More than one year into coronavirus pandemic, your questions answered on pregnancy and COVID-19

April 29, 2021

(NEW YORK) — Being pregnant amid the global coronavirus pandemic has been a scary and unpredictable time for many expectant people.

The ongoing pandemic has led pregnant people to question everything from whether they should travel to whether they should work from home, self-quarantine and get a COVID-19 vaccine.

Here are six burning questions answered about pregnancy and the coronavirus:

1. Are pregnant people at higher risk?

Because COVID-19 is a new virus, there is less information known on whether pregnant people are more susceptible to contracting COVID-19 than the general population. The U.S. Centers for Disease Control and Prevention does point out though that pregnant people do have weakened immune systems and may be more susceptible to viral respiratory infections, including COVID-19.

More than one year into the pandemic though, there is now data showing the increased risks the virus poses during pregnancy.

Pregnant people who contracted COVID-19 were 22 times more likely to die than pregnant people who did not contract the virus, according to a global study published in April in JAMA Pediatrics. They also were found to have an increased risk of severe pregnancy complications, including preeclampsia, preterm birth and intensive care unit admission. Individuals who were symptomatic or had comorbidities, such as diabetes or were overweight, had a greater risk of complications and death, researchers said.

Pregnant people who had asymptomatic infections had a higher risk for preeclampsia, though otherwise had similar outcomes to pregnant women who were not diagnosed with COVID-19, researchers said.

Newborns of people diagnosed with COVID-19 were more likely to be born preterm and have severe complications, including NICU stays of seven days or longer, the study found.

Shortness of breath, chest pain and cough with fever were associated with a “substantial” increase in the risk of complications for the mother and preterm birth, the study found.

2. What precautions should pregnant people take?

The CDC recommends the general public, including pregnant people, take precautions including staying six feet apart from people who don’t live with you; wearing a face mask that covers the nose and mouth; getting a COVID-19 vaccine; avoiding crowds and poorly ventilated indoor spaces and washing hands often with soap and water.

In newly-released guidance, the CDC said that people who are considered fully immunized can forgo face coverings for some outdoor activities. However, guidelines say to keep a mask on in crowded indoor spaces like grocery stores or on public transportation.

3. Is the COVID-19 vaccine safe for pregnant people?

Messenger RNA vaccines for COVID-19, such as those produced by Moderna and Pfizer, showed no obvious safety concerns for pregnant women, according to a preliminary report published in April in the New England Journal of Medicine.

Messenger RNA, or mRNA, technology does not enter the nucleus of the cells and doesn’t alter the human DNA. Instead, it sends a genetic instruction manual that prompts cells to create proteins that look like the virus as a way for the body to learn and develop defenses against future infection.

Another study, published in the American Journal of Obstetrics & Gynecology in March, also found the Pfizer and Moderna vaccines are safe and effective in pregnant and lactating people and those people are able to pass protective antibodies to their newborns.

The CDC has concluded that pregnant people can receive the Johnson & Johnson one-shot vaccine, which is not made with mRNA, after reviewing more than 200 pages of data provided by the company and the U.S. Food and Drug Administration (FDA).

Pregnant people are recommended by the CDC to be included in Phase 1c of states’ vaccine distribution plans. The CDC says getting vaccinated is a personal choice for pregnant people and they should discuss the risks and benefits with their doctors.

Phase 1c includes “persons 65-74 years of age, persons 16-64 years of age with high-risk medical conditions, and other essential workers as defined in each jurisdiction,” according to the CDC. Pregnancy is classified as a high-risk medical condition by the CDC.

The World Health Organization (WHO) recently updated its guidance to say pregnant people at high risk of exposure to COVID-19 and those at risk of severe disease should be vaccinated.

4. Should pregnant people travel?

There is no guidance that pregnant women should not travel, so it’s ultimately a personal decision.

Pregnant women should consult with their doctors first. Factors to consider include where you’re considering traveling, how far along in your pregnancy you are and what your backup plan would be.

In addition to considering whether the country in question has seen a significant influx of COVID-19 cases, think about the situation on the ground. Has travel within the country been disrupted? How would you feel about potentially being quarantined upon returning to the United States? Is there a risk you could be grounded due to canceled flights or quarantines and not be able to travel home? Would you have access to medical care at your destination?

The U.S. State Department provides travel advisories that include up-to-date recommendations about which countries have reported cases of COVID-19 and how widespread infections have been. The situation is fluid and rapidly evolving, so you should check back often and use that information to inform what’s essentially a personal decision.

5. Can coronavirus be transferred to the fetus?

There is still more research to be done to determine whether a pregnant person could pass the virus to her fetus before, during or after delivery.

One small study in Italy last spring found that a pregnant person infected with the coronavirus might be able to spread it to her fetus, but the study’s leader said it was still “too early to make guidelines” or to change care.

According to the CDC, some newborns have tested positive for COVID-19 shortly after birth but it is not known if the newborns got the virus before, during, or after birth. There have been a “few reports” of newborns with severe COVID-19 illness, but most newborns who test positive have mild to no symptoms and recover.

6. Is it safe for a person with COVID-19 to breastfeed?

If a person is diagnosed with COVID-19, she should talk with her health care provider and family about whether to continue breastfeeding, according to the CDC.

“Current evidence suggests that breast milk is not likely to spread the virus to babies,” the CDC notes on its website.

People with COVID-19 should wash their hands before breastfeeding and should wear a mask when breastfeeding and whenever they are within six feet of the baby, according to the CDC.