Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients

COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, and trouble breathing. It also may cause stomach problems, such as nausea and diarrhea, and a loss of your sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms.

Researchers are still learning how COVID-19 affects pregnant women. Current reports suggest that pregnant women have a higher risk for more severe illness from COVID-19 than nonpregnant women. Reports note that:

• Pregnant women who have COVID-19 and show symptoms are more likely than nonpregnant women with COVID-19 and symptoms to need care in an intensive care unit (ICU), to need a ventilator (for breathing support), or to die from the illness. Still, the overall risk of severe illness and death for pregnant women is low.

• Pregnant women with some health conditions, such as obesity and gestational diabetes, may have an even higher risk of severe illness, similar to nonpregnant women with these conditions.

• Pregnant women who are Black or Hispanic have a higher rate of illness and death from COVID-19 than other pregnant women, but not because of biology. Black and Hispanic women are more likely to face social, health, and economic inequities that put them at greater risk of illness. To learn more about these inequities, see this page from the Centers for Disease Control and Prevention (CDC).

Remember that researchers are learning more about COVID-19 all the time. Some researchers are looking specifically at COVID-19 and its possible effects on a fetus. Here’s what they know now:

• Researchers have found a few cases of COVID-19 that may have passed to a fetus during pregnancy, but this seems to be rare.

• Researchers have studied COVID-19 infection, preterm birth, and stillbirth. Some studies suggest there may be an increased risk of preterm birth and stillbirth for women with COVID-19. Other studies have not found this to be true. But information is still limited. Researchers are continuing to study these outcomes to better understand the effects of COVID-19 before birth.

After birth, a newborn can get the virus if they are exposed to it.

Pregnant women may choose to get a COVID-19 vaccine. There is a limited amount of safety data available on COVID-19 vaccines during pregnancy at this time, but what experts know so far is reassuring.

The tests done before the first vaccines were approved for emergency use did not include pregnant women. But based on how the vaccines were made and the science behind how the vaccines work in the body, experts believe they should be safe in pregnancy. The CDC and some of the COVID-19 vaccine makers are now starting or planning tests with pregnant women. And thousands of pregnant women have already chosen to receive COVID-19 vaccines. Some of them have enrolled in the CDC’s vaccination tracking program. Data from this program do not show any safety concerns.

If you are pregnant and want to know more about the vaccines, you can talk with your obstetrician–gynecologist (ob-gyn) or other health care professional. This conversation is not required to get a vaccine, though it may be helpful. You can discuss your risk of getting COVID-19 and your risk of severe illness if you get sick. A vaccine may protect you from severe illness, which could help both you and your fetus.

Learn more from the CDC about COVID-19 vaccines, pregnancy, and breastfeeding.

Yes, ACOG recommends that breastfeeding women get a COVID-19 vaccine. There is no need to stop breastfeeding if you want to get a vaccine. When you get vaccinated, the antibodies made by your body can be passed through breastmilk and help protect your child from the virus.

Yes, if you are planning or trying to get pregnant, you can get a COVID-19 vaccine. There is no evidence that the COVID-19 vaccines cause infertility. You also do not need to delay getting pregnant after you get a vaccine.

Some COVID-19 vaccines will require two doses. If you find out you are pregnant after you have the first dose, you should still get the second dose.

Two vaccines require two shots (Pfizer and Moderna), and one vaccine requires only one shot (Johnson & Johnson). All available COVID-19 vaccines are proven to be safe and highly effective. Pregnant and nonpregnant people can choose to get any of the available vaccines. Learn more from the CDC about the different vaccines.

The Johnson & Johnson COVID-19 vaccine has a very rare risk of a serious condition involving blood clots and other symptoms. Most cases of these blood clots have been reported in women under age 50. These blood clots have only been reported in a few people out of every million doses of the Johnson & Johnson vaccine that have been given. No cases have been reported in pregnant women.

Scientists reviewed these reports and decided that the benefits of the vaccine are greater than the risks. So you can choose to get the Johnson & Johnson vaccine, but you should be aware of the rare risk of blood clots and related symptoms. Symptoms may include severe headaches, blurred vision, abdominal pain, leg pain, chest pain, shortness of breath, easy bruising, or small blood spots under the skin. Learn more from the CDC.

If you choose not to receive the Johnson & Johnson vaccine, you can choose another available vaccine. All vaccines have gone through intense safety studies and health officials continue to track their safety.

It is common to feel side effects after getting a COVID-19 vaccine. There are different types of COVID-19 vaccines that have varying side effects. Side effects also vary from person to person. Some vaccines may make you feel like you have the flu for a few days. This is normal.

