Getting COVID-19 during pregnancy increases your risk of severe illness compared to non-pregnant people, and it can lead to complications like preterm birth, preeclampsia, and stillbirth. The good news: current variants cause less severe disease than earlier ones, antiviral treatment is recommended and available during pregnancy, and vaccination substantially lowers the risks for both you and your baby.
Why Pregnancy Makes COVID-19 More Dangerous
Pregnancy naturally shifts your immune system and changes how your heart and lungs work, making you more vulnerable to respiratory infections. Data from over a million deliveries in 2020 showed that pregnant women with COVID-19 at delivery were roughly 2.6 times more likely to become severely ill than uninfected pregnant women. The risk of death was about 14 times higher among those with COVID-19 at delivery (64 per 100,000 deliveries versus 4.3 per 100,000). COVID-positive pregnant patients also had a greater need for ventilation and ICU care.
These numbers come from the earlier, more dangerous phases of the pandemic. Severity has shifted with newer variants. During the Delta wave, about 6.5% of unvaccinated pregnant women experienced severe outcomes like ICU admission or respiratory distress. During the Omicron wave, that dropped to 1.0%. Hospitalization rates also fell, from 17.2% with Delta to 12.5% with Omicron. The virus is still more risky during pregnancy than outside of it, but the absolute danger has decreased considerably with current circulating strains.
Preeclampsia Risk
One of the less obvious effects of COVID-19 in pregnancy is a higher chance of developing preeclampsia, a condition marked by high blood pressure and organ stress that can become life-threatening. A meta-analysis of nearly 800,000 pregnancies found that women with COVID-19 were about 62% more likely to develop preeclampsia than uninfected women (7.0% versus 4.8%). The risk was even higher for severe preeclampsia, eclampsia (seizures), and HELLP syndrome, a serious complication involving liver and blood clotting problems.
Symptomatic infections carried a greater risk than asymptomatic ones. Women with COVID symptoms were roughly twice as likely to develop preeclampsia, while those with no symptoms still had about a 59% increased risk. This means even a mild or silent infection can affect blood pressure and organ function during pregnancy.
Stillbirth and Pregnancy Complications
COVID-19 increases the risk of stillbirth, though it remains uncommon overall. Among more than 1.2 million deliveries tracked by the CDC between March 2020 and September 2021, stillbirth occurred in 1.26% of deliveries with COVID-19, compared to 0.64% without. That translates to roughly double the risk after adjusting for other factors.
The variant matters. During the Delta period, the stillbirth rate among COVID-positive deliveries jumped to 2.70%, four times higher than the baseline. During Omicron, the stillbirth rate dropped to about 0.9% in unvaccinated women. Pregnancy complications overall followed a similar pattern: 35.2% during Delta versus 30.3% during Omicron.
What Happens to the Placenta
COVID-19 can cause inflammation in the placenta, the organ that delivers oxygen and nutrients to your baby. Researchers have found that placentas from infected women sometimes show a pattern of immune cells flooding the space between the placenta’s tiny finger-like projections (called villi), along with damage to the outer layer of cells that normally forms a barrier between your blood and the baby’s. When both of these occur together, the virus is more likely to cross from mother to baby. Other findings include inflammation of the umbilical cord and signs of disrupted blood flow on either the maternal or fetal side of the placenta.
Can the Baby Get Infected?
Vertical transmission, where the virus passes from mother to baby before or during birth, happens but is uncommon. A large meta-analysis of 204 studies estimated the overall rate at about 4%. Most newborns who do test positive have mild or no symptoms. The placental barrier is effective at blocking the virus in the vast majority of cases, though the inflammation described above can sometimes compromise that protection.
Higher Cesarean Delivery Rates
Studies from the earlier pandemic found that cesarean delivery rates were notably higher among women hospitalized with COVID-19, with one review reporting 77.7% of deliveries were surgical. That number is somewhat misleading. COVID-19 alone is not a reason to perform a cesarean. The higher rate reflects the fact that severely ill women are more likely to need early or emergency delivery for their own health or the baby’s. When the infection is mild and the pregnancy is otherwise progressing normally, vaginal delivery remains appropriate. Close monitoring of the baby’s status during labor helps avoid the need for emergency surgery.
Treatment During Pregnancy
If you test positive for COVID-19 while pregnant, antiviral treatment is available and recommended. Both ACOG and the CDC advise against withholding treatment simply because someone is pregnant. The preferred outpatient treatment is Paxlovid, which is prescribed for mild to moderate illness in people at high risk of becoming sicker. Pregnancy itself qualifies as a high-risk condition.
Paxlovid is taken as three tablets twice daily for five days, starting as soon as possible after a positive test. If you also have the flu at the same time, both Paxlovid and a flu antiviral can be taken together. In general, treatment decisions for pregnant patients follow the same guidelines as for everyone else. The key is to get tested early and start treatment promptly rather than waiting to see if symptoms worsen.
How Vaccination Protects You and Your Baby
COVID-19 vaccination during pregnancy reduces emergency department and urgent care visits related to the virus by 52%. It also lowers the risk of severe illness, hospitalization, ICU admission, and death. But the benefits extend beyond your own health. When you’re vaccinated during pregnancy, your body produces antibodies that cross the placenta and reach your baby. Since no COVID-19 vaccine is approved for infants under 6 months old, this transferred immunity is the only form of protection available to newborns.
A completed two-dose mRNA series during pregnancy was shown to be 61% effective at preventing hospitalization in infants under 6 months. That protection covers the window when babies are most vulnerable and have no other option for vaccination. Getting an updated COVID-19 vaccine during pregnancy is currently recommended regardless of how many previous doses you’ve had.