FAQs: Coronavirus and pregnancy

Updated as of January 2021

Want to know what the COVID-19 vaccine developments mean and what you should expect if you're pregnant? Read the latest FAQs on the COVID-19 vaccine from Dr. Jane van Dis with all of the details she has gathered for pregnant women, as well as anyone looking for more information about the vaccine, effectiveness, limitations, and more.

The latest CDC research shines new light on the heightened risks for pregnant women due to COVID-19 with the largest CDC study on the virus during pregnancy to-date. The study suggests that pregnant women are at a heightened risk of death and severe illness if infected by COVID-19, and more likely to require admission to intensive care, compared with non-pregnant women of the same age—though there are important limitations to call out. Our Medical Director, Dr. Jane van Dis, breaks down what pregnant women need to know about the findings, what it means for them, and how to stay healthy.

“If you’re pregnant and these recent headlines are making you anxious, you’re not alone,” shares Maven Medical Director Dr. Jane van Dis. “I encourage you to reach out to a Maven Mental Health Provider to talk through your anxiety, and we also have OB-GYNS ready for a video appointment right now on Maven’s app who can help talk you through the risks of COVID-19, and how to keep you and your baby safe. We’re here for you.”

While these new findings will be troubling for many, please know that precautions remain very effective in preventing the spread of COVID-19 and keeping yourself healthy. Continue to wear a mask whenever you leave your house, wash your hands frequently, and avoid any indoor gatherings of any size. If you’re feeling anxious or stressed, please reach out for support. At Maven, we’ve seen marked utilization of our mental health services to support pregnant women—as well as all of our members.

We remain committed to helping our members, our providers, and our clients navigate COVID-19, and recommend staying up-to-date with information from the Centers for Disease Control and Prevention (CDC) and the Society of Maternal Fetal Medicine. Maven’s virtual clinic is open 24/7 with doctors and specialists who are available to provide the latest information, answer your questions and manage your concerns, and more.

FAQs: What pregnant women should know about COVID-19

FAQs answered by Dr. Jane van Dis, Maven Medical Director and OB-GYN, based on the latest clinical guidance and information.

Should pregnant women get the COVID-19 vaccine?

The American College of Obstetricians and Gynecologists (ACOG) released a statement on December 13th stating the following, among additional details:

• ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on CDC Advisory Committee on Immunization Practices (ACIP)-recommended priority groups.
• COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP.
• Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available.

Among my peers, the overall consensus is that it would be unethical to withhold this vaccine from pregnant women.  Here’s a helpful editorial about this and the process by which pregnant women were excluded from these trials to date.

For a complete breakdown of what pregnant women need to know about the COVID-19 vaccine and more details, read our FAQs here.

What does the latest CDC data tell us about how pregnant women are being disproportionately affected by COVID-19?

In contrast to previous CDC data, the latest research reveals pregnant women were more likely to die of COVID-19: 1.5 per 1,000 symptomatic pregnant women died of COVID, compared to 1.2 per 1,000 non-pregnant women.

This report also found that pregnant women were at slightly increased risk of needing to be connected to an ECMO machine—meaning extracorporeal membrane oxygenation, which pumps and oxygenates a patient’s blood outside the body; similar to the machine used in open-heart surgery: 17 per 1,000 for non-pregnant women versus 120 per 1,000 for pregnant women.

As has been previously reported by the CDC, researchers found that pregnant women were at increased risk of:

• ICU admission: approximately 10.5 out of 1,000 pregnant women admitted to ICUs compared to 3.9 out of 1,000 non-pregnant women admitted to ICUs
• Being placed on a ventilator: 3x higher than non-pregnant women

The most frequently reported signs and symptoms of COVID-19–as previously noted—experienced by pregnant women were: cough, headache, muscle aches, and fever.

Racial disparities reported here mirror the CDC’s June report noting that: “Hispanic pregnant women of any race not only experienced a disproportionate risk for COVID-19 infection but also a higher risk for death compared with non-pregnant Hispanic women, and, regardless of pregnancy status, non-Hispanic Black women experienced a disproportionate number of deaths relative to their distribution among reported cases. This analysis highlights racial and ethnic disparities in both risk for infection and disease severity among pregnant women, indicating a need to address potential drivers of risk in these populations.”

For more on this report's findings and what pregnant women need to know, read Dr. Jane van Dis's analysis here.

