COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics

General Considerations

• Q: What treatment options are available for pregnant individuals?

  There are several treatment options for COVID-19, and many are available for use in pregnancy. The Centers for Disease Control and Prevention (CDC) and ACOG recommend against withholding treatment options for pregnant and lactating individuals specifically because of pregnancy and lactation.

  Treatment for patients who do not require hospitalization

  Currently, the preferred treatment option for outpatient individuals with COVID-19 is ritonavir-boosted nirmatrelvir (Paxlovid). Paxlovid is prescribed for individuals with mild to moderate COVID-19 not severe enough to require hospitalization, who are at high risk of progressing to severe disease, including those with underlying cardiac or pulmonary disease, those who are immunosuppressed, and those who are unvaccinated or under-vaccinated. While pregnancy is not an exclusion for Paxlovid for eligible patients, it has been underutilized in pregnant and recently pregnant patients when compared to nonpregnant patients (Regan 2025). Paxlovid can be administered to nonhospitalized pregnant and lactating patients. If a pregnant patient tests positive for COVID-19, obstetric care professionals should prescribe Paxlovid. The dosage for Paxlovid is 300 mg of nirmatrelvir (two 150-mg tablets) with 100 mg of ritonavir (one 100-mg tablet), with all three tablets taken together twice daily for 5 days (FDA package insert). Treatment can be initiated in patients who are positive for COVID-19 or are highly suspected to be positive based on known exposure and symptoms.

  Obstetrician–gynecologists and other obstetric care professionals should ensure the patient has no contraindications and should review any possible drug–drug interactions and how to handle them before prescribing Paxlovid. See the Infectious Diseases Society of America (IDSA) Guidelines on the Treatment and Management of Patients with COVID-19 for more information on drug–drug interactions. If there is suspected or confirmed co-infection with influenza and COVID-19, both oseltamivir and Paxlovid should be prescribed, and can be taken together. There are no clinically significant drug–drug interactions between the antiviral agents or immunomodulators that are used to prevent or treat COVID-19 and the antiviral agents that are used to treat influenza.

  For additional information on Paxlovid and other outpatient treatment options such as remdesivir, molnupiravir, and neutralizing monoclonal antibodies, see the IDSA Guidelines on the Treatment and Management of Patients with COVID-19.

  Treatment for patients who require hospitalization

  Several treatment options are available for hospitalized pregnant patients. Recommendations for preferred treatment options for hospitalized individuals vary by disease severity and comorbidities. In general, the therapeutic management of pregnant women with COVID-19 is the same as the management of women who are not pregnant. The Infectious Diseases Society of America outlines these options in the IDSA Guidelines on the Treatment and Management of Patients with COVID-19.

• Q: What are the criteria to discontinue transmission-based precautions for previously COVID-19-positive patients?

  According to the CDC’s guidance, discontinuation of transmission-based precautions in the health care setting for an individual with confirmed COVID-19 should be made using a symptom-based strategy (CDC). The time period used depends on the patient’s severity of illness and whether they are severely immunocompromised. Meeting criteria for discontinuation of transmission-based precautions is not a prerequisite for discharge from a health care facility. Patients who are discharged home for required isolation or who are treated as outpatients with a diagnosis of COVID-19 should follow the CDC's guidance on the discontinuation of isolation precautions. Recommendations regarding discontinuation of transmission-based precautions may continue to evolve. The American College of Obstetricians and Gynecologists encourages members and patients to visit CDC’s website for up-to-date information and details.

  Detailed information on exposure, isolation, quarantine, and testing is available through the CDC. Individuals are encouraged to review this information regularly.

• Q: Does COVID-19 present an increased risk of severe morbidity and mortality for pregnant and recently pregnant individuals?

  Yes. The CDC reports pregnancy and recent pregnancy as conditions with conclusive evidence indicating an increased risk for at least one severe outcome from COVID-19. Pregnant and recently pregnant patients with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers (Strid 2022). Available data indicate an increased risk of intensive care unit admission, need for mechanical ventilation, and ventilatory support (extracorporeal membrane oxygenation) in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic nonpregnant women (Strid 2022, Khan 2021). The risk of death increased in the period of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections with Delta variant predominance in symptomatic pregnant compared to symptomatic nonpregnant women of reproductive age (adjusted risk ratio, 2.36; 95% CI, 1.87–2.97) (Strid 2022). Pregnant and recently pregnant patients with comorbidities such as preexisting diabetes mellitus, hypertension, cardiovascular disease, and obesity are at an even higher risk of severe illness, consistent with the general population with similar comorbidities (Smith 2023). Initial COVID strains posed risks for severe maternal illness and death that were mitigated by receipt of COVID-19 vaccines (Strid 2022). Subsequent and less virulent COVID strains, coincident with increased natural and vaccine-driven maternal immunity, decrease risks for severe maternal illness and death; however, vaccinated individuals still have improved maternal outcomes (Fernandez-Garcia 2024).

