Pregnant individuals are considered a group at increased risk for severe illness from COVID-19 compared to their non-pregnant counterparts. Physiological changes in pregnancy, such as altered immune responses and mechanical changes to the respiratory system, make the body more susceptible to complications from respiratory infections. Understanding the specific risks associated with COVID-19 infection during gestation is important for both the pregnant individual and their healthcare providers. Current data provides insights into the potential impacts on both maternal and fetal health, guiding recommendations for prevention and treatment.
Impact on Maternal Health
Infection with COVID-19 significantly raises the risk of severe outcomes for the pregnant individual. Studies have shown that pregnant people with COVID-19 are more likely to require hospitalization, admission to the intensive care unit (ICU), and invasive ventilation support compared to non-pregnant individuals with the infection. This heightened risk means that the illness can progress more quickly and severely in this population.
The infection is associated with an increased likelihood of specific obstetric complications. One such complication is preeclampsia, characterized by high blood pressure and signs of damage to another organ system. Pregnant individuals who contract COVID-19 are also at a higher risk for thromboembolism, or the formation of blood clots, which can be life-threatening.
Severe COVID-19 disease can also lead to acute respiratory distress syndrome (ARDS), a form of respiratory failure that requires prompt and specialized medical intervention. The physiological adaptations of pregnancy, including the diaphragm’s elevation, already reduce lung capacity, making pregnant patients particularly vulnerable to ARDS from viral pneumonia.
Risks to Fetal and Neonatal Outcomes
COVID-19 infection in the pregnant individual can also affect the developing fetus and the newborn, primarily by increasing the risk of adverse birth outcomes. The most frequently reported complication is preterm birth, defined as delivery before 37 weeks of gestation. This increased risk of early delivery often leads to a higher rate of admission to the neonatal intensive care unit (NICU) for the newborn.
Infection during pregnancy has also been associated with an increased risk of stillbirth and low birth weight. Severe maternal illness and related complications like preeclampsia are thought to contribute to these adverse outcomes.
The concern about vertical transmission, the passage of the virus from the pregnant individual to the baby before or during birth, has been a major focus of research. Current evidence suggests that while vertical transmission is possible, it appears to be a relatively rare event. Most newborns born to individuals with COVID-19 do not test positive for the virus immediately after birth. When newborns do contract the virus, they typically experience mild illness, and there is no evidence of an increased risk of congenital abnormalities.
Safety and Recommendations for Vaccination
COVID-19 vaccination is recommended for all individuals who are pregnant, breastfeeding, trying to conceive, or who may become pregnant in the future. Major health organizations, including the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG), advise that the vaccine can be received at any point during pregnancy. This recommendation is based on extensive data confirming the safety and effectiveness in this population.
Clinical studies and registry data have consistently shown that vaccination does not increase the risk of common pregnancy complications, including miscarriage, preterm delivery, or stillbirth. Furthermore, the vaccines have not been associated with fertility problems.
A primary benefit of vaccination during pregnancy is the transfer of protective antibodies to the baby. Antibodies created by the pregnant individual’s immune system cross the placenta, offering the newborn a measure of protection against the virus. These antibodies may help prevent severe illness in the baby during their first months of life. Vaccination is also safe for individuals who are breastfeeding.
Managing an Infection During Pregnancy
If a pregnant individual tests positive for COVID-19, contacting a healthcare provider immediately is the most important step. Because pregnancy is a high-risk factor for severe disease, a healthcare team can quickly assess the need for close monitoring and treatment. Even if symptoms are mild, the individual is considered a candidate for treatments aimed at preventing the infection from progressing.
Close monitoring of symptoms is necessary, particularly oxygen saturation levels, which should be maintained at a higher target in pregnant individuals (typically 94-98%). If symptoms become severe, such as difficulty breathing or persistent chest pain, immediate emergency medical care is necessary. Healthcare providers may consider various treatments, including antiviral medications like Paxlovid, which work best when started within five days of symptom onset.
While pregnant individuals were often excluded from initial clinical trials, guidelines recommend against withholding therapeutics solely because of pregnancy. The use of corticosteroids, such as dexamethasone, is standard for managing severe COVID-19 with an oxygen requirement. The overall goal is to manage the infection to minimize the risk of severe disease, which helps protect both the pregnant individual and the fetus.