Covid While Pregnant

Overview

COVID-19 is an infection caused by a virus called coronavirus (SARS-CoV-2). It mainly affects your breathing system, but it can make you feel unwell all over. It spreads easily from person to person through tiny droplets in the air when someone coughs, talks or breathes near you. Most pregnant women who catch COVID-19 have mild illness and recover well. But pregnancy does make you a little more likely to become seriously unwell, especially in the later months, so it's important to know what to look out for and who to call.

Yes. COVID-19 is very common and spreads easily. Many pregnant women around the world have had it, and most have recovered fully and had healthy babies.

Anyone can catch COVID-19, at any age. In pregnancy, the chance of becoming more seriously ill is higher in the later months, and also for women who are older, have a higher body weight, have diabetes or high blood pressure, are expecting twins or more, have other long-term health conditions, or are from some ethnic minority backgrounds. Health professionals use this information to decide who may need extra check-ups.

Symptoms

Common symptoms

• A high temperature (fever) or feeling shivery
• A new, continuous cough
• A sore throat or runny nose
• Feeling very tired or achy
• A headache
• Losing your sense of taste or smell, or things smelling or tasting different
• Shortness of breath, especially with mild activity
• Feeling sick, being sick, or loose stools (diarrhoea)

Causes

Main causes

• Infection with the coronavirus (SARS-CoV-2), which spreads through tiny droplets and particles in the air when an infected person breathes, talks, coughs or sneezes near you
• Being in close contact with someone who has COVID-19, especially indoors with poor airflow
• Touching surfaces that have the virus on them and then touching your eyes, nose or mouth (this is a less common route than breathing it in)

Risk factors

• Being in the later stages of pregnancy, especially the third trimester
• Having a higher body mass index (BMI)
• Having diabetes or high blood pressure, including conditions that start in pregnancy
• Being older when pregnant, or expecting twins or more
• Having a long-term health condition, such as heart or lung disease, or a weakened immune system
• Being from a Black, Asian or other ethnic minority background, where health services have recorded higher risks
• Smoking
• Not having had the COVID-19 vaccine

When to see a doctor

See a doctor urgently if:

• You have COVID-19 symptoms and you are pregnant — contact your midwife or maternity team for advice early on, even if you feel only mildly unwell
• Any change in your baby's movements, or bleeding, or fluid leaking from the vagina
• Breathlessness that is getting worse, or a fever that is not settling
• You are unable to keep fluids down, or you feel dizzy or faint
• You feel very low in mood, panicky, or unable to cope

Book a routine appointment if:

• You want to talk about the COVID-19 vaccine in pregnancy
• You feel unsure whether your symptoms need checking
• You are worried about how COVID-19 might affect your birth plan or your antenatal appointments
• You are feeling anxious or low and would like some support
• You have recovered but are still unusually tired or breathless

Diagnosis

COVID-19 is usually confirmed with a quick swab test of your nose and throat, or a test you do at home. If you are pregnant and unwell, your midwife or doctor will also check how you are doing overall: your temperature, your breathing, your oxygen levels, and how your baby is growing and moving.

Tests that may be done

• A swab test (nose and throat) or a home test kit to look for the virus
• A small clip on your finger called a pulse oximeter, which measures the oxygen level in your blood
• Blood tests to check how your body is coping
• Blood pressure and urine checks as part of your normal antenatal care
• An ultrasound scan, or a recording of your baby's heartbeat, to check on your baby
• A chest X-ray only if your breathing team thinks it is needed — this can be done safely in pregnancy with protection for your baby

What to expect at your appointment

If your symptoms are mild, you will usually be asked to stay at home, rest and keep in touch with your maternity team by phone. If you are more unwell, you may be asked to come to hospital for monitoring. Your team will explain each step and check on you and your baby regularly. You can always ask questions or say if something does not feel right.

Treatment

Treatment depends on how unwell you are. Most pregnant women manage at home with rest, fluids and medicines for fever and aches that are suitable in pregnancy. If you become more unwell, the hospital team will watch you closely, support your breathing, and give treatment to lower the risk of serious illness. Any treatment decisions will be made with you, not for you.