If you have a fever or other side effects after getting the vaccine, you can take acetaminophen, an over-the-counter medication that is safe during pregnancy. If you are worried about your side effects or they last more than a few days, talk with your ob-gyn or other health care professional.

The vaccines that have been approved so far work in different ways, and all of them are proven to be safe. It is important to know that:

• The vaccines cannot give you COVID-19. None of the vaccines use the live virus that causes COVID-19.

• The vaccines do not affect your genes or DNA.

• There is no evidence that the COVID-19 vaccines cause infertility. ACOG recommends vaccination for anyone who may consider getting pregnant in the future.

Visit the CDC’s website for the latest information on COVID-19 vaccines.

Pregnant women should take steps to stay healthy, including

• keeping your prenatal care visits

• wearing a mask or cloth face covering in public and any other needed protection while at work

• limiting contact with other people as much as possible

• staying at least 6 feet away from other people and avoiding crowds if you need to go out

• avoiding contact with other people in places that do not offer fresh air from the outdoors (open windows and doors when possible)

• washing hands often with soap and water for at least 20 seconds

• cleaning hands with a hand sanitizer that contains at least 60 percent alcohol if you can’t wash them (rub until your hands feel dry)

• avoiding touching your eyes, nose, and mouth

• having a good stock of essential supplies, including at least 30 days of any medications (so you don’t have to go out as often)

• talking with an ob-gyn or other health care professional if you have any questions about your health or COVID-19

• calling 911 or going to the hospital right away if you need emergency health care

See more advice from the CDC.

Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms. See the CDC's latest recommendations on face coverings.

Wearing a cloth face covering or mask is most important in places where you may not be able to stay 6 feet away from other people, like a grocery store or pharmacy. It also is important in parts of the country where COVID-19 is spreading quickly. But you should still try to stay at least 6 feet away from others whenever you leave home.

If you have COVID-19 or think you may have it, you should wear a mask while you are around other people. You also should wear a mask if you are taking care of someone who has COVID-19 or has symptoms. You do not need to wear a surgical mask or medical-grade mask (N95 mask).

It is important to keep your prenatal and postpartum care visits. Call your ob-gyn or other health care professional to ask how your visits may be changed. Some women may have fewer or more spaced out in-person visits. You also may talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It is a good way for you to get the care you need while preventing the spread of disease.

If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telemedicine or make sure you do not have symptoms of COVID-19 if you are going in to the office. You also can call them before your visits if you do not hear from them.

Yes, it is important to continue getting the health care you need to stay healthy, even while COVID-19 is spreading. Most pregnant women who are due for screenings, tests, vaccines, or other care from any health care professionals can go ahead with these appointments, with appropriate safety measures in place at the health care office.

You should call the office before your appointment to ask what precautions they are taking, including mask and support-person policies. You also can ask if telehealth is an option for your appointment. If you have an in-person visit, it is important to wear a cloth face covering or mask, stay at least 6 feet away from other people when possible, and keep your hands clean. Talk with your ob-gyn if you have questions about how to stay safe.

Pregnant women can stay healthy by following the usual recommendations during pregnancy, including

• eating healthy meals (see Nutrition During Pregnancy)

• exercising regularly (see Exercise During Pregnancy, though be mindful to stay at home or away from other people while exercising)

• getting plenty of sleep

• avoiding alcohol and drugs (see Tobacco, Alcohol, Drugs, and Pregnancy)

Some pregnant and postpartum women may be feeling fear, uncertainty, stress, or anxiety because of COVID-19. Reaching out to friends and family during this time may help. Phone calls, texts, and online chats are safe ways to stay connected.

There also are treatment and support resources you can access over the phone or online. Talk with your ob-gyn or other health care professional about how to get help if you’re having symptoms like these:

• Feeling sad, hopeless, worthless, or helpless

• Having fear or worry, which may cause a fast heartbeat

• Feeling that life is not worth living

• Having repeated, scary, and unwanted thoughts that are hard to get rid of

If you are in crisis or feel like you want to harm yourself or others, call 911 right away. See the Resources section for other support options, including helplines you can text or call and online support groups for pregnant and postpartum women.

Physical activity also may help your mental health. And it may be useful to focus on your breathing each day, especially if you are feeling anxious. Breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. Repeat three times.