Why are pregnant women more at risk of being admitted to the ICU?

The answer as to why pregnant women would be at increased risk of ICU admission and mechanical ventilation if they contract COVID-19 is likely multifactorial but may be due, in part, to changes in the physiology and anatomy of the maternal adaptation to pregnancy including:

• hormonal effects on vasculature
• changes in immune function
• decreased residual capacity of the lungs and increased resting ventilation
• increased blood volume, work of the heart and entire cardiovascular system

Another possible contributor is the increased risk for micro- and macro-thrombosis (blood clots) in pregnant women with COVID. Lastly, of those pregnant women who experience severe cases of COVID-19, some exhibit the exaggerated inflammatory response (cytokine storm), which has been known to lengthen the course and severity of COVID.  

Are there things pregnant women can do to try and protect themselves?

Wear a mask, wash your hands frequently, and definitely don’t let your guard down to the risks of contracting COVID-19. While society has changed since March, the virus has not changed, and it’s important to remember that keeping everyone healthy through this pandemic is a marathon, not a sprint. There are still asymptomatic persons who are infected but don’t yet know they are infected.

What would you say to someone who is expecting and is worried about COVID-19?

Continue to take precautions to stay safe and healthy: wear a mask whenever you leave your house, wash your hands frequently, and avoid any indoor gatherings. When you can, take walks outdoors: getting fresh air and exercise is also good for mind and body. If you’re feeling anxious or stressed, know that you’re not alone. At Maven, we’ve seen marked utilization of our mental health services to support pregnant women—as well as all of our members. Surveys show up to 85% of women have increased anxiety and/or depression during this time. We encourage women to reach out for support, whether through talk therapy alone, or, if necessary, with medication.  

What do you recommend for pregnant women who think they may have symptoms or fear they’ve been exposed?

Even with the latest research, there are still many unknowns and we’re learning more all the time about the impact of COVID-19 on pregnancy. We do know that due to the changes of pregnancy—decreased lung capacity and changes in the immune system—pregnant women are at increased risk of severe disease if they acquire COVID-19.

Because pregnant women are at increased risk, the following is recommended:

• Prompt evaluation and treatment of concerning symptoms
• If a pregnant woman has a fever over 100.4, she should call her physician immediately (Make sure you have a thermometer at home)
• If she is experiencing shortness of breath, she should call her doctor and go to the nearest emergency room right away, wearing a mask
• She should also call ahead to let Labor & Delivery know she is coming so that the hospital can have personnel ready to triage her once she arrives, thereby protecting other patients and healthcare workers
• Pregnant women who don’t have a fever, but may have a dry cough and feel under the weather should not go immediately to their doctor’s office and risk exposing other pregnant women in the waiting room. They should call their doctor and get instructions and establish a care plan
• Pregnant women, because they are a vulnerable population, should always wear face masks when in public and should practice social distancing. If you can, shop for groceries at hours when fewer people are around (or have someone shop for you) and avoid any indoor gatherings with friends or family (you can do so if keeping distance and all wearing masks)

For women and their families preparing to go into the hospital for delivery, what should they expect? How can they stay safe at the hospital from COVID-19 and how are hospitals preparing for safe deliveries?

• We are universally masking all patients, and also administering COVID-19 tests upon admission into the hospital. While the test is uncomfortable. please know that this is for your own safety and so that we can all know best how to keep you, your baby, and your providers healthy through delivery.
• Labor & Delivery units are improving every day, and have made great strides to keep everyone safe—patients, partners, doctors and staff, and babies.
• Most hospitals are limiting visitors, some to only one or two people. There can’t be any alternating between people, like we would commonly see in a Labor & Delivery room. A lot of hospitals are currently putting in a separate entrance for Labor & Delivery as well.
• One thing that will be different in the hospitals, in Labor & Delivery in particular, is that we’re going to see more virtual care. On Maven, we have virtual doulas, lactation consultants, certified nurse midwives; so even if your doula who you worked with throughout your pregnancy is restricted because your hospital is only allowing one person with you and you’re going to bring your partner, you can still connect virtually with birth personnel. I want to remind women that even though some of the systems are changing, you shouldn’t feel alone.

What should pregnant women in the 2nd or 3rd trimester know about COVID-19 and potential risks for preterm birth or labor and delivery?

