FAQs: Coronavirus and pregnancy

Updated as of January 2021

Want to know what the COVID-19 vaccine developments mean and what you should expect if you're pregnant? Read the latest FAQs on the COVID-19 vaccine from Dr. Jane van Dis with all of the details she has gathered for pregnant women, as well as anyone looking for more information about the vaccine, effectiveness, limitations, and more.

The latest CDC research shines new light on the heightened risks for pregnant women due to COVID-19 with the largest CDC study on the virus during pregnancy to-date. The study suggests that pregnant women are at a heightened risk of death and severe illness if infected by COVID-19, and more likely to require admission to intensive care, compared with non-pregnant women of the same age—though there are important limitations to call out. Our Medical Director, Dr. Jane van Dis, breaks down what pregnant women need to know about the findings, what it means for them, and how to stay healthy.

“If you’re pregnant and these recent headlines are making you anxious, you’re not alone,” shares Maven Medical Director Dr. Jane van Dis. “I encourage you to reach out to a Maven Mental Health Provider to talk through your anxiety, and we also have OB-GYNS ready for a video appointment right now on Maven’s app who can help talk you through the risks of COVID-19, and how to keep you and your baby safe. We’re here for you.”

While these new findings will be troubling for many, please know that precautions remain very effective in preventing the spread of COVID-19 and keeping yourself healthy. Continue to wear a mask whenever you leave your house, wash your hands frequently, and avoid any indoor gatherings of any size. If you’re feeling anxious or stressed, please reach out for support. At Maven, we’ve seen marked utilization of our mental health services to support pregnant women—as well as all of our members.

We remain committed to helping our members, our providers, and our clients navigate COVID-19, and recommend staying up-to-date with information from the Centers for Disease Control and Prevention (CDC) and the Society of Maternal Fetal Medicine. Maven’s virtual clinic is open 24/7 with doctors and specialists who are available to provide the latest information, answer your questions and manage your concerns, and more.

FAQs: What pregnant women should know about COVID-19

FAQs answered by Dr. Jane van Dis, Maven Medical Director and OB-GYN, based on the latest clinical guidance and information.

Should pregnant women get the COVID-19 vaccine?

The American College of Obstetricians and Gynecologists (ACOG) released a statement on December 13th stating the following, among additional details:

• ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on CDC Advisory Committee on Immunization Practices (ACIP)-recommended priority groups.
• COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP.
• Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available.

Among my peers, the overall consensus is that it would be unethical to withhold this vaccine from pregnant women.  Here’s a helpful editorial about this and the process by which pregnant women were excluded from these trials to date.

For a complete breakdown of what pregnant women need to know about the COVID-19 vaccine and more details, read our FAQs here.

What does the latest CDC data tell us about how pregnant women are being disproportionately affected by COVID-19?

In contrast to previous CDC data, the latest research reveals pregnant women were more likely to die of COVID-19: 1.5 per 1,000 symptomatic pregnant women died of COVID, compared to 1.2 per 1,000 non-pregnant women.

This report also found that pregnant women were at slightly increased risk of needing to be connected to an ECMO machine—meaning extracorporeal membrane oxygenation, which pumps and oxygenates a patient’s blood outside the body; similar to the machine used in open-heart surgery: 17 per 1,000 for non-pregnant women versus 120 per 1,000 for pregnant women.

As has been previously reported by the CDC, researchers found that pregnant women were at increased risk of:

• ICU admission: approximately 10.5 out of 1,000 pregnant women admitted to ICUs compared to 3.9 out of 1,000 non-pregnant women admitted to ICUs
• Being placed on a ventilator: 3x higher than non-pregnant women

The most frequently reported signs and symptoms of COVID-19–as previously noted—experienced by pregnant women were: cough, headache, muscle aches, and fever.

Racial disparities reported here mirror the CDC’s June report noting that: “Hispanic pregnant women of any race not only experienced a disproportionate risk for COVID-19 infection but also a higher risk for death compared with non-pregnant Hispanic women, and, regardless of pregnancy status, non-Hispanic Black women experienced a disproportionate number of deaths relative to their distribution among reported cases. This analysis highlights racial and ethnic disparities in both risk for infection and disease severity among pregnant women, indicating a need to address potential drivers of risk in these populations.”

For more on this report's findings and what pregnant women need to know, read Dr. Jane van Dis's analysis here.

Why are pregnant women more at risk of being admitted to the ICU?

The answer as to why pregnant women would be at increased risk of ICU admission and mechanical ventilation if they contract COVID-19 is likely multifactorial but may be due, in part, to changes in the physiology and anatomy of the maternal adaptation to pregnancy including:

• hormonal effects on vasculature
• changes in immune function
• decreased residual capacity of the lungs and increased resting ventilation
• increased blood volume, work of the heart and entire cardiovascular system

Another possible contributor is the increased risk for micro- and macro-thrombosis (blood clots) in pregnant women with COVID. Lastly, of those pregnant women who experience severe cases of COVID-19, some exhibit the exaggerated inflammatory response (cytokine storm), which has been known to lengthen the course and severity of COVID.  

