COVID-19 is still a new disease that we are learning more about each day. We still have relatively little information about how this virus affects pregnant people and their pregnancies. We know this has been a scary time for most people. Many people are living through their first pandemic, and just getting household essentials has been a challenge some days.
If you are pregnant or thinking about becoming pregnant, you’re likely concerned about how the pandemic will impact your pregnancy. It’s common to feel alarmed and stressed throughout this time, as starting or expanding a family brings up new questions. During pandemic outbreaks, recommendations to delay pregnancy are a complicated, controversial, and multifactorial issue — and so far, this recommendation has not been made (12).
Are pregnant people at higher risk for COVID-19?
The physiologic changes of pregnancy make pregnant people more likely to experience respiratory illness in general (1). Changes to both heart and lung function, as well as the immune system, make pregnant people vulnerable to infection (1). As a pregnant person or someone who hopes to be pregnant soon, you may need to be more cautious about COVID-19 than the average person.
Pregnant people who have symptoms of COVID-19 may be at an increased risk for more severe illness compared to non-pregnant people (2). In this case, severity is linked with more ICU admissions, use of ventilators, and death (2). Pregnant people who have other medical conditions might be at further increased risk for severe illness (2). Since COVID-19 is so new, more research is needed to know specifically how this virus impacts pregnant people.
How can I stay safe during the pandemic?
There are some steps you can take to limit your exposure to COVID-19 and optimize your health for your pregnancy. Maintaining your prenatal visit schedule will help your healthcare provider make sure you and your fetus are in good health (2). Washing your hands, maintaining social distancing, limiting contact with other individuals, wearing a mask at work and in public, and maintaining a supply of resources to keep you prepared to stay at home are all ways to reduce your risk (2). If you are pregnant and have symptoms of COVID-19 like fever, cough, or trouble breathing, call your healthcare provider right away, since pregnant people might require higher levels of care (3)
The American Society for Reproductive Medicine (ASRM) recommends receiving a flu vaccination if you are attempting to become pregnant (4). The American College of Obstetricians and Gynecologists (ACOG) recommends that anyone who will be pregnant during flu season receive a flu shot (5) and the World Health Organization (WHO) says that pregnant people are top priority for receiving flu shots (6). The Centers for Disease Control or CDC recommends every person over the age of 6 months should receive a flu shot during every flu season (7).
ACOG recommends that pregnant and lactating people should all receive the COVID-19 vaccine or vaccine series (18). If you are pregnant or lactating and have questions about the vaccine, you can discuss them with your healthcare provider, but you don’t have to visit a healthcare provider for the shot (18). You can access the vaccine in any clinical setting or non-clinical community based vaccination site (18).
Some pregnant people are hesitant to get the vaccine while pregnant (17). While it’s true that the clinical trials on COVID-19 vaccines purposefully excluded pregnant people, Pfizer reported 23 pregnancies in their clinical trial, including 12 in the vaccine group (16, 17). Moderna reported 13 pregnancies, including six in the vaccine group (16, 17). Twelve people in the vaccine group became pregnant during the AstraZeneca trials (17). Miscarriages rates in the vaccine groups were similar to the control groups (16, 17), indicating that the vaccine was not linked to miscarriage. It’s important to remember that contracting COVID-19 during pregnancy has more documented risks than receiving the vaccine while pregnant (18).
Considering becoming pregnant in the future and concerned that the COVID-19 vaccine might impact fertility? Reports that COVID-19 vaccines are linked to infertility have been disproven (18). The claim that ties COVID-19 vaccines to infertility is in reference to the Pfizer vaccine (17). The claim is that antibodies that recognize the virus’ spike protein might cross-react with a human placental protein and damage the placenta (17). If this were true, all COVID-19 vaccines and some natural COVID-19 infections would also harm the placenta (17). People who are infected with COVID-19 before conception or in the first trimester of pregnancy do not have higher miscarriage rates than people without infection, meaning this theory is unlikely to be true (17). The pregnancies that occurred during the clinical trials also debunk this theory (17).
What will happen if I’m pregnant and get COVID-19?
The symptoms of pregnant people with COVID-19 so far seem to be similar to non-pregnant people and include fever, shortness of breath, and cough (and some people will have no symptoms) (1). This can be confusing for some pregnant people since shortness of breath can be a normal physiologic occurrence in pregnancy (1). If you have trouble breathing while resting, or any other emergency warning signs, including pain or pressure in the chest, confusion, inability to stay awake, and blue lips or face, seek help immediately (8).
