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Let's take a look at what we know about the effect of COVID-19 on pregnancy. Most publishers make papers on COVID-19 freely available so I included the references. 

 First, one is ALWAYS concerned to stay healthy during pregnancy, just as a general rule of thumb. But COVID-19 is a concerning pathogen because it affects the blood clotting system. We know that because the patients frequently have blood clots in different parts of the body. Blood clots in the placenta, for example, are not good because they will inhibit blood flow and nourishment of the baby. The blood clotting system is also affected in the hypertensive inflammatory pregnancy disease preeclampsia and is immensely important during birth to make sure that the mother doesn’t lose too much blood after the placenta is delivered. So how are all these things impacted by the virus? 

Fetuses born to COVID-19 infected mothers are very rarely getting the infection in the womb or during birth. In other words, the babies were mostly negative for COVID-19 right after birth, although they may turn positive later (1-4). If they did turn positive later, it was mostly after cesarean delivery and the babies remained asymptomatic (5). 

There is no indication at this point that COVID-19 infection makes women more prone to preeclampsia or that it makes preeclampsia worse (6). The mother being infected does not seem to affect the baby’s Apgar score once it’s born (Apgar score tests for reflexes and signs of vitality, invented by Virginia Apgar). Pregnancy does not seem to make COVID-19 infection more dangerous. This is a concern since an infection with the Influenza virus (flu) is more dangerous for pregnant women (1-3). 

COVID-19 infected pregnant women (regardless of whether the disease was symptomatic or asymptomatic) experienced increased complications during birth compared to non-infected women such as: 

- Higher amount of post-partum blood loss >500ml (~ 1 pint, 14.2% infected vs 7.2% non-infected, RR 2.0 [95% CI 1.1-3.4])

- More women needed blood transfusion (5.5% infected vs. 1.1% non-infected, RR 4.9 [95% CI 1.5-16.6])

- Intensive Care Unit hospitalization (3.6% infected vs. 0.8% RR non-infected 4.5 [95% CI 1.1-18.6])2

Infection of the mom also had consequences for the baby (again, regardless of whether mom’s disease was symptomatic or asymptomatic): 

- Significantly increased chance of stillbirth (5.1% infected vs. 1.1% non-infected, RR 4.7 [95% CI 1.4-15.9]). All stillbirths occurred between 19 and 35 weeks of gestation (2).

- Increased chance of preterm birth (21.4% infected vs 6.7% non-infected) and increased chance of cesarean/operative birth (50% infected vs 26.9% non-infected) (3).

- In a study in Kuweit, 26.6% or 44 out of 165 COVID-19 infected pregnant women gave birth preterm (before gestational week 37) (6).

RR = Risk Ratio, CI = Confidence Interval 

Protect yourself as much as you can from the virus but you should really protect yourself reasonably from any type of serious infection when you're pregnant. Especially influenza! Influenza is actually KNOWN to have a much worse, life threatening prognosis in pregnant women so talk to your OB/GYN about getting the flu shot if you are pregnant or are considering becoming pregnant. Another option is to become involved in clinical studies so we can all learn more about what this new virus does and means for the body during pregnancy. We understand so little about pregnancy in general that any good clinical study about pregnancy adds to our very limited knowledge. And if we don't understand it, we can't help if things go wrong. You can always find out about clinical trials at https://clinicaltrials.gov/.  Currently ongoing studies are a registry study where you simply report your symptoms and then follow up and report about the health of your baby later. Studies to test the safety of the therapy Remdesivir and COVID-19 vaccines are going to be starting up soon. 

 1. Shmakov RG, Prikhodko A, Polushkina E, et al. Clinical course of novel COVID-19 infection in pregnant women. J Matern Fetal Neonatal Med. Nov 2020:1-7. doi:10.1080/14767058.2020.1850683

2. N H, F M, O P, et al. Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: A single-center prospective comparative study. European Journal of Obstetrics & Gynecology and Reproductive Biology; 2020.

3. Villalaín C, Herraiz I, Luczkowiak J, et al. Seroprevalence analysis of SARS-CoV-2 in pregnant women along the first pandemic outbreak and perinatal outcome. PLoS One. 2020;15(11):e0243029. doi:10.1371/journal.pone.0243029

4. Chi J, Gong W, Gao Q. Clinical characteristics and outcomes of pregnant women with COVID-19 and the risk of vertical transmission: a systematic review. Arch Gynecol Obstet. Dec 2020;doi:10.1007/s00404-020-05889-5

5. Wu P, Haththotuwa R, Kwok CS, et al. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 02 2017;10(2)doi:10.1161/CIRCOUTCOMES.116.003497

6. Ayed A, Embaireeg A, Benawadh A, et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth. Dec 2020;20(1):754. doi:10.1186/s12884-020-03461-2