Are there things pregnant women can do to try and protect themselves?

Wear a mask, wash your hands frequently, and definitely don’t let your guard down to the risks of contracting COVID-19. While society has changed since March, the virus has not changed, and it’s important to remember that keeping everyone healthy through this pandemic is a marathon, not a sprint. There are still asymptomatic persons who are infected but don’t yet know they are infected.

What would you say to someone who is expecting and is worried about COVID-19?

Continue to take precautions to stay safe and healthy: wear a mask whenever you leave your house, wash your hands frequently, and avoid any indoor gatherings. When you can, take walks outdoors: getting fresh air and exercise is also good for mind and body. If you’re feeling anxious or stressed, know that you’re not alone. At Maven, we’ve seen marked utilization of our mental health services to support pregnant women—as well as all of our members. Surveys show up to 85% of women have increased anxiety and/or depression during this time. We encourage women to reach out for support, whether through talk therapy alone, or, if necessary, with medication.  

What do you recommend for pregnant women who think they may have symptoms or fear they’ve been exposed?

Even with the latest research, there are still many unknowns and we’re learning more all the time about the impact of COVID-19 on pregnancy. We do know that due to the changes of pregnancy—decreased lung capacity and changes in the immune system—pregnant women are at increased risk of severe disease if they acquire COVID-19.

Because pregnant women are at increased risk, the following is recommended:

• Prompt evaluation and treatment of concerning symptoms
• If a pregnant woman has a fever over 100.4, she should call her physician immediately (Make sure you have a thermometer at home)
• If she is experiencing shortness of breath, she should call her doctor and go to the nearest emergency room right away, wearing a mask
• She should also call ahead to let Labor & Delivery know she is coming so that the hospital can have personnel ready to triage her once she arrives, thereby protecting other patients and healthcare workers
• Pregnant women who don’t have a fever, but may have a dry cough and feel under the weather should not go immediately to their doctor’s office and risk exposing other pregnant women in the waiting room. They should call their doctor and get instructions and establish a care plan
• Pregnant women, because they are a vulnerable population, should always wear face masks when in public and should practice social distancing. If you can, shop for groceries at hours when fewer people are around (or have someone shop for you) and avoid any indoor gatherings with friends or family (you can do so if keeping distance and all wearing masks)

For women and their families preparing to go into the hospital for delivery, what should they expect? How can they stay safe at the hospital from COVID-19 and how are hospitals preparing for safe deliveries?

• We are universally masking all patients, and also administering COVID-19 tests upon admission into the hospital. While the test is uncomfortable. please know that this is for your own safety and so that we can all know best how to keep you, your baby, and your providers healthy through delivery.
• Labor & Delivery units are improving every day, and have made great strides to keep everyone safe—patients, partners, doctors and staff, and babies.
• Most hospitals are limiting visitors, some to only one or two people. There can’t be any alternating between people, like we would commonly see in a Labor & Delivery room. A lot of hospitals are currently putting in a separate entrance for Labor & Delivery as well.
• One thing that will be different in the hospitals, in Labor & Delivery in particular, is that we’re going to see more virtual care. On Maven, we have virtual doulas, lactation consultants, certified nurse midwives; so even if your doula who you worked with throughout your pregnancy is restricted because your hospital is only allowing one person with you and you’re going to bring your partner, you can still connect virtually with birth personnel. I want to remind women that even though some of the systems are changing, you shouldn’t feel alone.

What should pregnant women in the 2nd or 3rd trimester know about COVID-19 and potential risks for preterm birth or labor and delivery?

• Most pregnant women, if they contract the virus, will have a mild form and will recover without complication
• Severe COVID-19, if untreated, could cause pneumonia and kidney failure which might impact their fetus and lead to premature births (before 37 weeks)
• In-utero transmission of COVID-19 is possible, but is relatively rare—according to research to-date. Research out of Italy from July 9th is an extremely small sample size: two babies tested positive out of 31 pregnant women infected with COVID-19. Importantly, both infants recovered quickly. We have seen similar studies throughout the pandemic, all demonstrating transmission is a rare event and that infants commonly test negative within a few days of testing positive. In this recent review published in June in Obstetrics & Gynecology, of 310 pregnancies, researchers found a vertical transmission rate of 0%. And this review found a 1.7% rate (3 out of 179) for infants testing positive for infection.

How might COVID-19 change my birth plan if I’m due soon?

• Call and speak with your doctor, and learn about your hospital’s Labor & Delivery policies
• Delivery will still be based on gestational age, how far along you are, whether there are any maternal indications such as severe preeclampsia, or whether there are any fetal indications such as intrauterine growth restriction, the baby not growing very well, or the like. The standard protocols by which we recommend delivery are still in practice and being followed
• Vaginal delivery will still be the preferred method of delivery for women with COVID-19 in labor. C-section is indicated for signs of shock, respiratory distress, fetal distress, or other maternal or fetal complications
• If you are infected with COVID-19 during your hospital stay, you may be put in a contact isolation room and visitors will be limited