There is no definite evidence that the COVID-19 virus can be passed from the pregnant parent to the fetus through the placenta, called vertical transmission (1). The most common side effect on the fetus of a pregnant parent positive for COVID-19 so far has been preterm birth (1). Some infants were born with a condition called intrauterine growth restriction or IUGR (1), which means they did not grow as expected for their gestational age or for the dating of the pregnancy. To date, there has been a small percentage (2%) of miscarriages (1). These outcomes may vary depending on when in pregnancy someone is infected with COVID-19, and more research is needed on COVID-19 infection in early pregnancy in particular.
If you birth while you are positive for COVID-19, you do not need to have a cesarean section, or c-section, unless otherwise medically indicated (3). After the birth of your baby, ACOG does not recommend separating parents from newborns (2). Keeping parents and babies together after birth promotes bonding and can lead to more successful breastfeeding/chestfeeding (2). Plus, breastfeeding/chestfeeding protects infants from infections and promotes their health and development (9).
So far, research suggests that infection risk for a newborn is not lower when separated from a mother who tests positive for COVID-19 (2). There are certain circumstances, like if a parent chooses, or is too sick to care for their baby, that the parent and infant might be separated (2). If for any reason an infant is separated from their parent/s, ACOG indicates that this decision should be made together with the healthcare provider and parents and be an informed decision free from coercion (2). ACOG also encourages breastfeeding and recommends that the breastfeeding parent wear a mask while nursing (2). Pumping your breast milk and having another family member who is COVID-19 negative feed your baby is also an option.
Is it safe to become pregnant after a COVID-19 diagnosis?
So far, the answer is yes, according to ASRM. But remember that the COVID-19 infection can last for weeks (10), and being both in the first trimester of pregnancy and recovering from COVID-19 may be far from ideal. ASRM advises that you can start trying for a pregnancy 10 days after your symptoms started or after a positive COVID-19 test (10). Consult your healthcare provider if you have lingering symptoms of COVID-19.
What about fertility cycles and COVID-19?
If you are seeking fertility treatment to become pregnant, you likely don’t consider it elective and have been faced with a few hard decisions during this pandemic. As of November 17, 2020, ASRM called for the resumption of all reproductive care, with providers following strict hygiene guidelines including mask wearing, hand washing, and telemedicine visits when appropriate (11).
What to do if you’re trying to conceive during coronavirus
Conception is a deeply personal choice. There will always be environmental and psychological factors that contribute to a person’s desire to start or grow their family. Understandably, the COVID-19 pandemic may make the decision whether or not to conceive overwhelmingly difficult. This pandemic will also force some people to change their reproductive plans without their consent.
During this time of uncertainty, the best people to guide your conception plans are you, your partner or support person, and your reproductive healthcare team. Although your reproductive plans might change temporarily because of the pandemic, providers are monitoring the situation closely. In the meantime, if you are hoping to conceive, continue to eat a balanced diet and take prenatal vitamins with folic acid.
If both you and your pregnancy are healthy, exercising during pregnancy is safe and has benefits like reduction of back pain, constipation, and even more serious pregnancy outcomes (12). Yoga (avoid hot yoga) in particular can be beneficial at reducing anxiety during pregnancy (13) and can be especially well adapted for pregnant bodies (12). Balancing stressful periods with rest and relaxation may also be helpful. Research suggests meditation can also reduce stress (14).
You can keep updating your cycle or pregnancy, body changes, mood, and sexual activity in Clue. To track your COVID-19 vaccine, you can track an injection or create a special tag.
*If you are currently experiencing domestic violence, and are located in one of the following countries, please call a hotline for resources. If your country is not listed below, please search for a trusted resource specific to your location online.
United States Domestic Violence Hotline 1-800-799-SAFE (7233)
United Kingdom National Domestic Violence Helpline 0808 2000 247
German Violence Against Women Hotline 08000 116 016
Australia National Sexual Assault, Domestic Family Violence Counselling Service 1800 RESPECT (1800 737 732)
New Zealand Women's Refuge 0800 REFUGE (0800 733 843)
Ending Violence Association of Canada: Visit website for phone number for each state
Violences Femmes Info 3919
SOS Viols (rape) 0 800 05 95 95
Domestic Violence Victims 08 842 846 37
Originally published on April 29, 2020.