Times of crisis can be very hard for people in abusive relationships. Abuse at home is known as intimate partner violence or domestic violence. Abuse can get worse during pregnancy. If you need help, call the 24-hour, toll-free National Domestic Violence Hotline: 800-799-SAFE (7233) and 800-787-3224 (TTY). Or you can text LOVEIS to 22522 or use the live chat option at www.thehotline.org

The CDC is updating travel recommendations often. See the CDC’s Coronavirus Disease 2019 Information for Travel page for the latest updates.

Other travel recommendations may be in place globally or locally as the virus continues to spread. Check with your local or state health department for information about travel in your area.

If you think you may have been exposed to the coronavirus and have a fever or cough, call your ob-gyn or other health care professional for advice.

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

• Having a hard time breathing or shortness of breath (more than what has been normal for you during pregnancy)

• Ongoing pain or pressure in the chest

• Sudden confusion

• Being unable to respond to others

• Blue lips or face

If you go to the hospital, try to call ahead to let them know you are coming so they can prepare. If you have other symptoms that worry you, call your ob-gyn or 911.

If you are diagnosed with COVID-19, follow the advice from the CDC and your ob-gyn or other health care professional. The current CDC advice for all people with COVID-19 includes the following:

• Stay home except to get medical care. Avoid public transportation.

• Speak with your health care team over the phone before going to their office. Get medical care right away if you feel worse or think it’s an emergency.

• Separate yourself from other people in your home.

• Wear a face mask when you are around other people and when you go to get medical care.

Talk with your ob-gyn or other health care professional about your birth plan. In most cases, the timing and method of delivery (vaginal birth or cesarean birth) do not need to be changed. Women who are sick probably do not need a cesarean birth.

ACOG believes that the safest place for you to give birth is a hospital, hospital-based birth center, or accredited freestanding birth center. Your hospital or birth center may be adjusting their policies. For example, there may be changes to the number of visitors allowed and how long you will stay in the hospital. Check with your hospital and ob-gyn or other health care professional about your birth plan. Be sure to mention if you are planning to have a doula with you during childbirth.

Check with your hospital or birth center. They may limit the number of visitors to help prevent the spread of COVID-19. The number of visitors you can have may depend on local and state recommendations and how quickly COVID-19 is spreading in your area.

Some hospitals and birth centers may consider doulas to be visitors. Check the hospital or birth center policy if you are planning to have a doula with you.

ACOG believes that the safest place for you to give birth is still a hospital, hospital-based birth center, or accredited freestanding birth center. COVID-19 has not changed this recommendation. Even the healthiest pregnancies can have problems arise with little or no warning during labor and delivery. If problems happen, a hospital setting can give you and your baby the best care in a hurry. Keep in mind that hospitals, hospital-based birth centers, and accredited freestanding birth centers follow strict procedures to clean and control infection.

While you are in the hospital or birth center, you should wear a mask if you have COVID-19. But when you are pushing during labor, wearing a mask may be difficult. For this reason, your health care team should wear masks or other protective breathing equipment. They also may take other steps to reduce the risk of spreading the virus, including wearing goggles or face shields.

There are many benefits to having your baby stay in the same room as you after delivery, even if you have COVID-19. For example, rooming together may help you bond with your baby and help you start breastfeeding if desired.

You also may choose for your baby to stay separated from you, such as in the hospital nursery. But current reports suggest that the risk of a baby getting COVID-19 does not change based on whether the baby stays in the mother’s room or in a separate room. (See "How can I avoid passing COVID-19 to my baby?") If you room together, the baby’s crib may be kept at least 6 feet away from you. Some facilities use clear plastic cribs that are enclosed and keep an even temperature.

Staying in a separate room may be encouraged if you are very sick or your baby is at a high risk of getting very sick. If you choose to be separated and you plan to breastfeed, you can ask for a breast pump and use it to express (pump) milk. This will allow someone who is not sick to bottle-feed breast milk to your baby. Pumping also may help you maintain your milk supply for when you begin breastfeeding.

Talk with your health care team about the options at your hospital or birth center well before your due date. Together you can discuss what you think is right for you and your baby. Be sure to talk about the best ways to

• reduce the risk of infection for your baby

• support the long-term health of you and your baby

• help you start breastfeeding if desired

Researchers are still learning if COVID-19 can pass through breast milk and cause infection in the baby. Most information shows that it is safe to feed breast milk to your baby when you have COVID-19. Remember that breast milk is the best source of nutrition for most babies. Breast milk also helps protect babies from infections, including infections of the ears, lungs, and digestive system. For these reasons, having COVID-19 should not stop you from giving your baby breast milk.

If you plan to breastfeed, talk with your ob-gyn or other health care professional. Make your wishes known so that you can begin to express milk or breastfeed before you take your baby home.