  Obstetrician–gynecologists and other obstetric care professionals should counsel pregnant individuals and those contemplating pregnancy about the potential risk of COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for these individuals and their families.

• Q: What is the effect of COVID-19 on fetal and neonatal outcomes?

  Pregnant people with COVID-19 are at increased risk for preterm birth, both spontaneous and clinician-initiated preterm birth (Lindsay 2023; Raffetti 2024). Data indicate that neonates born to people with COVID-19 are at increased risk for respiratory distress syndrome and admission to the neonatal intensive care unit (Shabil 2024; El-Atawi 2024). Furthermore, increased rates of neonatal death are associated with mothers positive for COVID-19 compared to those of mothers without COVID-19 (odds ratio, 2.20; 95% CI, 1.29–3.76) (El-Atawi 2024). However, neonates of mothers with COVID-19 have similar rates of small for gestational age, stillbirth, or fetal malformations compared to those of mothers without COVID-19 infection (El-Atawi 2024).

• Q: Should pregnant patients wear a mask?

  With regard to wearing a mask, pregnant patients should follow the same recommendations as the general population, as outlined by the CDC.

  Pregnant individuals are at increased risk for severe COVID-19 disease; therefore, it is extremely important that pregnant individuals wear masks in areas with high COVID-19 hospital admission levels or when other respiratory viruses are resulting in increased levels of illness in the community. Even in areas with low COVID-19 hospital admission levels, pregnant individuals may wish to wear masks and should be supported if they decide to do so. There are currently no known risks related to mask use during pregnancy.

• Q: Should testing for COVID-19 continue to occur in labor and delivery units?

  While routine universal screening is no longer being implemented, pregnant individuals admitted for labor and delivery with suspected COVID-19 or who develop symptoms suggestive of COVID-19 during admission should be tested. Performance of SARS-CoV-2 viral testing upon admission to labor and delivery is at the discretion of the facility. For asymptomatic patients, the yield of screening testing for identifying infection is likely lower when performed on those in counties with lower levels of SARS-CoV-2 community transmission. However, these results might continue to be useful in some situations (eg, when performing higher-risk procedures or for health care professionals caring for patients who are moderately to severely immunocompromised) to inform the type of infection control precautions used and prevent unprotected exposures. However, these results might continue to be useful in some situations (eg, when performing higher-risk procedures or for health care professionals caring for patients who are moderately to severely immunocompromised) to inform the type of infection control precautions used and prevent unprotected exposures.

  Regardless of vaccination status, individuals may decline testing for a variety of reasons, including stigma or mistrust. Facilities should have a plan for the care of individuals who decline COVID-19 testing.

Prenatal Care

• Q: If a patient receives a COVID-19 vaccine before becoming pregnant and an updated COVID-19 vaccine is not available during the time they are pregnant, should they receive the same COVID-19 vaccine?

  No. The guidance recommends that only one dose of the updated vaccine should be completed. Once a patient has the current COVID-19 vaccine, it is not recommended that they receive a repeat vaccine during the same season. The goal of the COVID-19 vaccine is to provide protection against the most current strains of the virus, and vaccination helps protect the pregnant patient from contracting COVID-19, thus protecting the patient and their fetus from severe illness and complications.

• Q: Should pregnant patients be encouraged to get a COVID-19 booster immunization?

