University of Chicago Medicine patient, you can sign up to get a COVID-19 test at our clinic. First, you should call our COVID-19 triage hotline at 773-702-2800 or log in to your MyChart account to complete a screening questionnaire. The healthcare provider who reviews your questionnaire will determine if you should schedule an appointment to be tested. You can then schedule the testing appointment over the phone or through your MyChart account. If you are unable to completely avoid others while you are sick, you should wear a face mask when you are around other people. If you feel worse, call your doctor right away and your doctor will decide if you need to come into the hospital.

What if I test positive for COVID-19 while I am pregnant?

If you do test positive for COVID-19, you should quarantine at home for at least 10 days after your symptoms first appear and it has been at least 24 hours with no fever, without fever-reducing medications. While you are at home, stay away from others as much as possible, including other family members and pets. You should remain in a specific “sick room” and away from other people in your home. Use a separate bathroom, if available. Make sure to carefully dispose of all potentially infectious waste, such as used tissues, and wash your hands thoroughly and frequently.

Even if you are experiencing no to light symptoms, self-quarantine for 10 days after you test positive. If there are other family members in the home, try to isolate yourself to lessen the chance of spreading.

Discuss choices that you will make for you and your baby beforehand with the baby’s co-parent, a family member and your healthcare team in the case that you may become critically sick and unable to make those choices. The mode of delivery (vaginal versus C-section) and choice of pain control should not be different for COVID-19 positive patients. However, the number of companions who can be with you during labor will be limited.

Should I keep my prenatal appointments if I’m sick with COVID-19?

It is strongly recommended that you stay home and avoid being around other people while you are sick. If you believe you may have COVID-19, we ask that you call your physician to discuss your symptoms and determine next steps. At UChicago Medicine, we are currently conducting many appointments via telemedicine. After a virtual visit or telephone call, we can decide if you need to come in for an appointment based on your pregnancy history and needs.

There is evidence that COVID-19 leads to increased risk of preterm birth, cesarean delivery, hypertensive disorders of pregnancy such as preeclampsia, and postpartum hemorrhage. It is therefore important that you let your doctor know if you suspect you have or have been diagnosed with COVID-19.

If you have a pre-scheduled appointment, call your doctor’s office and see if it is possible to do a telemedicine visit. If you are asked to come into the doctor’s office, practice social distancing (do not give your doctor or nurse a hug or shake their hand), and wash your hands frequently. Your doctor’s office should follow cleaning protocols commonly used in clinical spaces in between patient visits.

Similar principles apply for your ultrasound. Confirm with your doctor if it is necessary that you get an ultrasound or if it can be delayed. Contact your doctor’s office immediately if you have any signs of labor, bleeding or if your baby is not moving.

What extra precautions are UChicago Medicine taking to safeguard pregnant and delivering patients when there are current patients that have the virus?

Patients who have tested positive for COVID-19 are kept in special isolation rooms. Patients who have COVID-19 who are delivering will be on the Labor and Delivery unit but in a separate area from other patients.

We have developed protocols in coordination with the infectious diseases team and other specialists, including from other prestigious healthcare institutions from Boston, New York and Texas, to provide the safest and most evidence-driven care for all our patients during the pandemic.

Will my partner be allowed in the delivery room during the pandemic? Will visitors be allowed after birth?

We are allowing two support people to accompany you during vaginal delivery and one support person during a cesarean section.

For more information, read our current Family Birth Center visitor guidelines.

Can I transmit the virus to my baby?

Though it is uncommon, it does appear to be possible for parents to transmit the virus to their unborn child, either just before, during or after birth, as some newborns test positive for COVID-19. Most newborns who test positive for COVID-19 experience only mild symptoms or are asymptomatic (experience no symptoms at all). Rarely, a newborn may develop a severe illness.

If you test positive for COVID-19, please wear a mask when you are within six feet of your infant and when breastfeeding, and stay more than six feet away as much as possible. You should wash your hands with soap and water for at least 20 seconds before holding or touching your newborn. A team of pediatricians will be available to care for your baby if any medical conditions arise.

Even after you are no longer positive for COVID-19, and/or if there are other caregivers who are providing care for newborns, all caregivers should wash their hands for at least 20 seconds with soap and water before touching the baby, or should use a hand sanitizer with at least 60% alcohol if soap and water are not available.

You should monitor your newborn for COVID-19 symptoms. Contact your physician if your baby has a fever, appears to be lethargic (overly tired), has a runny nose or cough, appears to be having difficulty breathing, or is vomiting or has diarrhea.

Despite the COVID-19 pandemic, the American College of Obstetricians and Gynecologists (ACOG) guidelines suggest that it is still safer to deliver in a hospital.

Should I think about home birth?

If you are considering home birth, please discuss this with your doctor. Despite the COVID-19 pandemic, the American College of Obstetricians and Gynecologists (ACOG) guidelines suggest that it is still safer to deliver in a hospital. At UChicago Medicine, we are taking steps to ensure the safety of all of our patients, with and without COVID-19, and the risk of contracting the virus in the hospital is very low.

Individuals with COVID-19 are at increased risk of complications during pregnancy and delivery. If you tested positive for COVID-19 and plan to deliver at home, please consider your ability to get an emergency cesarean section (C-section). As the Labor and Delivery unit continues to follow rules and recommendations from the infection control team, your care may be delayed. This could have adverse effects on your pregnancy outcome and outcomes of your baby if you are attempting to deliver at home and reach the hospital in critical condition.