While you are in the hospital or birth center and after you go home, you should take the following steps to avoid passing the infection to your baby:

• Use a face mask or covering when holding your baby, including during feeding. Do not put a mask or covering over the baby’s face.

• Wash your hands before touching your baby. See the CDC’s handwashing tips.

• Wash your hands before touching any breast pump or bottle parts and clean all pump and bottle parts after use. See the CDC’s advice for cleaning a breast pump.

• If possible, let someone who is healthy help care for your newborn. They can bottle-feed your breast milk to your baby after you pump. They should wear a mask and keep their hands clean. And they should not be at risk of severe illness from COVID-19.

Tell your employer if you are pregnant or if you have a health condition that may put you at higher risk. People with some health conditions, such as diabetes mellitus, lung disease, heart disease, and obesity, have a higher risk of severe illness from COVID-19.

Talk with your employer about how you can stay safe while doing your job. Ask if remote work is possible. If remote work is not possible, and you work in a job with a high risk of exposure to COVID-19, ask your employer if you can switch to a role with lower exposure risk.

No matter what your job is, your employer should follow guidelines from the CDC and state and local health departments. These guidelines can help reduce the risk of infection for employees. If there is a chance you could be exposed to the virus at work, ask your employer about masks, gloves, and other equipment that can help protect you.

If you aren’t given the protection you need, tell your ob-gyn or other health care professional. Together you should talk about how you can discuss your safety with your employer.

Your ob-gyn or other health care professional should continue to be your main resource for all questions about your pregnancy. For the most current information about the coronavirus and COVID-19, check CDC web pages, which are updated often and listed below.

Pregnancy is a personal choice. It may help to think about your health and the potential risks of COVID-19. You and your ob-gyn or other health care professional should talk about the latest research on possible increased risk of severe illness during pregnancy. You also should talk about taking steps to prevent exposure to COVID-19 during pregnancy.

Current reports suggest that pregnant women have a higher risk for more severe illness and death from COVID-19 than nonpregnant women. And pregnant women with some health conditions, such as gestational diabetes and obesity, may have an even higher risk of severe illness from COVID-19.

Also, there are some reports that COVID-19 may have passed from a woman to her baby during pregnancy or delivery, but this seems to be rare.

Centers for Disease Control and Prevention (CDC)

• Coronavirus (COVID-19): A hub for the latest information on what everyone needs to know about the coronavirus and COVID-19.

• Pregnancy & Breastfeeding: More information about COVID-19, pregnancy, and breastfeeding.

• Prevent Getting Sick: Learn how the virus spreads and how to protect yourself and your family.

• Vaccines: Learn about the vaccines that can protect you from COVID-19.

  • Who gets vaccinated first?

  • Vaccination considerations for people who are pregnant or breastfeeding

  • What to expect at your vaccine appointment

  • Ensuring the safety of vaccines

  • Other frequently asked questions

• If You Are Sick: Guidance on what to do if you have COVID-19 or think you may have it.

• Travel: Frequently asked questions for travelers and travel notices for each country.

National Association of County and City Health Officials
www.naccho.org/membership/lhd-directory
A tool to help you search for health departments in your area. Your local health department can answer questions about COVID-19 vaccines, testing, travel, and other local issues.

Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Helpline
www.samhsa.gov/find-help/disaster-distress-helpline
800-985-5990 (TTY 800-846-8517)
Text TalkWithUs to 66746
Offers crisis counseling for people in emotional distress and referrals to local crisis call centers for follow-up care and support.

Postpartum Support International Helpline
https://www.postpartum.net
800-944-4773
Text 503-894-9453 (English) or 971-420-0294 (Spanish)
Contact this non-emergency helpline for support, information, or referrals to postpartum mental health providers. The helpline is open 7 days per week. Leave a confidential message at any time, and a volunteer will return your call or text as soon as possible.
PSI also offers online support group meetings to connect with other pregnant and postpartum women. You also can join PSI’s weekly Chat with an Expert.  

National Domestic Violence Hotline
800-799-SAFE (7233) and 800-787-3224 (TDD)
Text LOVEIS to 22522
Live chat and more information: www.thehotline.org

National Suicide Prevention Lifeline
800-273-8255
https://suicidepreventionlifeline.org
Lifeline chat: https://suicidepreventionlifeline.org/chat
Offers free, confidential support 24/7.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Doula: A birth coach who gives continual emotional and physical support to a woman during labor and childbirth.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Gestational Diabetes: Diabetes that starts during pregnancy.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.