  Yes. The CDC reports pregnancy and recent pregnancy as conditions with conclusive evidence indicating an increased risk for at least one severe outcome from COVID-19. Pregnant patients should be immunized against COVID-19 because they are at higher risk of severe illness, hospitalization, and complications from COVID-19, which can also be harmful to the newborn. Initial COVID strains posed risks for severe maternal illness and death that were mitigated by receipt of COVID-19 vaccines (Strid 2022). Subsequent and less virulent COVID strains, coincident with increased natural and vaccine-driven maternal immunity, decrease risks for severe maternal illness and death; however, vaccinated individuals still have improved maternal outcomes (Fernandez-Garcia 2024). Updated COVID-19 vaccines keep up with new coronavirus strains and remain effective at reducing morbidity from COVID-19 complications in pregnant patients and their infants as measured by emergency department or urgent care encounters (Ciesla 2024). Furthermore, the data support the benefit of vaccination in reducing pregnancy complications, such as severe maternal morbidity, preterm birth, and stillbirth (Ciapponi 2024; Lei 2025; Lindsay 2023). Vaccination during pregnancy provides passive immunity to the infant, protecting them from COVID-19 in the first few months of life before they can be vaccinated. Maternal COVID-19 vaccination during pregnancy results in significantly greater antibody persistence in infants when compared to infants born to mothers who experienced infection during pregnancy without vaccination (Shook 2022).

  Infants aged less than 6 months are at increased risk for severe COVID-19 disease but are not yet eligible for COVID-19 vaccination, and they depend upon transplacental transfer of maternal antibodies for protection. They continue to be hospitalized for COVID-19 at higher rates than all age groups except adults 75 years and older. During the 2023–2024 respiratory virus season, less than 5% of mothers whose infants were hospitalized for COVID-19 were vaccinated during pregnancy (Havers 2024). COVID-19 vaccination in pregnancy reduces the rate of symptomatic and severe COVID-19 resulting in hospitalization in infants during the first 6 months of life (Cardemil 2024; Halasa 2022). Infants born to vaccinated birthing people are at 35–52% reduced risk of COVID-19-related hospitalization for up to 6 months of age (Halasa 2022; Simeone 2023). In addition, obtaining a COVID-19 booster vaccination during pregnancy reduces the infant’s risk of acquiring COVID-19 in the first 6 months by 56% (95% CI, 8–79%; P=.03) relative to no boosting (Cardemil 2024). Finally, data suggest the benefit of vaccination in protecting against post-acute sequelae of SARS-CoV-2 infection (PASC; also referred to as long COVID) (Sterian 2025).

• Q: Do patients with suspected or confirmed COVID-19 need additional antenatal fetal surveillance?

  During acute illness, fetal management should be similar to that provided to any critically ill pregnant person. Continuous fetal monitoring in the setting of severe illness should be considered only after fetal viability, when delivery would not compromise maternal health, or as another noninvasive measure of maternal status.

  Very little is known about the natural history of pregnancy after a patient recovers from COVID-19. In the setting of a mild infection, management similar to that for a patient recovering from influenza is reasonable. It should be emphasized that patients can decompensate after several days of apparently mild illness, and thus should be instructed to call or be seen for care if symptoms, particularly shortness of breath, worsen. Given how little is known about this infection, a detailed midtrimester anatomy ultrasound examination may be considered following prepregnancy or first-trimester maternal infection. Interval growth assessments could be considered depending on the timing and severity of infection, with the timing and frequency informed by other maternal risk factors. Antenatal testing is reserved for routine obstetrical indications (see the Society for Maternal-Fetal Medicine’s COVID-19 and Pregnancy).

Postpartum Care

• Q: How should lactating individuals be counseled about special considerations for infant feeding with breast milk in the setting of suspected or confirmed maternal COVID-19 infection?

  Breast milk provides protection against many illnesses, and there are few contraindications to breastfeeding (Committee Opinion 756, CDC). A systematic review of nine studies including 5,572 neonates noted no associated increased risk of neonatal SARS-CoV-2 infection among neonates who were born to mothers with perinatal infection who were breastfed (Babata 2025). The frequency of SARS-CoV-2 infection was similar in neonates breastfed compared with those non-breastfed (2.7% versus 2.2%, respectively; risk ratio, 0.82; 95% CI, 0.44–1.53). Current evidence suggests that breast milk is not a source of COVID-19 infection. Therefore, suspected or confirmed maternal COVID-19 is not considered a contraindication to infant feeding with breast milk.

