Tested positive for COVID while pregnant? Here’s what you need to know

A positive test for COVID-19 while pregnant calls for a different response than it would for most other adults. Pregnancy changes how your immune system, lungs and heart work, which is why COVID during pregnancy is something that warrants a call to your care team.

Here's what to do if you test positive for COVID while pregnant, what's safe to take for symptoms of COVID-19 and when to seek immediate care.

Why COVID during pregnancy carries added risk

Most pregnant women who are diagnosed with COVID-19 have a mild course and recover without complications. Having COVID while pregnant does not mean that you will have pregnancy complications. Your OBGYN can help you understand your individual risk and determine whether you need additional monitoring.

Pregnancy naturally lowers some of your body's immune defenses. Your lungs have less room to expand as the uterus grows and your heart is working harder to circulate a larger volume of blood. Those changes can make pregnant women more likely than non-pregnant adults to develop severe illness, require hospitalization or experience complications such as preterm birth and preeclampsia.

Research into how COVID affects the placenta is still evolving. Some studies have found signs of inflammation or reduced immune activity in the placentas of women who had COVID, particularly with certain variants, though findings vary and much remains unknown about which pregnancies are affected and why.

Separately, a high, sustained fever during the first trimester from any illness, not just COVID, has been linked to a modestly higher risk of certain birth defects, which is one more reason to treat a fever promptly rather than let it run its course.

Transmission of COVID from mother to baby before birth appears to be uncommon. A small number of newborns tested positive shortly after delivery, but it's often unclear whether that happened in the womb or through close contact after birth.

Identifying symptoms of COVID

If you test positive for COVID-19 or develop symptoms that you suspect may be related to COVID, call your OBGYN. Let them know when your symptoms started, what symptoms you have and any other health conditions or risk factors.

Don't wait to see if things get better or worse on their own. Your care team can help you decide whether you need to be seen, whether further treatment makes sense for you and what to watch for as you recover.

Common symptoms of COVID include:

• Fever
• Cough
• Sore throat
• Congestion
• Body aches
• Fatigue
• Nausea
• Diarrhea
• Loss of taste or smell

Symptoms of COVID that need urgent attention

While most cases of COVID during pregnancy don't require emergency care, some symptoms shouldn't wait for a callback from your doctor. Head to the emergency room or call 911 if you develop any of the following:

• Trouble breathing or shortness of breath that's new or getting worse
• Persistent pain or pressure in your chest
• New confusion or trouble staying awake
• Bluish lips or face
• A fever that won't come down after 24 hours despite taking acetaminophen

There is a group of severe COVID symptoms that can overlap with pregnancy complications like preeclampsia. It’s important to mention them to your doctor, even if you are not sure they’re related to COVID. These include:

• Decreased fetal movement
• Vaginal bleeding
• Severe swelling in your hands or face
• A severe headache or vision changes
• Persistent vomiting

When to call your doctor about COVID while pregnant

Some symptoms of COVID-19 may need medical attention during pregnancy, even if they initially seem mild. Use the guide below to know when to contact your care team or seek emergency care.
 

4 tips to manage COVID during pregnancy

For mild cases of COVID during pregnancy, you should be able to treat symptoms and recover at home with rest, fluids and symptom relief. A few simple steps can help you manage your symptoms while also protecting others in your household.

1. Rest and stay hydrated. Most pregnant women recover at home with supportive care. Use of a humidifier or saline nasal spray may also help relieve some symptoms.
2. Stay away from others in your household as much as you can while you're sick, and mask around family members if you need to be in shared spaces.
3. Track how you're feeling day to day rather than counting down a fixed number of days. Current guidance says you can return to normal activities once your symptoms have been improving overall and you've gone 24 hours without a fever, without the help of fever-reducing medication. For the several days after that, it's still worth masking around others and washing your hands frequently, since you can still be contagious.
4. If you're far enough along to feel your baby move regularly, pay attention to that pattern. Contact your OBGYN if you have a noticeable drop in movement.

What medications can you take for COVID while pregnant?

There is no single medication that treats every case of COVID-19 during pregnancy. Treatment depends on your symptoms, how long you have been sick and your risk of becoming seriously ill.

Acetaminophen remains the recommended option for fever and body aches during pregnancy, generally up to 3,000 mg in 24 hours unless your doctor tells you otherwise. Talk to your doctor if you have any questions about dosing or medication alternatives rather than skipping treatment altogether.

Take care with using other medications during pregnancy to treat symptoms of COVID and ask your doctor or a pharmacist if they are appropriate for you to take:

• Avoid NSAIDs like ibuprofen and naproxen, especially after 20 weeks. They've been linked to low amniotic fluid and issues with fetal kidney and heart development later in pregnancy.
• Decongestants such as pseudoephedrine can be used with caution, but check with your doctor first if you have high blood pressure or are in your first trimester.
• Guaifenesin, dextromethorphan and most standard antihistamines (loratadine, cetirizine, diphenhydramine) are generally considered fine during pregnancy, along with throat lozenges and antidiarrheal products like loperamide.

If your symptoms and risk factors put you in a higher-risk category, your OBGYN may discuss an antiviral like nirmatrelvir-ritonavir (Paxlovid), which is typically started within five days of symptom onset.

Studies have not shown an increased risk of pregnancy complications among women who took it, though it can interact with several other medications, so your care team will want to review what else you're taking before prescribing it.

Whatever you take, mention your pregnancy to any provider treating you and check with your OBGYN before starting anything new, including supplements.

Will COVID change your prenatal visits or delivery plan?

Routine care generally continues as planned, even if you are diagnosed with COVID while pregnant. If you test positive close to a scheduled prenatal visit, call your doctor’s office first and make sure they are aware. Some appointments can move to telehealth, while others, like growth ultrasounds or anything involving a concerning symptom, are usually still done in person with precautions such as masking.

If you go into labor while positive or suspect you might be, call your OBGYN or your hospital's labor and delivery unit so staff can prepare a room and take appropriate precautions. The same applies if you have a scheduled induction or cesarean delivery.

Hospitals typically no longer follow the broad separation policies used earlier in the pandemic. Current guidance favors keeping you and your newborn together after delivery, with simple safeguards like mask-wearing and hand hygiene during feeding and care, unless you're too sick to safely care for your baby.

Can you breastfeed if you have COVID-19?

In most cases, yes, breastfeeding with COVID-19 is safe. Current evidence indicates that breast milk is not a source of COVID transmission, and the CDC recommends that people with COVID-19 continue breastfeeding when possible while taking precautions to reduce respiratory virus spread.

Wash your hands before touching your baby or expressing breast milk. You might also consider wearing a mask during close contact with your baby, including while breastfeeding. It is important to thoroughly clean breast pumps and feeding equipment according to the manufacturer's instructions.

If you are too sick to breastfeed directly, ask your healthcare team about expressing breast milk and having a healthy caregiver feed your baby.

Still worried about what happens if you get COVID while pregnant? Talk to your doctor about your specific questions. Together, you can come up with a plan for what to do if you get the virus and how to keep yourself and your baby safe.

Tell us where you are in your pregnancy journey, and we’ll connect you with personalized checklists and trusted guidance from our experts.