As the COVID-19 pandemic continues to have a significant impact on daily life inside and outside of the hospital, there are many questions and concerns about what this outbreak means during pregnancy. The brief comments below reflect both available data and expert opinions as of 11/19/2020. Most advice for pregnant people regarding COVID-19 is similar to the advice for the general population in the United States.

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Q: Are pregnant people more susceptible to infection or at increased risk for severe illness, morbidity or mortality with COVID-19?

A: Pregnant people experience changes in their bodies that may increase their risk of serious infection. Studies during outbreaks of other related coronavirus infections (SARS-CoV, MERS-CoV) as well as influenza have demonstrated that pregnant people are more susceptible to severe illness. Early data from around the world and at Massachusetts General Hospital during the COVID-19 pandemic initially did not demonstrate a greater risk of acquisition or severity of COVID-19 in pregnant people compared to other adults. New data from the CDC, however, suggest that there is small increase of the risk for severe COVID-19 illness in pregnancy defined as an increased risk of intensive care unit admission, need for mechanical ventilation, and even death. Encouragingly, even though the risk appears increased in pregnancy, these severe outcomes of COVID-19 remain rare among pregnant people.  Pregnant people living with underlying conditions, such as obesity, hypertension, or diabetes, may be at additional risk of severe disease.  

Q: Does COVID-19 cause miscarriage?

A:  Early data regarding COVID-19 in pregnancy was derived primarily from individuals infected during the third trimester and the postpartum period. Information about pregnancy outcomes from people infected with COVID-19 around the time of conception and during the first trimester is still limited. Available early pregnancy data, however, has not demonstrated an increase in miscarriage.

Q: Can COVID-19 Infection cause preterm birth?

A:  Several studies found that pregnant people with COVID-19 infection had a higher rate of preterm delivery then would be expected in the population. The evidence at this point in the pandemic however is inconclusive about whether COVID-19 infection is associated with spontaneous preterm labor or whether the early deliveries are the result of medical decisions made to deliver early in the course of treating COVID-19.

Q: Can pregnant people pass COVID-19 to their fetuses during pregnancy?

A: Although there are cases of reported transmission of SARS-CoV-2 from mother to baby during pregnancy, the majority of published data has not found the virus in the newborns, placentas, amniotic fluid or breast milk of mothers with COVID-19. If there is potential for vertical transmission (infection traveling from mother to fetus before delivery), it appears that this event is uncommon but when it does occur, is generally associated with deliveries that happen within two weeks of infection.

Transmission of COVID-19 from mother to newborn, after birth, through infectious respiratory droplets is a concern and there have been a few cases reported of newborns as young as a few days old with infection. To reduce the risk of this transmission, mothers who are infected themselves or with symptoms that suggest infection will need to pay close attention to hand hygiene and wearing a mask when caring for their infants. While in our hospital, mothers with suspected or confirmed COVID 19 will stay in the same room with their babies but the health care team will help to arrange the room so that the baby can be 6 feet away from the mother. When possible, whether in the hospital or at home, care should be provided to the infant by a healthy caregiver until the mother has cleared the infection.

Learn more from the CDC >

Q: I am pregnant and a health care worker. Can I work with patients who are potentially infected with COVID-19?

A: Pregnant health care workers, like all health care workers, should be aware of and follow all updated infection control guidelines for their health care facilities to keep themselves and others safe in the health care environment. Some facilities may want to consider limiting exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher-risk procedures (eg, aerosol-generating procedures), if feasible, based on staffing availability. In order to promote further physical distancing and reduce, as much as possible, the risk for infection near the time of delivery, pregnant people may consider stopping in-person work at 37 weeks or at an earlier point if based on their individual circumstances their obstetric provider feels that delivery is anticipated earlier.

Q: I am pregnant and planning to travel this summer/fall. Should I cancel my trip?

A: Given the ongoing spread of COVID-19 in many states in the U.S. and around the globe, and because travel increases your chances of getting infected and spreading COVID-19, avoiding travel is the best way to protect yourself and others from getting sick.

