Being pregnant is already a mix of emotions and worries, but if you come down with COVID-19, it can be even more stressful.
There are seven different types of coronaviruses known to infect people, according to the Centers for Disease Control and Prevention (CDC). Many are mild and cause colds, but some forms of the virus — including COVID-19 — can cause severe illness.
How does COVID-19 spread when you're pregnant?
Like other coronaviruses, COVID-19 spreads from an infected person to other people via respiratory droplets that get into the air by coughing or sneezing.
Touching or shaking hands, or touching a surface that has been contaminated with the virus and then touching your mouth, nose or eyes before you wash your hands, may also spread COVID-19, though that doesn't seem to be the main way to catch it, according to the CDC.
What are the symptoms of COVID-19 when you're pregnant?
The following are the main symptoms of COVID-19, whether you're pregnant or not:[1]
- Fever
- Cough
- Shortness of breath
- Chills
- Muscle or body aches
- Fatigue
- Headache
- Sore throat
- A new loss of taste or smell
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
These aren't all the possible symptoms of COVID-19. Symptoms can appear anywhere from two to 14 days after a person has been exposed to the virus.
Some people with COVID-19 have only mild illness, while others become seriously ill. And others don't show any symptoms, though they can still spread the virus.
What should you do if you're pregnant and were exposed to COVID-19?
If you came into close contact with someone with COVID-19, you should start wearing a mask right away. If you develop any symptoms, begin quarantining or isolating yourself and take a home COVID-19 test or one at your doctor's office as soon as you can.
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If you're not having symptoms, take a test on day six. If you test negative, keep taking precautions until 10 days after your initial exposure.
If you test positive at any point, quarantine yourself and stay isolated from others in your house for at least five days, or until you're fever-free for 24 hours and your symptoms have started to improve (whichever happens first), CDC guidelines recommend.
Wear a mask in the house if you do have to leave your room, use a separate bathroom from others in your family if you can, and don't go out in public for your five-day quarantine period. Once the five days are over, it's recommended (but no longer required) that you wear a mask for another five days. Count your first day of any symptoms as day zero.
It’s natural to have lots of questions about COVID-19 and wonder what the virus means for your pregnancy, especially as new strains continue to circulate. Here’s what parents and parents-to-be need to know.
Does pregnancy increase risk for COVID-19 complications?
Yes. The immune system changes during pregnancy, and experts have learned that those changes do put pregnant women at an increased risk of complications from COVID-19.
That's especially true during the third trimester. By then, "there are changes in a pregnant person's pulmonary status that predispose the person to respiratory illness, including decreased lung reserve and a higher respiratory rate," explains Shannon Smith, M.D., a board-certified OB/GYN and partner at Brigham Faulkner OB/GYN Associates in Boston, Massachusetts, and a member of the What to Expect Medical Review Board.
The CDC says the following about pregnancy and COVID-19: "If you are pregnant or were recently pregnant, you are more likely to get severely ill from COVID-19 compared to people who are not pregnant. Pregnancy causes changes in the body that could make it easier to get very sick from respiratory viruses like the one that causes COVID-19."[2]
Additionally, the CDC says that COVID-19 puts pregnant women at a higher risk of certain complications.
"People with COVID-19 during pregnancy are more likely to experience complications that can affect their pregnancy and developing baby compared to people without COVID-19 during pregnancy," the CDC says. "For example, COVID-19 during pregnancy increases the risk of delivering a preterm (earlier than 37 weeks) or stillborn infant. People with COVID-19 during pregnancy may also be more likely to have other pregnancy complications."
Research has also found that pregnant women are at a higher risk of breakthrough COVID-19 infections, meaning those contracted among people who are vaccinated. Pregnant women are nearly two times as likely to get a breakthrough case of COVID than those who aren't pregnant, the study found.
Scientists continue to learn more about how this virus impacts pregnancy. In the meantime, the best way pregnant women can protect themselves from COVID-19 is to get an updated COVID-19 vaccine and follow the CDC's recommendations to avoid crowds and wear a face mask when there are a lot of people around, particularly inside in areas with high COVID-19 transmission rates.
The good news is that being vaccinated against COVID-19 significantly reduces your chances of severe illness and hospitalization, whether you're pregnant or not.
Can you get the COVID-19 vaccine if you're pregnant or breastfeeding?
You can — and you should.
Leading experts including the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) strongly recommend that all who are eligible, including pregnant and lactating women, get the COVID-19 vaccine.
Tens of thousands of pregnant women have gotten vaccinated, and we have good evidence showing that the vaccines are safe and effective when you're expecting, the CDC notes.
"Safety data about vaccination in pregnancy is rapidly accumulating, with more women being vaccinated and no safety concerns have been detected despite the large number of pregnant women being vaccinated. Globally, the recommended COVID-19 vaccine, and numerous other vaccines, have been proven to be safe and effective in preventing COVID-19 in pregnant women," researchers wrote in a May 2023 review published in the journal Obstetrics & Gynecology Science.
The risks of contracting COVID-19 while pregnant — including increased risk of preterm birth and other adverse outcomes for your baby — are higher than the potential risks of getting the vaccine while pregnant, says the CDC.
Compared to women who are not pregnant, expectant moms have an increased risk of severe illness and hospitalization from COVID-19, according to the CDC.