  Individuals with suspected or confirmed COVID-19 can transmit the virus through respiratory droplets while in close contact with the infant, including while breastfeeding. Therefore, obstetrician–gynecologists and other maternal care practitioners should counsel patients with suspected or confirmed COVID-19 who intend to infant feed with breast milk on how to minimize the risk of transmission, including:

  • Breast milk expression with a manual or electric breast pump. This includes the importance of proper hand hygiene before touching any pump or bottle parts and following recommendations for proper pump cleaning after each use. If possible, individuals should consider having someone who does not have suspected or confirmed COVID-19 infection and is not sick feed the expressed breast milk to the infant. Additionally, individuals should be counseled on whether the birthing facility is able to provide a dedicated breast pump.
  • Safety measures if breastfeeding. A mother with suspected or confirmed COVID-19 who wishes to breastfeed her infant directly should take all possible precautions to avoid spreading the virus to her infant, including hand hygiene and wearing a mask or cloth face covering, if possible, while breastfeeding. 

  Even in the setting of the COVID-19 pandemic, obstetrician–gynecologists and other maternal care practitioners should support each patient’s informed decision about whether to initiate or continue breastfeeding, recognizing that the patient is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal (Committee Opinion 756).

  A child being breastfed by someone with suspected or confirmed COVID-19 should be considered as a close contact of a person with COVID-19, and should be quarantined for the duration of the lactating parent’s recommended period of isolation and during their own quarantine thereafter (CDC).

  For additional information on breastfeeding and COVID-19, see the American Academy of Pediatrics (AAP) recommendations.

• Q: Should a mother–infant dyad be separated in the hospital?

  No. Early and close contact between the mother and neonate has many well-established benefits, including increased success with breastfeeding, facilitation of mother–infant bonding, and promotion of family-centered care. Given the available evidence on this topic, mother–infant dyads where the mother has suspected or confirmed SARS-CoV-2 infection should ideally room-in according to usual facility policy. Although data are still emerging and long-term effects are not yet fully understood, data suggest that there is no difference in risk of SARS-CoV-2 infection in the neonate whether a neonate is cared for in a separate room or remains in the mother’s room.

  For additional information on the management of newborns of COVID-19-positive mothers, see the AAP recommendations.

 Staffing, Personnel, and Hospital Resources

• Q: What is the COVID-19 vaccine availability for health care workers? (NEW)

  In August 2025, the FDA (FDA 2025) updated eligibility criteria for the 2025–2026 COVID-19 vaccine to include adults aged 65 years or older and individuals under 65 years with at least one underlying health condition associated with increased risk for severe COVID-19 outcomes (CDC 2025a). Concerns have been raised that individuals who fall outside the current FDA eligibility criteria for COVID-19 booster vaccination—including health care workers who no longer qualify under the updated guidelines—may face barriers to access. Although current infection control measures, such as the use of personal protective equipment, are effective in clinical settings, the risk of SARS-CoV-2 infection among health care workers may also stem from community and non–patient care exposures (Jacob 2021).

  While rigorous infection prevention practices remain essential in health care settings, vaccination continues to play a critical role in minimizing SARS-CoV-2 infection among health care workers. This population remains a priority for vaccination due to ongoing occupational exposure risks, the need to maintain health care system capacity, and the potential for transmission from infected workers to vulnerable patient populations.

• Q: When can an obstetric care professional with SARS-CoV-2 infection or exposure return to work? When they return to work, what personal protective equipment (PPE) do they need to wear on a regular basis?

  The Centers for Disease Control and Prevention (CDC) has developed guidance outlining work restrictions for health care professionals (HCPs) with SARS-CoV-2 exposures based on the risk level of the exposure, the PPE used at the time of exposure, regardless of the vaccination status of the individual. Furthermore, the CDC provides recommended work restrictions for HCPs with SARS-CoV-2 infection and exposures based on a facility’s level of need to mitigate HCP and staffing shortages. Clinicians are encouraged to review these work restrictions and recommendations from the CDC regularly, as they are updated frequently. Additionally, clinicians are encouraged to work with their facilities, as situations may vary based on local circumstances.

  After adhering to any applicable restrictions and returning to work, HCPs should do the following:

  • Always wear a face mask for source control (to contain respiratory secretions) while in the health care facility until all symptoms are completely resolved or at baseline. After this time period, HCPs should revert to their facility’s policy regarding universal source control during the pandemic.
  • As with other respiratory illnesses, a residual nonproductive cough may persist for weeks after the illness has otherwise resolved. This is also the case for SARS-CoV-2 infection. Therefore, it is possible that an individual will meet the criteria for returning to work despite having lingering symptoms.
  • A face mask for source control does not replace the need to wear an N95 or higher-level respirator (or other recommended PPE) when indicated (read “What personal protective equipment (PPE) should health care professionals wear to reduce their risk of COVID-19 infection?”).
  • Self-monitor for symptoms and seek reevaluation from an occupational health specialist if respiratory symptoms recur or worsen.
• Q: What personal protective equipment (PPE) should health care professionals wear to reduce their risk of COVID-19 infection?