• Most pregnant women, if they contract the virus, will have a mild form and will recover without complication
• Severe COVID-19, if untreated, could cause pneumonia and kidney failure which might impact their fetus and lead to premature births (before 37 weeks)
• In-utero transmission of COVID-19 is possible, but is relatively rare—according to research to-date. Research out of Italy from July 9th is an extremely small sample size: two babies tested positive out of 31 pregnant women infected with COVID-19. Importantly, both infants recovered quickly. We have seen similar studies throughout the pandemic, all demonstrating transmission is a rare event and that infants commonly test negative within a few days of testing positive. In this recent review published in June in Obstetrics & Gynecology, of 310 pregnancies, researchers found a vertical transmission rate of 0%. And this review found a 1.7% rate (3 out of 179) for infants testing positive for infection.

How might COVID-19 change my birth plan if I’m due soon?

• Call and speak with your doctor, and learn about your hospital’s Labor & Delivery policies
• Delivery will still be based on gestational age, how far along you are, whether there are any maternal indications such as severe preeclampsia, or whether there are any fetal indications such as intrauterine growth restriction, the baby not growing very well, or the like. The standard protocols by which we recommend delivery are still in practice and being followed
• Vaginal delivery will still be the preferred method of delivery for women with COVID-19 in labor. C-section is indicated for signs of shock, respiratory distress, fetal distress, or other maternal or fetal complications
• If you are infected with COVID-19 during your hospital stay, you may be put in a contact isolation room and visitors will be limited

Should people fear that hospitals will not have room for pregnant women?

What pregnant women need to know is that hospitals are not going to be giving away their Labor & Delivery rooms. Pregnancy is not an elective case, and those units will still be operating for deliveries only.

Should pregnant women consider a home birth?

COVID-19 should not be the sole reason that you choose a home birth. Women choose many different types of births, and we respect that maternal choice.

• If you are considering a home birth, you should speak with a provider in order to fully evaluate what the risks might be for you, and what the risks might be for your newborn.
• Maven’s care team of certified nurse midwives, doulas, nurse practitioners, and OB-GYNs can help you gather all of the information you need so you make a choice that is comfortable and right for you.

What should pregnant women know about Routine OB care in light of the spread of the coronavirus and recommended limits on travel and socialization?

With recommended guidance from ACOG, OB-GYNs are moving some of their typical in-person prenatal visits to telehealth, which will ultimately be a long-term shift that is positive for everyone. We’re learning more every day, and thinking about how best to shift care in the future based on what we’re learning during this time and the important role that telehealth can play in improving access and care delivery.

We do know there are a couple of milestones in a pregnancy that require you to either get a lab or an ultrasound:

• A first trimester ultrasound to date the pregnancy and determine a due date, and make sure it’s in the uterus, as well as obtain some first trimester baseline labs
• There’s another lab draw at 18 weeks
• An anatomy scan is very important at 20–22 weeks
• There are labs again at 28 weeks, including rhogam if you are Rh-negative
• Lastly, there’s an important lab at 35 weeks to determine your GBS (Group B Strep) status

We as a workforce, as OB-GYNs, are working with the American College of OB-GYNs (ACOG) and the Society for Maternal Fetal Medicine (SMFM) trying to understand what has to happen in-person, and what can be accomplished via telehealth, and we believe there may be some new guidelines coming.

If a mother and her newborn test positive for COVID-19, will they be separated in the hospital, and for how long?

• This is varying by hospitals and by doctors and care teams, based on the individual circumstances and health of mom and baby.  
• If separation is best, what that separation looks like depends on a specific hospital’s protocol: in some hospitals, baby and mom are in separate rooms, but in other instances, hospitals are putting a six-foot distance with some type of barrier (like a cloth curtain) in between mom and baby.
• Know that hospitals and OB-GYNs are working through protocols, and recommendations will be specific to the hospital you are delivering at. Given that we are seeing that newborns and infants are affected by this virus, and that they can require critical care, taking the appropriate precautions for COVID-positive pregnant women after birth in terms of separation are very much warranted.

Is it safe for pregnant women to travel?

Pregnant women are considered high-risk and should avoid all unnecessary travel, such as train, bus, public transportation, and plane rides. If you do have to travel by car, make sure to get a copy of your medical records from your doctor’s office to take with you in the event you become infected with COVID-19 and end up needing to seek urgent medical care away from your local doctor and hospital.

I’m in my 1st trimester, should I be worried about increased risk of miscarriage if I get COVID-19?