Self-care at home

• Rest as much as you can, and ask for help with chores and other children
• Drink fluids regularly — small sips often is easier than large drinks
• Take a medicine for fever and aches that is safe in pregnancy — ask your midwife, doctor or pharmacist which one is right for you
• Check your breathing and how you feel each day, and keep a note of any changes
• Keep up your usual antenatal appointments by phone or in person as your team advises
• Sleep propped up on your side if you are more comfortable that way, and rest on your left side if you feel lightheaded
• Keep the room ventilated and stay away from others at home as much as you can

Medical treatments

If you are unwell enough to be in hospital, your team may give you extra oxygen, fluids through a drip, and medicines chosen to help your immune system fight the virus. Some pregnant women are offered antiviral treatment or other medicines after an individual discussion about the benefits and risks. You may also be given treatment to reduce the risk of blood clots, which is a known risk in pregnancy and with infections. Your baby will be monitored more often. Your team will explain each option and ask for your consent before anything is given.

When is surgery considered?

Most women with COVID-19 do not need a caesarean (C-section) because of the infection. If you become very unwell, or your baby needs to be born early for their safety or yours, your team may recommend delivering your baby sooner. This is always a shared decision, discussed with you and your family where possible.

Living with this condition

While you are recovering, take things slowly. Your body is working hard growing a baby as well as fighting an infection, so tiredness can last a while. Keep in touch with your midwife, keep track of your baby's movements, and ask family or friends for practical help with shopping, cooking and childcare. Follow your local health service's advice about staying away from others while you may be infectious.

Lifestyle tips

• Wash your hands often with soap and water, and keep rooms well ventilated
• Wear a mask in crowded or enclosed places if you feel comfortable doing so
• Avoid close contact with people who are unwell where you can
• Do not smoke, and avoid being around others who smoke — ask for help to stop if you need it
• Keep up gentle movement when you feel able, and rest when you need to
• Attend your antenatal appointments — your team will make them as safe as possible

Diet and exercise

Eat regularly, even if your appetite is small — little and often works well. Try to include fruit and vegetables, protein like beans, eggs, fish or meat, and starchy foods like bread, rice or potatoes. Drink water throughout the day. Once your fever has gone and you feel up to it, gentle activity such as a short walk or light stretching is fine. Do not push through breathlessness or exhaustion. Avoid contact sports, heavy lifting and anything that feels too much while you recover.

Mental health and emotional wellbeing

It is very normal to feel anxious, frightened or low when you are ill in pregnancy. You may worry about your baby, about being alone, or about birth plans changing. These feelings usually ease as you recover, but they deserve attention. Talk to your midwife — they can arrange extra support. If you ever feel you cannot keep yourself safe, or you have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away. You deserve help, and help is available.

Prevention

You cannot fully guarantee you will not catch COVID-19, but you can lower the risk. Vaccination is the single most effective step. Good hand hygiene, ventilated rooms, and avoiding crowded indoor spaces also help. If someone in your household is unwell, try to keep some distance, sleep in a separate room if possible, and ventilate shared spaces.

Vaccines

Health services, including the NHS in the UK, recommend the COVID-19 vaccine in pregnancy. It has been given to many thousands of pregnant women and is considered safe for you and your baby. It also passes some protection to your baby in the first months of life. You can have it at any stage of pregnancy, and you may be offered boosters depending on local guidance. If you have questions or are unsure, talk them through with your midwife, GP or pharmacist — no question is too small.

Screening programmes

There is no routine screening test for COVID-19 in pregnancy. You may be tested if you have symptoms, if you are admitted to hospital, or before some hospital appointments, depending on local rules. Your usual antenatal screening tests, such as blood tests and scans, should continue as normal.

Complications

If left untreated

• Breathlessness that worsens, and in some cases pneumonia (infection of the lungs)
• A small number of pregnant women become seriously unwell and need intensive care support
• A higher chance of your baby being born early (preterm), which can mean extra care for your baby after birth
• A higher chance of caesarean birth if you or your baby need it sooner
• An increased risk of blood clots, which pregnancy and infection both raise — your team may give preventative treatment
• A higher chance of stillbirth in the rare cases where a mother becomes severely unwell, which is why monitoring and early contact with your team matter so much

Long-term outlook

The great majority of pregnant women who catch COVID-19 recover well and go on to have healthy babies, often with no lasting effects. Being pregnant does not mean you will become seriously ill — it just means your team will keep a closer eye on you. If you do become more unwell, hospitals are experienced at caring for pregnant women with COVID-19, and treatments are available. Getting vaccinated, seeking advice early, and keeping in touch with your maternity team are the best things you can do.

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