FAQ: COVID-19 and Pregnant Patients

Where can I get up-to-date information on COVID-19 in pregnancy?

Reliable sources on this subject include the following:

• American College of Obstetricians and Gynecologists (ACOG)
• Centers for Disease Control and Prevention (CDC)
  • COVID-19 and pregnancy
  • COVID-19 and newborn care, including breastfeeding
• Society for Maternal-Fetal Medicine (SMFM)
• The ObG Project
• UCSF Women's Health Resource Center (offering webinars on COVID-19 and pregnancy care)
• California Maternal Quality Care Collaborative (link opens PDF)

Is it OK to get pregnant during the COVID-19 pandemic?

Yes. At this time, national health agencies have made no recommendations around delaying spontaneous conception (trying to get pregnant on your own). However, the American Society for Reproductive Medicine states that you should try to avoid conceiving during an active COVID-19 infection.

I am pregnant. Do I need to take special precautions?

In general, pregnant people experience immune system and physiological changes that make them more susceptible to viral respiratory infections. We now know that pregnant patients are at risk for more severe illness from a COVID-19 infection.

Patients who are pregnant or trying to conceive should follow the same precautions as people who are not pregnant:

• Get vaccinated for COVID-19, and get a booster shot when eligible. (Find information on appointments and eligibility on our COVID-19 vaccines page.)
• Wash your hands often with soap and water for at least 20 seconds each time.
• If soap and water aren't available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid close contact with people outside your home.
• Don't go to work if you're sick.
• Avoid nonessential travel.
• Cover your mouth and nose with a tissue when you cough or sneeze, and throw the tissue in the trash. Then wash your hands with soap and water.
• Clean and disinfect frequently touched objects and surfaces.
• Stay home as much as possible, and if you need to go out, avoid crowded public spaces, staying at least 6 feet from other people.
• Wear a well-fitting, multilayered mask when in public places, such as grocery stores. Don't choose a mask with a valve; these masks allow droplet release, so they don't protect people near you.

Can I get prenatal care during the COVID-19 pandemic?

Yes. As we work to protect our patients and staff from COVID-19 exposure, our health care providers are rethinking how to best deliver care to our patients. As with many other specialties, it makes sense to convert some of the traditional visits to telehealth visits. This doesn't mean you'll never see a provider in person, but the number of in-person visits will be fewer. Ultrasound exams, routine blood work (genetic testing and third trimester labs) and nonstress tests will all continue to be done in person.

Your health care provider will teach you how to do kick counts, a way to monitor fetal health. It will be helpful if you have a blood pressure cuff (preferably an arm cuff, which is more accurate than a wrist cuff) and a scale at home, so you can provide your blood pressure and weight during telehealth visits.

We look at this as an opportunity to innovate and even improve the quality and delivery of our care, and we encourage our patients to embrace this perspective.

I have heard of women delivering in hospitals without a support person present. Could this happen to me?

Stay informed on the most up-to-date visitor policies, including screening rules, by regularly visiting the UCSF Health visitation page. We encourage you to select one support person who is healthy, asymptomatic and without concern for active COVID-19 infection to be with you during the birthing process as well as your postpartum stay. In addition, a doula is welcome to support you during labor and delivery. We encourage you to choose vaccinated and boosted individuals to be with you during this important and vulnerable time for you and your newborn.

We know that support during the birthing process is key to a having a positive experience. However, the pandemic has forced hospitals to make difficult decisions in order to preserve the health of patients and workers. We regret that the new visitation restrictions may feel burdensome to some patients, but they are necessary at this time. To date, our labor and delivery unit has done exceptionally well at maintaining a safe environment for our patients, providers and staff.

I heard about a COVID-19 registry for pregnant women. What is that?

UCSF enrolled willing patients in the PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) Study, a nationwide study of pregnant or recently pregnant women who were either under investigation for COVID-19 infection or had a confirmed infection. The goal of this study is to help us better understand how COVID-19 impacts pregnant patients and their newborn babies. Enrollment closed on Oct 1, 2020.

Please visit the PRIORITY Study page to learn more.

Can I participate in other studies of COVID-19 in pregnancy at UCSF?

We have ongoing studies of COVID-19 infection and COVID-19 vaccination in pregnancy and lactation, both led by Dr. Stephanie Gaw, a UCSF maternal-fetal medicine specialist. If you have been or are infected with COVID-19 during pregnancy, or you are getting the vaccine or booster during or shortly after pregnancy, you may be eligible to participate in either the PRIORITY-B or COVIPAL studies. Please visit the Gaw Lab website and select "Research" to learn more.

Do pregnant women who get a COVID-19 infection have an increased risk of adverse pregnancy outcomes?

Since the onset of the pandemic, we have amassed a growing body of data on adverse pregnancy outcomes and COVID-19.

Early pregnancy loss due to COVID-19 infection has not been observed (unlike with other related coronaviruses, such as SARS and MERS). There's also no evidence that COVID-19 causes congenital malformations, and there's no data suggesting that the virus routinely crosses the placenta and harms the newborn.

There is evidence, however, that pregnant patients with COVID-19 are more likely to progress to severe illness. They're more likely to be hospitalized, intubated and admitted to the intensive care unit than patients who aren't pregnant. We also know that COVID-19 infection during pregnancy can increase the risk of preterm birth and stillbirth.

Several large, well-designed studies point to these concerns. For more information, see the ACOG, CDC and SMFM links provided in the first FAQ, as well as studies published in the New England Journal of Medicine, JAMA Pediatrics and Obstetrics & Gynecology.

