Last updated August 12, 2020

General Information Regarding Pregnant Individuals and COVID-19

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. View the algorithm (Spanish version).

Historically, respiratory infections in pregnant individuals have been thought to increase their risk for severe morbidity and mortality. With regard to COVID-19, early available data did not indicate that pregnant individuals were at an increased risk of infection or severe morbidity compared with nonpregnant individuals in the general population. However, a recent data analysis from the Centers for Disease Control and Prevention (CDC) COVID-19 surveillance suggest that in women with COVID-19, pregnant women (n = 8,207) appear to be at increased risk for certain manifestations of severe illness compared to non-pregnant peers (n = 83,205). Specifically, these data indicate an increased risk of ICU admissions (1 in 68 of pregnant versus 1 in 110 non-pregnant women, crude risk ratio 1.6, 95% CI 1.3-1.9) and mechanical ventilation (1 in 195 of pregnant versus 1 in 370 non-pregnant women, crude risk ratio 1.9, 95% CI 1.4-2.6). Yet no increase was noted in the rate of mortality (1 in 513 of pregnant versus 1 in 400 of non-pregnant women, crude risk ratio 0.8, 95% CI 0.5-1.3). Consistent with previously reported data regarding non-pregnant individuals, this analysis suggests that pregnant patients who are Black or Hispanic may be disproportionately affected by SARS-CoV-2 infection. Of note, when stratified by race/ethnicity, ICU admission was more common among non-Hispanic Asians (3.5%) than among all pregnant women (1.5%). Further, while this report suggests an increase in risk of severe outcomes in pregnant women with SARS-CoV-2 infection, it is important to highlight that the overall risk to pregnant women is still low, and consider this risk compared to risks from other upper respiratory illnesses, especially while counseling patients. For example, based on data currently available, the absolute risk is still substantially lower than that of pandemic H1N1 influenza infection during pregnancy. During the H1N1 influenza pandemic, pregnant women made up 5% of deaths, despite only making up 1% of the population and pregnancy risk of ICU admission was reported as high as a 7-fold increase (Rasmussen et al 2012; Mosby et al 2011). ACOG recognizes the need for further data, analysis, and peer review literature on SARS-CoV-2 infection during pregnancy.

Importantly, these new data have several key limitations including missing pregnancy status for 72% of women included in the surveillance. Moreover, among COVID-19 cases in female patients with known pregnancy status, data was unavailable for race/ethnicity in 20%, symptoms in 35%, and underlying medical conditions in 77%. Information on gestational age at the time of infection and whether the hospitalization, ICU admission, or mechanical ventilation was related to delivery or other pregnancy conditions rather than for COVID-19 illness are not available, which limits the interpretation (CDC).

Pregnant patients with comorbidities such as obesity are likely at increased risk for severe illness consistent with the general population with similar comorbidities. However, given that pregnancy itself is now identified as a risk factor for certain outcomes, the magnitude of further increase from such comorbidities will need to be further delineated. Although there are cases of reported vertical transmission of SARS-CoV-2, the data are reassuring that vertical transmission appears to be uncommon. Finally, the surveillance data analyzed in this report do not capture pregnancy or birth outcomes. ACOG continues to monitor the emerging literature on these topics.

Clinicians should counsel pregnant women and those contemplating pregnancy about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families. Pregnant individuals in particular are encouraged to take all available precautions to optimize health and avoid exposure to COVID-19 including:

maintaining prenatal care appointments

wearing a mask and other recommended PPE, if applicable, at work and in public

washing hands frequently

maintaining physical distancing

limiting contact with other individuals as much as practicable

maintain an adequate supply of preparedness resources including medications

The findings in this report underscore the need to advocate for protection measures such as appropriate PPE for individuals with increased risk of exposure and infection due to occupation or other circumstances.

ACOG understands that many pregnant individuals are experiencing increased stress due to COVID-19. When counseling pregnant individuals about COVID-19, it is important to acknowledge that these are unsettling times (see How can I help my pregnant and postpartum patients manage stress, anxiety, and depression?) and to encourage patients to communicate regularly with the health care team. Clinicians are encouraged to share ACOG’s patient resources as appropriate.

ACOG is working to address the concerns that have been raised about the effect of COVID-19 in pregnant individuals. While this data analysis from CDC increases our knowledge of the impact of COVID-19 on pregnant women, more robust and complete data, including data on race/ethnicity, are needed to truly understand the impact of COVID-19 on pregnancy. ACOG encourages our members and all clinicians who care for pregnant patients with known or suspected COVID-19 to submit information to an appropriate COVID-19 registry to augment the collective knowledge about the effect of COVID-19 during pregnancy.

Obstetrician–gynecologists and other health care professionals should be vigilant in counseling pregnant women and in screening for exposure as well as symptoms of COVID-19 for pregnant patients. This can be done via phone or telehealth before a visit to allow facilities to appropriately prepare and optimize care coordination needs. For any patient with fever or acute respiratory illness, clinicians should follow the CDC’s Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19) and guidance for Overview of Testing for SARS-CoV-2. Of note, health care professionals should follow their health care facility’s policies and their local and state health department policies for notification of a person under investigation for COVID-19.

ACOG will continue to work with CDC and diligently monitor the literature for any COVID-19 risk signals in pregnancy.