24/11/21 19:32 COVID-19 and pregnancy: Questions and answers - UpToDate

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COVID-19 and pregnancy: Questions and answers

Written by the doctors and editors at UpToDate

All topics are updated as new evidence becomes available and our peer review process is
complete.

Literature review current through: March 2021. | This topic last updated: November 18, 2021.

This topic provides answers to some of the most commonly asked questions by UpToDate
users. Additional content on coronavirus disease 2019 (COVID-19) is provided separately.

● (See "COVID-19: Epidemiology, virology, and prevention".)

● (See "COVID-19: Clinical features" and "COVID-19: Diagnosis".)
● (See "COVID-19: Management in hospitalized adults".)
● (See "COVID-19: Management of the intubated adult".)
● (See "COVID-19: Pregnancy issues and antenatal care".)
● (See "COVID-19: Arrhythmias and conduction system disease".)
● (See "COVID-19: Anesthetic concerns, including airway management and infection
control".)
● (See "COVID-19: Cancer screening, diagnosis, post-treatment surveillance in uninfected
patients during the pandemic, and issues related to COVID-19 vaccination in cancer
patients".)
● (See "Society guideline links: COVID-19 – Index of guideline topics".)
● (See "Patient education: COVID-19 and pregnancy (The Basics)".)
● (See "Patient education: COVID-19 overview (The Basics)".)
● (See "Patient education: COVID-19 vaccines (The Basics)".)
● (See "Patient education: COVID-19 and children (The Basics)".)
● (See "COVID-19: Questions and answers".)

PRENATAL CARE

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Are pregnant women more susceptible to COVID-19 or at higher risk for complications of
COVID-19?

Pregnancy and childbirth generally do not increase the risk for acquiring severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but appear to worsen the clinical
course of COVID-19 compared with nonpregnant individuals of the same sex and age; however,
most (>90 percent) infected persons recover without undergoing delivery. (See "COVID-19:
Pregnancy issues and antenatal care", section on 'Maternal course'.)

Does COVID-19 increase the risk for pregnancy complications?

Yes, infected women, especially those who develop pneumonia, appear to have an increased
frequency of preterm birth (birth before 37 weeks of gestation) and possibly cesarean delivery,
which is likely related to severe maternal illness. Most preterm births are iatrogenic (ie, induced
labor or scheduled cesarean delivery). (See "COVID-19: Pregnancy issues and antenatal care",
section on 'Pregnancy and newborn outcome'.)

Does SARS-CoV-2 cross the placenta?

There is no definite evidence that SARS-CoV-2 crosses the placenta and infects the fetus;
however, a few cases of placental tissue or membranes positive for SARS-CoV-2 and a few cases
of possible in utero infection have been reported. Some of the neonatal cases may have been
false-positive test results or due to acquisition of infection soon after birth. Reports of COVID-19
infection in the neonate have generally described mild disease. (See "COVID-19: Pregnancy
issues and antenatal care", section on 'Frequency of congenital infection'.)

How can prenatal care be modified to decrease risk of contracting COVID-19?

The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-
Fetal Medicine (SMFM) support modifying traditional protocols for prenatal visits to limit
person-to-person contact and thus help prevent spread of COVID-19. Modifications should be
tailored for low- versus high-risk pregnancies (eg, multiple gestation, hypertension, diabetes)
and may include telehealth in areas of active infection transmission, reducing the number of in-
person visits, timing of visits, grouping tests (eg, aneuploidy, diabetes, infection screening) to
minimize maternal contact with others, restricting visitors during visits and tests, timing of
indicated obstetric ultrasound examinations, and timing and frequency of use of nonstress
tests and biophysical profiles. (See "COVID-19: Pregnancy issues and antenatal care", section on
'Uninfected pregnant persons'.)

Should glucocorticoids be avoided in pregnant women with COVID-19?

