Written by the doctors and editors at UpToDate
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: August 2022. | This topic last updated: September 7, 2022.
This topic provides answers to some of the most commonly asked questions by UpToDate users. Additional content on coronavirus disease 2019 (COVID-19) is provided separately.
●(See "COVID-19: Epidemiology, virology, and prevention".)
●(See "COVID-19: Clinical features" and "COVID-19: Diagnosis".)
●(See "COVID-19: Occupational health issues for health care personnel".)
●(See "COVID-19: General approach to infection prevention in the health care setting".)
●(See "COVID-19: Evaluation of adults with acute illness in the outpatient setting" and "COVID-19: Management of adults with acute illness in the outpatient setting".)
●(See "COVID-19: Management in hospitalized adults".)
●(See "COVID-19: Management of the intubated adult".)
●(See "COVID-19: Arrhythmias and conduction system disease".)
●(See "Society guideline links: COVID-19 – Index of guideline topics".)
●(See "Patient education: COVID-19 and pregnancy (The Basics)".)
●(See "Patient education: COVID-19 overview (The Basics)".)
●(See "Patient education: COVID-19 vaccines (The Basics)".)
●(See "Patient education: COVID-19 and children (The Basics)".)
●(See "COVID-19: Questions and answers".)
PRENATAL CARE
Are pregnant women more susceptible to COVID-19 or at higher risk for complications of COVID-19?
Pregnancy and childbirth generally do not increase the risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but appear to worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same sex and age; however, most (>90 percent) infected persons recover without undergoing delivery. (See "COVID-19: Overview of pregnancy issues", section on 'Maternal course'.)
Does COVID-19 increase the risk for pregnancy complications?
Yes, infected women, especially those who develop pneumonia, appear to have an increased frequency of preterm birth (birth before 37 weeks of gestation) and possibly cesarean delivery, which is likely related to severe maternal illness. Most preterm births are iatrogenic (ie, induced labor or scheduled cesarean delivery). (See "COVID-19: Overview of pregnancy issues", section on 'Pregnancy and newborn outcomes'.)
Does SARS-CoV-2 cross the placenta?
There is no definite evidence that SARS-CoV-2 crosses the placenta and infects the fetus; however, a few cases of placental tissue or membranes positive for SARS-CoV-2 and a few cases of possible in utero infection have been reported. Some of the neonatal cases may have been false-positive test results or due to acquisition of infection soon after birth. Reports of COVID-19 infection in the neonate have generally described mild disease. (See "COVID-19: Overview of pregnancy issues", section on 'Risk of vertical transmission'.)
How can prenatal care be modified to decrease risk of contracting COVID-19?
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) support modifying traditional protocols for prenatal visits to limit person-to-person contact and thus help prevent spread of COVID-19. Modifications should be tailored for low- versus high-risk pregnancies (eg, multiple gestation, hypertension, diabetes) and may include telehealth in areas of active infection transmission, reducing the number of in-person visits, timing of visits, grouping tests (eg, aneuploidy, diabetes, infection screening) to minimize maternal contact with others, restricting visitors during visits and tests, timing of indicated obstetric ultrasound examinations, and timing and frequency of use of nonstress tests and biophysical profiles. (See "COVID-19: Overview of pregnancy issues", section on 'Uninfected pregnant patients'.)
Should glucocorticoids be avoided in pregnant women with COVID-19?
No, pregnant women who meet criteria for use of glucocorticoids for maternal treatment of COVID-19 can receive standard doses of dexamethasone. For those who also meet criteria for use of antenatal corticosteroids for fetal lung maturity, we suggest administering the usual doses of dexamethasone (four doses of 6 mg given intravenously 12 hours apart) to induce fetal pulmonary maturation and continuing dexamethasone to complete the usual course of treatment for maternal COVID-19 (6 mg orally or intravenously daily for 10 days or until discharge, whichever is shorter). (See "COVID-19: Antepartum care of pregnant patients with symptomatic infection", section on 'Use of dexamethasone'.)
Are SARS-CoV-2 vaccines safe for pregnant women and women planning pregnancy?
Yes. We recommend that all unvaccinated people planning pregnancy or those who are pregnant or recently pregnant undergo COVID-19 vaccination, and those who are vaccinated should receive booster doses, when eligible, in agreement with major medical organizations and public health authorities. This recommendation is based on data showing vaccine safety and efficacy in pregnant people and data that pregnancy itself is associated with an increased risk of severe infection (Centers for Disease Control and Prevention [CDC] tier 1c vaccine allocation).