If you must travel, be sure to discuss your plans with your OB providers and check the most up to date CDC guidance. Protect yourself and others during your trip by practicing hand hygiene, wearing a face covering in public, and maintaining six feet of physical distance from others.

U.S. travel advice from the CDC >

Q: I am pregnant and have been invited to a social gathering. Should I decline all social settings?

A: Given the potential increased risk of ICU admissions and mechanical ventilation for pregnant people who become infected with COVID-19, it is important to decrease your risk of exposure as much as possible. This includes wearing a mask and other recommended personal protective equipment (if applicable), at work and in public, washing hands frequently, maintaining physical distancing, and limiting contact with other individuals as much as practicable. Gathering with others in the outdoor setting where physical distancing can be maintained is reasonable, although it is important to discuss the risks of different social environments with your OB providers.

Learn more from the CDC >

Q: I was recently visiting with a family member who has now tested positive for COVID-19. Should I be tested for coronavirus?

A: Some personal interactions are higher risk than others, depending on where the interaction took place, how long you spent face to face with the infected individual, and whether face coverings were worn by all. A gathering that is low risk for COVID-19 exposure is one that occurs outside, with physical distancing and face coverings. Your OB and/or primary care provider can guide you in evaluating symptoms and exposures and need for testing.

Q: I am pregnant and have a new fever, cough, and a headache. Could this be COVID-19?

A: Please call your OB's office to report your symptoms right away. Other symptoms to look out for include: sore throat, runny nose/nasal congestion, shortness of breath, muscle aches and loss of smell or taste. Your OB provider will work with the hospital’s Infection Control and Infectious Diseases consultants to determine if you need to be tested for COVID-19. They will provide instructions to you on where testing can be arranged, if needed.

Q: The office just called to delay my routine prenatal care appointment. How will my pregnancy be monitored for complications?

A: During the ongoing COVID-19 pandemic, the OB/GYN Department at Mass General is committed to keeping all of our patients safe. In order to promote physical distancing and create a safe environment for you when you come to Mass General for visits, some prenatal care visits may be performed virtually—when doing so is safe for your pregnancy. It is important to understand that many appointments during pregnancy will still be held in person and these are safe to attend. We want to reassure you that we are always open 24/7 for all urgent care in the OB/GYN office, on the Labor and Delivery floor, and in the hospital. If you have an urgent question or concern, please call the OB office number which will be available day and night.

Q: I have heard that some hospitals are testing all pregnant people for COVID-19 who arrive to the hospital for labor—even people without any symptoms. Will I be tested when I arrive at Mass General?

A: With guidance from infection control specialists and our colleagues in other states, Mass General, along with all our partner hospitals, is testing all pregnant people arriving at Labor and Delivery for COVID-19. Some patients who have no symptoms may be identified as COVID positive, and this information will allow us to take the best care of all the mothers and babies on the unit.

Q: I have heard that hospitals are restricting visitors. Will I be allowed to bring a support person with me for labor and my postpartum stay?

A: Despite the many challenges posed by COVID-19, we are committed to helping pregnant people have the best labor and delivery experience possible which includes having a birth partner in the room during labor. Given the evolving pandemic, and in line with current hospital policy and needs to protect the health of our staff, the individuals who come to support you must be free from symptoms of coronavirus infection and wear a face covering during the entire visit. You can find the latest information on the Obstetrical Visitor Policy page of our website.

Q: If I develop COVID-19, will I still be able to breastfeed?

A: Breast milk is the best source of nutrition for most infants. Although much is unknown about COVID-19, all data to date has not identified coronavirus transmission through the breast milk. A mother with confirmed or suspected COVID-19 should take all precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, the infant should be fed the expressed breast milk by a healthy caregiver.

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Additional References and Resources

This content was prepared by Ilona Goldfarb, MD, for the Department of Obstetrics and Gynecology.
Date originally published: 3/20/2020
Most recently updated: 11/19/2020