Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

COVID-19 During Pregnancy


Lara A. Friel

, MD, PhD, University of Texas Health Medical School at Houston, McGovern Medical School

Reviewed/Revised Nov 2023

COVID-19 COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more is a respiratory illness that can be serious. It is caused by a infection with a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

  • The risk of getting COVID-19 seems to be similar for pregnant women and other adults.

  • Doctors suspect COVID-19 based on symptoms and the likelihood of exposure, but tests are needed to confirm the diagnosis.

  • Once symptoms develop, COVID-19 is more likely to cause severe illness in pregnant women, particularly if they have certain conditions (such as diabetes or heart disease), than in people who are not pregnant.

  • The risk of problems during pregnancy (such as preterm labor, birth of a premature newborn, and preeclampsia) is increased if COVID-19 symptoms are moderate or severe.

The risk of a pregnant woman transmitting COVID-19 to the fetus or to the newborn during the birth process appears to be very low. But once the baby is born, person-to-person spread is possible.

Symptoms of COVID-19 During Pregnancy

Most people with COVID-19 have mild or no symptoms, but some become severely ill and die. Symptoms can include fever, cough, and shortness of breath. Occasionally, loss of smell or taste can be the first symptom.

Once COVID-19 symptoms start, pregnant women are more likely to have severe illness than other people, particularly if they have certain conditions (such as diabetes or heart disease). Women with severe illness may require hospitalization, intensive care, and/or a ventilator. However, the overall risk of severe illness and death due to COVID-19 remains low for pregnant women.

Diagnosis of COVID-19 During Pregnancy

  • A doctor's evaluation

  • Tests to identify the virus

Diagnosis of COVID-19 in pregnant women is similar to diagnosis in people who have COVID-19 and are not pregnant Diagnosis COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more . COVID-19 is suspected if people have a fever, a cough, sudden loss of smell or taste, and/or trouble breathing and they could have been exposed to the virus.

To confirm the diagnosis, doctors may take samples of fluids from the respiratory tract to be tested. If a test is not readily available or if symptoms are mild, the diagnosis may be based on symptoms and likelihood of exposure (if it can be determined).

If needed, chest x-ray and/or computed tomography (CT) is done.

Treatment of COVID-19 During Pregnancy

  • Acetaminophen to relieve fever and muscle aches

  • Sometimes, combination nirmatrelvir and ritonavir

Acetaminophen may be used to relieve fever and pain, such as muscle aches.

Within a few days of developing mild to moderate COVID-19 symptoms, a doctor may consider treating pregnant women with a combination of nirmatrelvir and ritonavir to shorten the length of illness and make symptoms less severe. A small study found that pregnant patients did not develop any serious side effects from the treatment, and no complications were associated with the medication.

Before delivery, pregnant women with COVID-19 should notify the hospital that they have the infection. Then the hospital staff can take the needed precautions to prevent spread of the virus.

Prevention of COVID-19 During Pregnancy

The best way to prevent COVID-19 is to avoid being exposed to the virus, which can be difficult because some infected people do not know they have the virus. The Centers for Disease Control and Prevention (CDC) has issued recommendations for preventing the spread of COVID-19. These recommendations apply to all people (see also Prevention of COVID-19 Prevention COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more ).

If a pregnant woman may be infected, separating her from her baby after delivery may be necessary to avoid passing the infection to the baby.

COVID-19 Vaccine

The CDC recommends COVID-19 vaccination for all eligible people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. The benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy. (See also CDC: COVID-19 Vaccines While Pregnant or Breastfeeding.)

Vaccination may also provide protection for infants if they are breastfed. A National Institutes of Health (NIH)-supported study found that when a pregnant person has antibodies against SARS-CoV-2 after being vaccinated or having COVID-19, those antibodies may be transferred to the infant through breast milk. The antibodies help infants gain immunity that can protect them from COVID-19.


The risk of a mother transmitting the virus through breast milk is low or nonexistent. (See also CDC: COVID-19 and Breastfeeding.)

If a woman with known SARS-CoV-2 infection chooses to breastfeed directly, she should wear a face mask and maintain proper hand hygiene.

If bottle feeding breast milk, prior to expressing milk, the woman should put on a mask and thoroughly wash hands and any pump parts, bottles, and artificial nipples.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American College of Obstetricians and Gynecologists: Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients: This web site discusses how COVID-19 may affect pregnant women and the fetus, whether pregnant women should get a COVID-19 vaccine, how to avoid getting the virus, what to do if pregnant women think they have or if they get COVID-19, and how COVID-19 affects their plans for labor and delivery. Breastfeeding and COVID-19 are also discussed.

  • Centers for Disease Control and Prevention (CDC): Coronavirus (COVID-19): This web site provides links to information about the COVID-19 vaccines (including how to find a vaccine), the number and location of cases (including maps and charts tracking cases, deaths, and trends of COVID-19) in the United States, and recommendations about how to stay safe in schools and the workplace.

Drugs Mentioned In This Article

Generic Name Select Brand Names
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Aphen, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
quiz link

Test your knowledge

Take a Quiz!