The benefits of vaccination are:
●Reduction in maternal SARS-CoV-2 infection
●Reduction in maternal COVID-19 of any severity (including severe and critical disease)
●Reduction of perinatal death
●Reduction of COVID-19 hospitalization among infants up to six months of age
Vaccination can occur at the same time as administration of a routinely administered vaccine, such as the Tdap and influenza; a separation period is unnecessary. (See "COVID-19: Overview of pregnancy issues", section on 'Vaccination in people planning pregnancy and pregnant or recently pregnant people'.)
Vaccination does not affect fertility, and it is not necessary to delay pregnancy after vaccination. (See "COVID-19: Overview of pregnancy issues", section on 'Vaccination in people planning pregnancy and pregnant or recently pregnant people'.)
Are antiviral COVID-19 and monoclonal antibody therapies contraindicated in pregnancy?
No. Pregnant and recently pregnant people with mild to moderate COVID-19 are potential candidates for COVID-19-specific therapy because they are at increased risk for progression to severe disease and treatment can substantially reduce the risk of progression to severe illness and hospitalization (and with some interventions, mortality). In our practice, we suggest this therapy to pregnant outpatients with additional risk factors for severe disease (table 1) or who are unvaccinated, after discussion of the benefits/risks and drug-drug interaction potential. We provide it to outpatients who request therapy but have no risk factors for severe disease other than pregnancy.
Selection of COVID-19-specific therapy for hospitalized adults who have severe disease requiring oxygen supplementation is shown in the algorithm (algorithm 1). (See "COVID-19: Antepartum care of pregnant patients with symptomatic infection", section on 'Antiviral drugs and other COVID-19-specific therapies' and "COVID-19: Antepartum care of pregnant patients with symptomatic infection", section on 'Use of antiviral drug and monoclonal antibody therapy'.)
LABOR AND DELIVERY
Is maternal COVID-19 an indication for cesarean delivery?
No, COVID-19 is not an indication to alter the route of delivery. Even if vertical transmission is confirmed as additional data are reported, this would not be an indication for cesarean delivery since it would increase maternal risk and would be unlikely to improve newborn outcome. (See "COVID-19: Intrapartum and postpartum issues", section on 'Choosing the route of birth'.)
Should planned induction of labor or cesarean delivery of asymptomatic women be postponed during the pandemic?
No, in asymptomatic women, inductions of labor and cesarean deliveries with appropriate medical indications should not be postponed or rescheduled. This includes 39-week inductions or cesarean deliveries after patient counseling. (See "COVID-19: Antepartum care of pregnant patients with symptomatic infection", section on 'Timing of delivery'.)
How should labor pain be managed in women with COVID-19?
A neuraxial anesthetic is generally preferred to other options for management of labor pain because it provides good analgesia and thus reduces cardiopulmonary stress from pain and anxiety. In addition, it is available in case an emergency cesarean is required, thus obviating the need for general anesthesia. The Society of Obstetric Anesthesia and Perinatology (SOAP) suggests considering suspending use of nitrous oxide for labor analgesia in patients with confirmed or suspected COVID-19 because of insufficient data about cleaning, filtering, and potential aerosolization of nitrous oxide systems, but it remains an option for patients with a negative SARS-CoV-2 test. (See "COVID-19: Intrapartum and postpartum issues", section on 'Labor analgesia and anesthesia'.)
Can an asymptomatic partner/support person attend labor and delivery?
Practices vary by institution. At a minimum, the support person should be screened in accordance with hospital policies, and those with any symptoms consistent with COVID-19, exposure to a confirmed case within 14 days, or a positive test for COVID-19 within 14 days should not be allowed to attend the labor and birth. Most facilities recognize that a support person is important to many laboring women and permit one support person who must remain with the laboring woman (may not leave the room and then return). Additional support persons may be allowed or can be a part of the patient's labor and delivery via video. (See "COVID-19: Intrapartum and postpartum issues", section on 'Infection control precautions, intrapartum and postpartum'.)
POSTPARTUM
How should the newborn be evaluated?
