Are Pregnant Women at Higher Risk With COVID-19?

Your body undergoes significant physiological, mechanical, and immunologic changes during pregnancy. You're not more likely to get COVID-19 because you're pregnant.

Pregnancy is a delicate and vulnerable period. Your body is under additional strain, and any illness affects both you and your baby. COVID-19 is a highly infectious disease caused by a coronavirus called SARS-CoV-2. Though COVID-19 can be harmful at any time, it's particularly dangerous during the third trimester.

Your body undergoes significant physiological, mechanical, and immunologic changes during pregnancy. These changes can potentially increase your likelihood of getting the COVID-19 infection. 

But studies have found that the prevalence of infection, symptomatic or asymptomatic, is the same in pregnant and non-pregnant people. In other words, you're not more likely to get COVID-19 because you're pregnant.

The symptoms of COVID-19 in pregnant women are much the same as in non-pregnant people:

• Fever
• Cough
• Fatigue
• Dyspnea (difficulty breathing)
• Diarrhea
• Malaise (feeling unwell)

Yes, the risks of severe COVID-19 disease are much higher if you are pregnant. These risks include:

• Severe disease needing hospitalization
• Admission to an intensive care unit (ICU) 
• Needing a ventilator or special equipment to breathe
• Death

The CDC has data on more than 400,000 people of reproductive age. This data shows that pregnant persons were three times more likely to be admitted to an intensive care unit (ICU), 2.9 times more likely to need ventilator support for breathing, and 1.7 times more likely to die than non-pregnant women.

Factors contributing to increased severity in pregnancy may be:

• Decreased lung volume as the baby grows 
• Immunologic changes of pregnancy
• Increased risk for thromboembolic disease

Preterm birth or pregnancy loss is more likely if you have severe or critical COVID-19 illness. Other factors increasing the likelihood of severe disease are. 

• Being overweight or obese
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• High blood pressure (hypertension)
• Diabetes, pre-existing or gestational
• Older age (35 years or older) 

Severe COVID-19 disease in pregnancy is commonly seen in the second and third trimester.

Mild COVID-19 is not dangerous to pregnancy, but pregnant women are more likely to develop severe or critical COVID-19.

Among pregnant women with a severe or critical illness diagnosed before 37 weeks, pregnancy loss or preterm birth occurred in 60%. The risk of premature delivery increases with increasing maternal COVID-19 severity.

Another danger to pregnant women with COVID-19 is the increased risk of preeclampsia. Preeclampsia is a dangerous condition that causes raised blood pressure and protein in the urine. It can progress to eclampsia, with seizures, coma, and the risk of death for both mother and baby.

Preeclampsia is more likely to happen when symptoms (shortness of breath, chest pain, and cough with fever) persist for a long time. If you have such symptoms for 5 to 10 days, you are at higher risk for preeclampsia.

Transmitting COVID-19 across the placenta to the baby is a concern. Since babies have immature immune systems, the infection will likely cause severe disease. But SARS-CoV-2 is rarely found in the amniotic fluid, umbilical cord blood, neonatal throat swabs, or breast milk.

Newborn babies born with COVID-19 are not common. One study among pregnant women with COVID-19 found that only 3% of babies were infected. 

All these babies were born to women with COVID-19 infection in the third trimester of pregnancy. Most of them were born to women with mild or asymptomatic COVID-19 infection. Severe disease is not associated with a higher risk of transmission to babies, and it is unknown whether treatment for COVID-19 protects the baby from getting infected.

If you had COVID-19 during the third trimester of pregnancy and at the time of delivery, you might be infectious when your baby is born. The good news is the coronavirus is not transmitted by breastmilk. 

You can safely breastfeed your baby if you take some precautions. These include:

• Wear a mask at all times when you are in the same room as your baby.
• Cleanse the nipple and breast before feeding.
• Wash your hands frequently, and every time you handle your baby.

With these precautions, there is a very low likelihood of passing COVID-19 infection to your baby.

Avoiding the infection keeps you and your baby safe. These measures will help.

• Avoid going out. Get shopping delivered to your home. Crowded indoor stores and malls put you at risk.
• Keep all your physician appointments. Ask your doctor for larger prescriptions so that you don't have to visit the pharmacy often.
• Stay away from people exposed to COVID-19.
• Isolate yourself from anyone in your home who is sick.
• When going out, wear a mask, keep 6 feet away from people who don't live with you. Avoid crowded and indoor spaces.
• Wash your hands frequently.

If you are pregnant or planning to be, getting vaccinated is the best thing you can do for safety. Keep yourself up-to-date with vaccination, including booster doses. If you take the vaccine during pregnancy, your baby will be born with COVID-19 antibodies. 

Moderna and Pfizer (mRNA COVID-19 vaccines) are preferred during pregnancy. The Janssen vaccine is a live adenoviral vaccine, and live vaccines should be avoided during pregnancy.

The CDC states:

• COVID-19 vaccination will reduce your risk of getting the disease if exposed.
• If you get infected, being vaccinated will protect you from severe illness and death.
• COVID-19 vaccines during pregnancy are safe and effective. They cannot cause COVID-19.

Most women who develop COVID-19 during pregnancy have mild or asymptomatic disease. But you are likely to get severe or critical illness if you are pregnant when you get infected. During your pregnancy, take all sensible precautions to avoid getting COVID-19. COVID-19 vaccines are very effective in preventing severe disease and death and are safe during pregnancy. Vaccination is the most effective way of keeping yourself and your baby safe from COVID-19.