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No, pregnant women who meet criteria for use of glucocorticoids for maternal treatment of
COVID-19 can receive standard doses of dexamethasone. For those who also meet criteria for
use of antenatal corticosteroids for fetal lung maturity, we suggest administering the usual
doses of dexamethasone (four doses of 6 mg given intravenously 12 hours apart) to induce
fetal pulmonary maturation and continuing dexamethasone to complete the usual course of
treatment for maternal COVID-19 (6 mg orally or intravenously daily for 10 days or until
discharge, whichever is shorter). (See "COVID-19: Pregnancy issues and antenatal care", section
on 'Use of dexamethasone'.)

Are SARS-CoV-2 vaccines safe for pregnant women and women planning pregnancy?

Yes. We recommend COVID-19 vaccination for pregnant women rather than deferring
vaccination until after delivery. This recommendation is based on increasingly reassuring data
regarding the safety and efficacy of COVID-19 vaccines during pregnancy as well as data that
pregnancy itself is associated with an increased risk of severe infection (CDC tier 1c vaccine
allocation). The SARS-CoV-2 vaccines that are clinically available do not contain virus that
replicates.

Because of their increased risk for severe infection, pregnant people are eligible for a booster
dose when public health authorities recommend boosters for individuals at high risk for severe
COVID-19.

Vaccination can occur at the same time as administration of a routinely administered vaccine,
such as the Tdap and influenza; a separation period is unnecessary. (See "COVID-19: Pregnancy
issues and antenatal care", section on 'Vaccines'.)

Vaccination does not affect fertility, and it is not necessary to delay pregnancy after vaccination.
(See "COVID-19: Pregnancy issues and antenatal care", section on 'Reproductive decision-
making'.)

LABOR AND DELIVERY

Is maternal COVID-19 an indication for cesarean delivery?

No, COVID-19 is not an indication to alter the route of delivery. Even if vertical transmission is
confirmed as additional data are reported, this would not be an indication for cesarean delivery
since it would increase maternal risk and would be unlikely to improve newborn outcome. (See
"COVID-19: Labor, birth, and postpartum issues and care", section on 'Choosing the route of
birth'.)

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Should planned induction of labor or cesarean delivery of asymptomatic women be

postponed during the pandemic?

No, in asymptomatic women, inductions of labor and cesarean deliveries with appropriate
medical indications should not be postponed or rescheduled. This includes 39-week inductions
or cesarean deliveries after patient counseling. (See "COVID-19: Pregnancy issues and antenatal
care", section on 'Timing of delivery'.)

How should labor pain be managed in women with COVID-19?

A neuraxial anesthetic is generally preferred to other options for management of labor pain
because it provides good analgesia and thus reduces cardiopulmonary stress from pain and
anxiety. In addition, it is available in case an emergency cesarean is required, thus obviating the
need for general anesthesia. The Society of Obstetric Anesthesia and Perinatology (SOAP)
suggests considering suspending use of nitrous oxide for labor analgesia in patients with
confirmed or suspected COVID-19 because of insufficient data about cleaning, filtering, and
potential aerosolization of nitrous oxide systems, but it remains an option for patients with a
negative SARS-CoV-2 test. (See "COVID-19: Labor, birth, and postpartum issues and care",
section on 'Labor analgesia and anesthesia in patients with known or suspected COVID-19'.)

Can an asymptomatic partner/support person attend labor and delivery?

Practices vary by institution. At a minimum, the support person should be screened in

accordance with hospital policies, and those with any symptoms consistent with COVID-19,
exposure to a confirmed case within 14 days, or a positive test for COVID-19 within 14 days
should not be allowed to attend the labor and birth. Most facilities recognize that a support
person is important to many laboring women and permit one support person who must remain
with the laboring woman (may not leave the room and then return). Additional support persons
may be allowed or can be a part of the patient's labor and delivery via video. (See "COVID-19:
Labor, birth, and postpartum issues and care", section on 'What infection control precautions
should be taken on the labor and delivery unit?'.)

POSTPARTUM

How should the baby be evaluated?

If the mother has known COVID-19, the infant is a COVID-19 suspect and should be tested,
isolated from other healthy infants, and cared for according to infection control precautions for

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patients with confirmed or suspected COVID-19. (See "COVID-19: Labor, birth, and postpartum
issues and care", section on 'Newborn evaluation'.)

Should mothers with COVID-19 be separated from their baby?