I am pregnant and work in health care. Is it safe to continue working?

For the most part, yes. There are some circumstances in which a change in daily duties may be recommended (for example, if you are the active performer of aerosol-generating procedures without access to appropriate personal protective equipment). If there's reason to be concerned about your work situation, talk with your direct supervisor and obstetric care provider to come up with a plan that's safe for you.

According to the CDC, pregnant health care personnel (HCP) should follow risk assessment and infection control guidelines if exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all workers in health care settings, regardless of pregnancy status. ACOG and SMFM both look to the CDC for guidance on this issue.

Can a pregnant woman pass the virus to her baby during pregnancy or delivery?

It's unlikely. The virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through respiratory droplets. Few COVID-19 cases have been reported in newborns, and in studies, the majority of pregnant women with COVID-19 have given birth to healthy babies. One study found that among nine pregnant women with COVID-19 pneumonia, samples of amniotic fluid, cord blood and breast milk all tested negative for the virus, as did throat swabs from the babies following birth. Another small study reported that a few newborns who tested positive for the virus had no adverse symptoms or effects. It's not clear when these babies became infected, but it was most likely in the immediate postpartum period.

Can breastfeeding pass the virus to the baby?

COVID-19 has not been detected in breast milk, so there's no risk of transmission from ingestion of human milk. While the CDC currently recommends separating mother and baby if there's concern the mother may be positive for COVID-19, this doesn't mean your baby can't have your breast milk if you have COVID. Pumping is fine, as long as you take appropriate hand and skin hygiene precautions. Mothers can express breast milk but should wash their hands thoroughly beforehand and disinfect the pump and bottles after use. An uninfected person should feed the child. If an infected mother decides to breastfeed, she should wash her hands thoroughly and wear a face mask. The CDC website has additional information on breastfeeding with COVID-19.

Should I get a COVID-19 vaccine or booster if I'm pregnant or trying to get pregnant?

All leading public and professional health organizations strongly recommend vaccination if you are pregnant or planning to be pregnant. Pregnancy increases the risk of severe complications from COVID-19, and the protection conferred by the vaccine helps to keep mother and baby healthy. If you have been fully vaccinated, the recommendation is to get the booster as soon as you’re eligible. Learn more on our COVID-19 vaccines page.

Should I wait until after my first trimester to get a vaccine or booster? I've heard the vaccine can cause miscarriage.

No. We now have large, well-designed studies that show there's no harm in obtaining the vaccine during any trimester. A large study of more than 100,000 pregnancies showed no increase in miscarriage. You should get any COVID-19 vaccine available to you and a booster when eligible.

Does the COVID-19 vaccine cause infertility?

No. Unreliable sources have spread a lot of misinformation about the COVID-19 vaccine and infertility. There's no evidence that the vaccine interferes with natural or assisted fertility in any way. Thousands of women have become pregnant after vaccination, and fertility clinics have reported no drop in pregnancy rates after vaccination in patients undergoing fertility treatments. For more information, please visit the American Society for Reproductive Medicine.

Does the COVID-19 vaccine cause menstrual problems?

There's a lot of misinformation about the COVID-19 vaccine and menstrual problems but no data to support a concern for lasting trouble. In general, disruptions to the menstrual cycle are common and frequently associated with stress, sleep disturbances, infection, physical activity or diet. In fact, up to 35 percent of women reported menstrual irregularities after a COVID-19 infection. Reports of menstrual changes after getting the vaccine are much less common (0.0005 percent of approximately 41 million doses given in the United Kingdom). Ongoing studies are seeking a better understanding of how COVID-19 vaccines might affect the female reproductive cycle. Scientists predict that any impact from the vaccine would be uncommon and limited to one or two cycles.

Can I get an abortion during the pandemic?

Yes. While hospitals are canceling some elective surgeries to limit potential exposures as well as use of personal protective equipment, abortions are not elective procedures. Abortions are time-sensitive procedures, and a delay in care can increase associated risks. Certain states have pushed legislation limiting access to abortion care during the pandemic. UCSF supports a patient's right to choose, and you can visit the Center for Pregnancy Options for more information.

On March 18, 2020, early in the COVID-19 pandemic, numerous leading obstetric and gynecologic professional organizations – including the American College of Obstetricians and Gynecologists, American Board of Obstetrics and Gynecology, and American Society for Reproductive Medicine – issued a joint statement on abortion access, which ended as follows: "[We] do not support COVID-19 responses that cancel or delay abortion procedures. Community-based and hospital-based clinicians should consider collaboration to ensure abortion access is not compromised during this time."

Can I get birth control during the pandemic?

Absolutely. Your OB-GYN or primary care provider can provide birth control counseling via a telehealth visit. Many types of birth control can be prescribed without an in-person physical exam, such as hormonal pills, NuvaRing or hormone patches.

Long-acting reversible contraception, such as Nexplanon or intrauterine devices (IUDs), require an in-person visit. Talk to your provider to determine whether you need an office visit for your preferred option. Remember to weigh the risks and benefits of going into a health care facility during this time. If you decide to wait, consider trying an option that doesn't require a visit or continuing to use your current birth control method and coming in when the new-case rates in your area have dropped.

You can also use the Planned Parenthood website to make an appointment for contraceptive counseling. Many of their centers across the country remain open, and in-person visits require going through a COVID-19 screening process.