The vaccines offer protection against serious illness, including from the variants circulating during the current cold and flu season, and increase the chances that you would experience mild symptoms if you do get infected. The vaccines also builds protective antibodies for your baby until your little one turns 6 months old and can get vaccinated.
The CDC approved newly updated COVID-19 vaccines in September 2023. The updated shots are aimed at the current circulating strains in order to deliver the best possible protection against severe symptoms during the 2023-2024 cold and flu season.
Everyone, including pregnant and breastfeeding women, should get an updated shot if it's been two months or longer since your last COVID-19 vaccine, or 90 days since you had the COVID-19 virus.
The following vaccines have received full approval for pregnant and breastfeeding women from the Food & Drug Administration (FDA) for the prevention of COVID-19:
Pfizer-BioNTech (marketed as Comirnaty)
Moderna (marketed as Spikevax)
In October 2023, the FDA also approved an updated version of the Novavax vaccine for the 2023-2024 season for emergency use for children and adults ages 12 and up.
Unlike the Pfizer and Moderna vaccines, which are mRNA vaccines, the Novavax vaccine is a subunit protein vaccine. Subunit protein vaccines contain antigens that stimulate the immune system to launch a protective response against a virus.
All the vaccines has been shown to be effective against COVID-19, particularly when it comes to preventing serious illness and death, in large-scale clinical trials.
What impact could COVID-19 have on a newborn?
Most newborns of women who had COVID-19 during pregnancy do not test positive when they're born, but it is possible for an infant to contract COVID-19 from a mother or other caregiver. According to the American Academy of Pediatrics (AAP), around 2 percent of infants born to mothers with an active COVID-19 infection tested positive for COVID-19 themselves within 96 hours of being born.
Infants are at a higher risk of severe illness than older children due to their smaller airways and immature immune systems, which make them more vulnerable to breathing issues from all respiratory infections. That's reason to take precautions, but you shouldn't panic.
Most babies who tested positive for COVID-19 as newborns had mild or no symptoms, and made a full recovery.
What do you need to know about COVID-19 if you're breastfeeding?
All pregnant and breastfeeding women should be vaccinated against COVID-19, recommend the CDC, ACOG, and the Society for Maternal-Fetal Medicine.
Whether you've received previous vaccines or not, adults (and children 5 years and older) are now considered up-to-date on their immunizations when they've received one updated COVID-19 vaccine. Babies and young children 6 months to 4 years old need multiple doses of one of the pediatric COVID-19 vaccines to be fully vaccinated.
You can get an updated COVID-19 vaccine as long as it's been at least two months since your last COVID-19 shot, says the CDC.
It's safe for breastfeeding mothers who are infected with COVID-19 to keep breastfeeding, according to the CDC. There's currently no evidence showing that COVID-19 can be transmitted through breast milk.
What's more, breast milk contains antibodies that can help guard babies against many illnesses, including antibodies that can protect babies from getting COVID-19.
If you're currently breastfeeding and have a suspected, probable, or confirmed case of COVID-19, here's what the CDC recommends:
Breastfeeding mothers should wash their hands using soap and water before touching their babies.
If breastfeeding mothers do not have soap and water available to them, they should use hand sanitizer with at least 60 percent alcohol.
Breastfeeding mothers should wear a mask when in close contact with their babies, including while nursing or while feeding pumped milk from a bottle.
Mothers should practice good hand hygiene when expressing breast milk.
If you're feeling too sick to breastfeed, consider letting expressed breast milk be bottle-fed to the baby by a healthy caregiver who is fully vaccinated against COVID-19.
If the breastfeeding mother requires lactation services that cannot be done virtually, the lactation provider should follow recommended infection prevention and control measures, and wear personal protective equipment (PPE).
What happens if you test positive for COVID-19 just before giving birth?
The AAP had previously recommended that infants born to mothers with confirmed COVID-19 be temporarily separated to lower the risk that the baby would be infected. Since then, the guidelines have changed. Now you're allowed to continue sharing a hospital room with your newborn if you have COVID-19 when you give birth.
The AAP now recommends the following if a new mother has confirmed COVID-19:
- The mother and the newborn may share a room.
- The mother should keep a "reasonable distance" from the newborn during hospitalization.
- The mother should wear a mask and clean her hands often when caring for the newborn.
- The mother can breastfeed if she chooses to do so, while wearing a mask. If she doesn't plan to breastfeed, she can express milk to be fed to the baby by another caregiver.
- Non-infected family members at the hospital should wear a mask and clean their hands often.
Should pregnant women be concerned about germs at the hospital?
Some moms-to-be worry about being exposed to COVID-19 at the hospital or doctor's appointments.
Experts stress that it's still very important that moms-to-be continue to receive prenatal care, regardless of what COVID-19 case counts might be like in your area.
Prenatal care providers have made many changes to their services during the pandemic to protect patients, such as spacing out appointments, condensing visits to limit the amount of time you’re in the office, and disinfecting frequently. Your doctor may also offer telehealth consulting for some visits.
Other strategies to stay safe when at doctor's appointments or the hospital:
- Practice good hand hygiene.
- Maintain a distance of 6 feet from others and try to avoid people who appear ill.
- Avoid touching surfaces and then touching your face with unwashed hands.
- Wear a mask at your appointments.
It's normal to be concerned about COVID-19 during your pregnancy. While being pregnant can increase your risk of serious complications, there are more tools than ever to help you stay protected, starting with the latest vaccines. So if you haven't already gotten your updated shot, don't wait any longer.
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