Generally no because the newborn's risk for acquiring SARS-CoV-2 from the mother is low, and
data suggest no difference in risk of neonatal SARS-CoV-2 infection whether the neonate is
cared for in a separate room or remains in the mother's room. However, mothers should wear a
mask and practice hand hygiene during contact with their infants. At other times, physical
distancing >6 feet between the mother and neonate or placing the neonate in an incubator is
desirable when feasible. (See "COVID-19: Labor, birth, and postpartum issues and care", section
on 'Mother-newborn contact in the hospital'.)

How long should mother-baby precautions at home continue after recent infection?

Previously symptomatic mothers with suspected or confirmed COVID-19 are not considered a
potential risk of virus transmission to their neonates if they have met the criteria for
discontinuing isolation and precautions:

● At least 10 days have passed since their symptoms first appeared (up to 20 days if they
have more severe to critical illness or are severely immunocompromised).

● At least 24 hours have passed since their last fever without the use of antipyretics.

● Their other symptoms have improved.

For asymptomatic mothers identified only by obstetric screening tests, at least 10 days should
have passed since the positive test. (See "COVID-19: Labor, birth, and postpartum issues and
care", section on 'Criteria for discontinuing mother-newborn infection precautions'.)

Can breast milk transmit SARS-CoV-2?

There is general consensus that breastfeeding should be encouraged because of its many
maternal and infant benefits. It is unknown whether SARS-CoV-2 can be transmitted through
breast milk because very few breast milk samples have been tested. In a World Health
Organization (WHO) study, breast milk samples from 43 mothers were negative for SARS-CoV-2
by reverse transcription polymerase chain reaction (RT-PCR) and samples from three mothers
tested positive, but specific testing for viable and infective virus was not performed. (See
"COVID-19: Labor, birth, and postpartum issues and care", section on 'Breastfeeding and
formula feeding'.)

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What precautions should mothers with confirmed or suspected COVID-19 take when
breastfeeding?

Droplet transmission from infected mothers to their baby could occur through close contact
during breastfeeding. Mothers can take precautions to prevent this by performing hand and
breast hygiene and using a face mask. In a study from New York City that tested and followed
82 infants of 116 mothers who tested positive for SARS-CoV-2, no infant was positive for SARS-
CoV-2 postnatally, although most roomed-in with their mothers and were breastfed. The infants
were kept in a closed isolette while rooming-in, and the mothers wore surgical masks while
handling their infants and followed frequent hand and breast washing protocols.

Alternatively, the infant can be fed expressed breastmilk by a healthy caregiver following
hygiene precautions until the mother has recovered or is proven uninfected. In such cases, the
mother should use strict handwashing before pumping and wear a face mask during pumping.
(See "COVID-19: Labor, birth, and postpartum issues and care", section on 'Breastfeeding and
formula feeding'.)

Can pregnant and postpartum women with COVID-19 take NSAIDs and acetaminophen?

Yes, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be used for
treatment of fever and pain during pregnancy and postpartum. Antepartum, the lowest
effective NSAID dose is used, ideally for less than 48 hours and guided by gestational age-
related potential fetal toxicity (eg, oligohydramnios, premature closure of the ductus
arteriosus). Low-dose aspirin for prevention of preeclampsia is safe throughout pregnancy. In
patients with abnormal liver chemistries secondary to COVID-19, a potential concern of
acetaminophen use is hepatic toxicity; however, doses less than 2 grams per day are likely safe
in the absence of severe or decompensated hepatic disease. (See "COVID-19: Pregnancy issues
and antenatal care", section on 'Use of NSAIDs and acetaminophen'.)

Are SARS-CoV-2 vaccines safe for breastfeeding women?

Yes. We recommend COVID-19 vaccination for breastfeeding women rather than deferring
vaccination until after breastfeeding. Maternal COVID-19 antibodies induced by maternal
vaccination can pass into breast milk and may have protective effects for the infant. If any
vaccine crosses into breast milk and is then ingested by the infant, it is likely to be inactivated
by the infant's digestive system. (See "COVID-19: Labor, birth, and postpartum issues and care",
section on 'SARS-CoV-2 vaccines'.)

REFERENCES
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