If the mother has known COVID-19, the newborn is a COVID-19 suspect and should be tested, isolated from other healthy newborns, and cared for according to infection control precautions for patients with confirmed or suspected COVID-19. (See "COVID-19: Intrapartum and postpartum issues", section on 'Newborn evaluation'.)
Should mothers with COVID-19 be separated from their newborn?
Generally no because the newborn's risk for acquiring SARS-CoV-2 from the mother is low, and data suggest no difference in risk of neonatal SARS-CoV-2 infection whether the neonate is cared for in a separate room or remains in the mother's room. However, mothers should wear a mask and practice hand hygiene during contact with their infants. At other times, physical distancing >6 feet between the mother and neonate or placing the neonate in an incubator is desirable when feasible. (See "COVID-19: Intrapartum and postpartum issues", section on 'Mother-newborn contact in the hospital'.)
How long should mother-newborn precautions at home continue after recent infection?
Previously symptomatic mothers with suspected or confirmed COVID-19 are not considered a potential risk of virus transmission to their neonates if after 5 days from testing positive they have no symptoms or their symptoms are resolving, but they should continue to wear a mask around others for 5 additional days. For asymptomatic mothers identified because of routine SARS-CoV-2 screening upon hospital admission, the recommended time for isolation is 5 days, followed by 5 days of wearing a mask when around others. (See "COVID-19: Intrapartum and postpartum issues", section on 'Criteria for discontinuing mother-newborn infection precautions'.)
Can breast milk transmit SARS-CoV-2?
There is general consensus that breastfeeding should be encouraged because of its many maternal and infant benefits. It is unknown whether SARS-CoV-2 can be transmitted through breast milk because very few breast milk samples have been tested. In a World Health Organization (WHO) study, breast milk samples from 43 mothers were negative for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and samples from three mothers tested positive, but specific testing for viable and infective virus was not performed. (See "COVID-19: Intrapartum and postpartum issues", section on 'Breastfeeding and formula feeding'.)
What precautions should mothers with confirmed or suspected COVID-19 take when breastfeeding?
Droplet transmission from an infected mother to their uninfected baby could occur through close contact during breastfeeding. Mothers can take precautions to prevent this by performing hand hygiene and using a well-fitting face mask. In a study from New York City that tested and followed 82 infants of 116 mothers who tested positive for SARS-CoV-2, no infant was positive for SARS-CoV-2 postnatally, although most roomed-in with their mothers and were breastfed. The infants were kept in a closed isolette while rooming-in, and the mothers wore surgical masks while handling their infants and followed frequent hand and breast washing protocols.
Alternatively, the infant can be fed expressed breastmilk by a healthy caregiver following hygiene precautions until the mother has recovered or is proven uninfected. In such cases, the mother should use strict handwashing before pumping and wear a face mask during pumping.
When both the mother and the breastfed infant have suspected or confirmed COVID-19, no special precautions (eg, wearing a mask) are needed during breastfeeding, expressing milk, or feeding from a bottle, or during the period of isolation. (See "COVID-19: Intrapartum and postpartum issues", section on 'Breastfeeding and formula feeding'.)
Can pregnant and postpartum women with COVID-19 take NSAIDs and acetaminophen?
Yes, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be used for treatment of fever and pain during pregnancy and postpartum. Antepartum, the lowest effective NSAID dose is used, ideally for less than 48 hours and guided by gestational age-related potential fetal toxicity (eg, oligohydramnios, premature closure of the ductus arteriosus). Low-dose aspirin for prevention of preeclampsia is safe throughout pregnancy. In patients with abnormal liver chemistries secondary to COVID-19, a potential concern of acetaminophen use is hepatic toxicity; however, doses less than 2 grams per day are likely safe in the absence of severe or decompensated hepatic disease. (See "COVID-19: Antepartum care of pregnant patients with symptomatic infection", section on 'Use of NSAIDs and acetaminophen'.)
Are SARS-CoV-2 vaccines safe for breastfeeding women?
Yes. We recommend COVID-19 vaccination for breastfeeding women rather than deferring vaccination until after breastfeeding. Maternal COVID-19 antibodies induced by maternal vaccination can pass into breast milk and may have protective effects for the infant. If any vaccine crosses into breast milk and is then ingested by the infant, it is likely to be inactivated by the infant's digestive system. (See "COVID-19: Intrapartum and postpartum issues", section on 'Vaccination'.)
REFERENCES — Supporting references can be found in the linked UpToDate topics.