  COVID-19 infection is highly contagious, and this must be taken into consideration when planning intrapartum care. Recommendations for personal protective equipment (PPE) from the Centers for Disease Control and Prevention (CDC) can be found on the CDC's website.

  It is critical to maintain general infection control strategies in health care settings. Regardless of vaccination status, obstetric care professionals should still wear adequate and appropriate PPE when caring for patients with suspected or confirmed COVID-19.

Pharmacy and Insurance Access

• Q: What is the status of COVID-19 vaccine access for pregnant individuals?

  The 2025–2026 COVID-19 vaccine has been shipped and is available in most pharmacies. Both the FDA and the CDC define pregnancy and recent pregnancy as high-risk conditions that qualify patients as eligible to receive the 2025–2026 COVID-19 vaccine. The American College of Obstetricians and Gynecologists has strongly reaffirmed the recommendation that all pregnant and lactating people receive an updated COVID-19 vaccine. However, given HHS’s recent removal of its recommendation of the COVID-19 vaccine for pregnant people from the CDC’s Immunization Schedule (developed by the Advisory Committee on Immunization Practices [ACIP]), many clinicians and patients may be understandably confused about COVID-19 vaccine access and insurance coverage for pregnant individuals.

  Vaccine access at community pharmacies currently depends on regulations and some states only allow pharmacists to administer vaccines according to ACIP guidance. Meanwhile, these states are taking steps to ensure access by allowing pharmacists to administer the COVID-19 vaccine. The largest effect of these conflicting policies may be the inability of pregnant patients to “walk in” to local pharmacies to receive the new 2025–2026 COVID-19 vaccine, as recommended by ACOG and other national medical societies. In some states, a pharmacist may request a prescription before they can administer the updated COVID-19 vaccine.

• Q: What can obstetric care professionals do to improve access?

  The American College of Obstetricians and Gynecologists recommends that if clinicians are not stocking and administering COVID-19 vaccines on-site to pregnant patients, they should provide patients with a prescription to obtain the vaccine at their local pharmacy. In many regional jurisdictions, such an action has been judged as documentation of shared decision making between the provider and patient regarding a recommendation for the patient—whose pregnancy places them at high risk for COVID complications—to receive a COVID vaccine and lower the risk of complications for them and their newborn.

  Some regional jurisdictions have developed standardized vaccination forms for pregnant patients that are valid for use when reproduced for office use (bit.ly/prenatalRX). Patients should also be counseled, depending on the laws in their state jurisdiction, to call their local pharmacy or check the pharmacy’s webpage or app before presenting for vaccination to ask about their vaccination policies and vaccine availability.

  Additionally, the American Pharmacists Association provides vaccine access maps that show local pharmacies that offer vaccinations.

• Q: Will COVID-19 vaccines be covered by my patient’s insurance plan?

  The American College of Obstetricians and Gynecologists and other national organizations call upon payers and insurers to continue making the COVID-19 vaccine available to pregnant people without undue utilization management or cost-sharing requirements. As organizations dedicated to public health and evidence-based health care for pregnant patients, we are particularly passionate about ensuring equitable and free access to these critical vaccines. We are deeply concerned about the recently adopted HHS policy to no longer recommend COVID-19 vaccination during pregnancy. Given the historic gaps in research, investment, and support for women’s health, it is essential that all aspects of obstetric and gynecologic care—including COVID-19 vaccination—be grounded in the best available scientific evidence.

  Patients and clinicians should confirm insurance coverage as close to the time of vaccine administration as possible to ensure they are using the most up-to-date policies. This should be available online or via the patient’s insurance app. The removal of the COVID-19 vaccine during pregnancy from the CDC Immunization Schedule allows insurers to determine coverage. While at this time ACOG is not aware of changes in coverage policies, plans can vary significantly, even among those offered by the same health insurance provider. For issues or questions about insurance coverage, please contact ACOG’s Health Policy team through the Payment Advocacy and Policy Portal.

  The American College of Obstetricians and Gynecologists continues to monitor the situation closely and will provide updated information as it becomes available.