There is simply not enough information to know if and how COVID-19 could affect a pregnancy. Remain calm, and if you’re feeling anxious, talk to a mental health provider who specializes in working with women early on in pregnancy on Maven.

Can COVID-19 lead to birth defects?

• Every woman has a baseline 3-5% chance of having a baby with a birth defect. This is called her “background risk.” There are no published studies to-date on coronavirus infection in pregnancy and birth defects
• A high fever in the first trimester can increase the chance of certain birth defects. If you develop a high fever, please speak with your healthcare provider as soon as possible; hydrate; and consider acetaminophen (Tylenol) to bring the fever down.

Can I safely breastfeed if infected? Can coronavirus be transmitted via breast milk?

Testing performed thus far has shown no evidence of the virus in breast milk; however we do not know of women infected with COVID-19 can transmit the virus via breast milk [CDC]. Breast milk can be beneficial to the infant as it may contain antibodies to help protect the infant against infections. In a similar situation to COVID-19, the CDC recommends that a mother with flu (influenza) continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant.

• Precautions for women who are infected with COVID-19 should be taken to avoid spreading the virus to the infant and include:
• Wash hands for at least 20 seconds with soap and water before touching the infant
• Wear a face mask near infant
• If using a pump, wash your hands before touching supplies and wash supplies thoroughly before and after every use
• In addition, an infected mom should isolate from the other family members if possible, and be with her infant solely for breastfeeding or, if pumping, consider having a non-COVID infected family member feed the infant

What should I be aware of with a newborn?

Infants do not appear to be at greater risk, even if they do acquire COVID-19. While it hasn’t shown to transmit from mother to baby through breast milk, it can be transmitted via respiratory droplets (through coughing or sneezing, even breathing). Wash your hands often, especially before and after touching a newborn, and wear a mask if you’re infected or believe that you’ve been exposed [CDC].

Who should be tested for coronavirus?

Commonly those who have fever and/or cough, or shortness of breath. The recommendations are changing quickly—check the CDC guidelines here for the latest. If you are being tested for COVID your doctor will likely recommend a chest x-ray (this is normal and okay for pregnant women).  If your doctor recommends a CT scan, know that with abdominal shielding, the radiation levels from a chest CT do not harm a pregnancy.

What should I do if I have any flu-like symptoms?

A pregnant woman at any gestation, even very early pregnancy, with a fever (temperature greater than 100.4) should call her doctor. If your primary doctor is unavailable, we recommend consulting with a telehealth provider like an OB-GYN on Maven. If you develop a fever, wear a mask while transporting to the hospital and in the emergency room. If you don’t have a thermometer at home, now is a good time to get one.

How can I navigate my anxiety and mental health during this time?

We at Maven want to stress that your mental health is just as important as your physical health—it’s why we have amazing mental health providers on our platform who specialize in caring for women, new parents, LBGTQ+ individuals, and families, as well as those needing therapists with backgrounds in trauma-informed care.

In a pandemic like COVID-19, if you are feeling extra amounts of anxiety or depression, know that is a normal response to a crisis. It might be helpful to reach out and ask for help. Also know that fear and anxiety can lead to social stigma toward people, places, or things. The CDC has a resource page to address social stigma around COVID here. And Maven has mental health providers in our virtual clinic who can help you navigate this public health emergency.

Maven is here for you.

Maven is a virtual clinic for women and families. If you have a specific question, or cannot get through to your doctor, you can schedule a virtual appointment to speak with one of Maven’s providers. There are more than 20 types of care providers available on Maven, including OB-GYNs, pediatricians, nurse practitioners, mental health specialists, doulas, and more.

To get started: Join Maven today. Download the Maven Clinic app (search for “Maven Clinic” in the iTunes or Google Play app store).

Already a member, and have questions about how Maven works? Sign in to your Maven account and message your Care Advocate.

Sources: Society of Maternal Fetal Medicine, Centers for Disease Control and Prevention, World Health Organization, Academy of Breastfeeding Medicine

Disclaimer: The information provided here is for educational purposes only. This information is not intended as legal advice or medical advice, and is provided on an “as is” and “as available” basis without any warranties of any kind. Moreover, due to rapidly changing developments, we make no warranty or guarantee concerning the accuracy or reliability of the content on this page. For the latest information regarding COVID-19, we refer you to the Centers for Disease Control and Prevention website (www.cdc.gov).