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COVID-19 During Pregnancy

By

Lara A. Friel

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

Reviewed/Revised Sep 2023
View PATIENT EDUCATION

Based on several studies, the epidemiology, virology, transmission, and symptoms and signs of COVID-19 in pregnant women are similar to those in nonpregnant patients. Data from the Centers for Disease Control and Prevention (CDC) and other publications indicate an increased risk of intensive care unit admission, mechanical ventilation, and death in pregnant patients with symptomatic COVID-19, particularly in those with underlying health conditions such as diabetes and cardiovascular disease (1 General references COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on several studies, the epidemiology, virology, transmission, and symptoms and signs... read more ). However, the overall risk of severe illness and death due to COVID-19 remains low for pregnant women.

General references

  • 1. Khan DSA, Pirzada AN, Ali A, et al: The Differences in Clinical Presentation, Management, and Prognosis of Laboratory-Confirmed COVID-19 between Pregnant and Non-Pregnant Women: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health18(11):5613, 2021. doi:10.3390/ijerph18115613

  • 2. Metz TD, Clifton RG, Hughes BL, et al: Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA 327(8):748-759, 2022. doi:10.1001/jama.2022.1190

  • 3. Lyu T, Liang C, Liu J, et al: Risk for stillbirth among pregnant individuals with SARS-CoV-2 infection varied by gestational age [published online ahead of print, 2023 Feb 28]. Am J Obstet Gynecol S0002-9378(23)00132-1, 2023. doi:10.1016/j.ajog.2023.02.022

  • 4. DeSisto CL, Wallace B, Simeone RM, et al: Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021. MMWR Morb Mortal Wkly Rep 70:1640–1645, 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7047e1external icon.

  • 5. Olsen EO, Roth NM, Aveni K, et al: SARS-CoV-2 infections among neonates born to pregnant people with SARS-CoV-2 infection: Maternal, pregnancy and birth characteristics. Paediatr Perinat Epidemiol 36(4):476-484, 2022. doi:10.1111/ppe.12883

  • 6. Musa SS, Bello UM, Zhao S, et al: Vertical Transmission of SARS-CoV-2: A Systematic Review of Systematic Reviews. Viruses 13(9):1877, 2021. doi:10.3390/v13091877

Diagnosis of COVID-19 During Pregnancy

  • Real-time reverse transcriptase–polymerase chain reaction (RT-PCR) or other nucleic acid amplification test (NAAT) of upper and lower respiratory secretions

  • Antigen testing of upper respiratory secretions

Chest x-ray and/or CT, if indicated, may be done because the fetal radiation doses are low.

Treatment of COVID-19 During Pregnancy

  • Supportive

  • Sometimes, combination nirmatrelvir and ritonavir

General medical treatment for COVID-19 Treatment COVID-19 is a respiratory illness caused by the novel coronavirus SARS-CoV-2. Infection may be asymptomatic or have symptoms ranging from mild upper respiratory symptoms to acute respiratory... read more is mainly supportive and is similar in pregnant and nonpregnant patients. Acetaminophen is recommended for treatment of fever and mild to moderate pain. Treatment with a combination of nirmatrelvir and ritonavir may be considered in pregnancy, because it can shorten the length of illness and make symptoms less severe. A small study found that pregnant patients did not develop any serious adverse effects from the treatment, and no complications were associated with the medication (1 Treatment reference COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on several studies, the epidemiology, virology, transmission, and symptoms and signs... read more ).

Oxygen saturation should be kept > 95% or a PaO2 of > 70 mm Hg.

Management of symptomatic hospitalized pregnant patients with COVID-19 should involve a multidisciplinary team, including respiratory or infectious disease specialists as needed.

Treatment reference

  • 1. Garneau WM, Jones-Beatty K, Ufua MO, et al: Analysis of Clinical Outcomes of Pregnant Patients Treated With Nirmatrelvir and Ritonavir for Acute SARS-CoV-2 Infection. JAMA Netw Open 5(11):e2244141, 2022. doi:10.1001/jamanetworkopen.2022.44141

Prevention of COVID-19 During Pregnancy

Pregnant women should follow general good-health practices to avoid exposure to infections, including regular handwashing and avoiding other people with contagious infections, if possible.

COVID-19 vaccine

The Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) recommend COVID-19 vaccination COVID-19 Vaccine COVID-19 vaccines provide protection against COVID-19, the disease caused by infection with the SARS-CoV-2 virus. Vaccination is the most effective strategy to prevent severe illness and death... read more for all eligible people who are pregnant, breastfeeding, trying to get pregnant, or who might become pregnant in the future (see CDC: COVID-19 Vaccines While Pregnant or Breastfeeding and ACOG: COVID-19 Vaccination Considerations for Obstetric–Gynecologic Care). Evidence supports the safety and effectiveness of COVID-19 vaccination during pregnancy (1 Prevention references COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on several studies, the epidemiology, virology, transmission, and symptoms and signs... read more ). These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.

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 (2 Prevention references COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on several studies, the epidemiology, virology, transmission, and symptoms and signs... read more ). The antibodies help infants gain immunity that can protect them from COVID-19.

Breastfeeding

Risk of transmitting the virus in breast milk is low or absent. 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, the woman should put on a mask and thoroughly wash hands and any pump parts, bottles, and artificial nipples prior to expressing milk (3 Prevention references COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on several studies, the epidemiology, virology, transmission, and symptoms and signs... read more ).

Prevention references

  • 1. Ciapponi A, Berrueta M, P K Parker E, et al: Safety of COVID-19 vaccines during pregnancy: A systematic review and meta-analysis. Vaccine 41(25):3688-3700, 2023. doi:10.1016/j.vaccine.2023.03.038

  • 2. Gray KJ, Bordt EA, Atyeo C, et al: Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol 225(3):303.e1-303.e17, 2021. doi:10.1016/j.ajog.2021.03.023

  • 3. American Academy of Pediatrics (AAP): Post-Hospital Discharge Guidance for Breastfeeding Parents or Newborn Infants With Suspected or Confirmed SARS-CoV-2 Infection. Last updated August 2, 2022.

Key Points

  • Manifestations, diagnosis, and treatment of COVID-19 are similar in pregnant and nonpregnant patients.

  • Risks of obstetric complications are increased.

  • Vertical transmission is rare, and transmission in breast milk is unlikely.

  • Counsel pregnant women about COVID-19 vaccination.

Drugs Mentioned In This Article

Drug Name Select Trade
Norvir
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
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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