What if I test positive for COVID during pregnancy?
First of all, don’t panic. Most pregnant women with COVID-19 don’t get severely ill, and they go on to have healthy pregnancies. If you’ve been vaccinated and received your booster, you’re even better protected!
If you test positive for COVID during pregnancy:
- Call your healthcare provider for advice. (Also call your provider if you’ve been exposed to the virus and develop symptoms, such as a fever or cough, even if you haven’t tested positive.) They’ll give you instructions about when to call if your symptoms worsen and may start you on a temporary blood thinning medication to prevent blood clots.
- Stay away from others, including those at home. The CDC recommends isolating for at least 5 days depending on your symptoms: If, after 5 days, you have been fever-free for 24 hours (without using fever reducers), and your symptoms are improving, you can end isolation. If you never had symptoms, the CDC states you can end your isolation period 5 days after you receive a positive test. However, it’s important to note that if you’re still feeling sick, you should isolate for 10 days, and everyone, regardless of when your isolation period ends, should wear a mask for 10 days out in public and at home.
- Stay home, except for necessary medical care. Call ahead and wear a mask when you go in for appointments.
- Take care of yourself by drinking plenty of water to stay hydrated and getting plenty of rest to help your body fight the infection.
- If you’re running a fever, take acetaminophen to reduce it. Many over-the-counter remedies are safe to take in pregnancy for congestion and cough. Ask your doctor if you have questions about what’s safe to take.
- Get a pulse oximeter if you don’t have one, and check your oxygen levels a few times a day. Call your doctor if you routinely measure under 94 percent.
Go to the emergency room or call 911 if you have:
- Shortness of breath (beyond what’s normal for your pregnancy)
- Pain or pressure in your chest
- Sudden confusion
- Blue lips or face
Are there any pregnancy-safe treatments for COVID-19?
Two types of medications are used to treat COVID-19 – monoclonal antibodies and antiviral agents. Because pregnant women are at high risk of complications from COVID, they’re eligible to receive some of these treatments under the FDA’s emergency use authorization. They may be especially appropriate for pregnant women with other risk factors, such as obesity, diabetes, or cardiovascular disease.
Antibodies are proteins your body makes to attach to parts of the virus (or bacteria, etc.) to help the immune system recognize and respond more effectively to infection. You make them naturally with any infection and in response to any vaccine.
Monoclonal antibodies are produced for one specific purpose (in this case to fight COVID-19). They are similar to antibodies your immune system would make itself. For a mild to moderate COVID-19 infection, treatment with monoclonal antibodies has been found to be up to 80 percent effective in preventing severe illness and hospitalization. They should be used as soon as possible after diagnosis and within 10 days of the onset of symptoms.
Monoclonal antibodies are thought to be safe for pregnant women, especially when weighing the risks of severe COVID-19 disease. Multiple national societies, including the National Institutes of Health (NIH) and the American College of Obstetricians and Gynecologists (ACOG), have endorsed the use of monoclonal antibodies in pregnant women.
Sotrovimab is the only monoclonal antibody currently available that works against the Omicron virus, and it’s in very short supply. (Remdesivir and Regenron (casiriyimab-imdevimab), the monoclonal antibodies most commonly used last year, are not effective against the Omicron variant.) These treatments are all given intravenously by a medical provider.
Note: If you’re not yet vaccinated, you should wait to get a COVID-19 vaccine until 90 days after monoclonal antibody treatment.
Two oral antiviral medications are available to treat COVID-19 symptoms. Both are five-day medications that are effective if started within 3 to 5 days of the beginning of symptoms. One of these medications, Paxlovid, contains nirmatrelvir and ritonavir. It’s recommended for treating outpatients with mild to moderate COVID-19 infections who are at high risk of disease progression.
There aren’t human studies proving the safety of Paxlovid in pregnancy, although observational studies on ritonavir in pregnancy haven’t identified an increased risk of birth defects. The Society of Maternal-Fetal Medicine (SMFM) and ACOG support the use of Paxlovid for pregnant women with COVID-19.
(Another new oral antiviral medication for use in COVID patients is called Molnupiravir, but at this time it’s not recommended for use in pregnancy.)
Your provider can help you weigh the benefits of the use of any of these medications against the significant risks of COVID-19 for you and your baby.
What happens if I have COVID when it’s time to deliver?
If you have COVID when you’re approaching your delivery date, review your birth plan with your healthcare provider. While there may be some changes that need to be made in terms of visitors and your postpartum stay, in most instances you won’t need to change other plans. The timing and method of delivery – whether you’re having a vaginal birth or cesarean, for example – can usually stay the same.
Staff will likely place you in an isolated area if you have COVID, and providers will take safety precautions, including wearing extensive personal protective equipment (PPE). If you already know you have COVID-19 before you go to the hospital or birth center, call ahead to let them know so you can be cared for effectively while taking the safety of other patients and medical staff into consideration. Your support person (if they don’t have COVID) can likely stay with you, though they probably won’t be able to come and go as normal.
After delivery, unless you’re very sick or your baby’s at high risk of getting very sick, your baby can still stay in your room with you, though the crib may be kept 6 feet away from you. A special, enclosed plastic crib is used to protect the baby in some facilities.
Could I give coronavirus to my baby during pregnancy or delivery?
It’s unlikely. While some newborns (rarely) have tested positive for COVID-19 shortly after birth, most babies born to mothers who had COVID-19 during pregnancy don’t get the virus themselves.
Transmission of COVID-19 through the placenta appears to be extremely rare and limited to cases where the mother was extremely ill with what doctors call a “large viral load” at the time of delivery. Newborns who tested positive shortly after birth may have had the virus transmitted during an active infection in the mother, most likely through respiratory droplets.
There are now hundreds of documented cases where the virus wasn’t transmitted to the baby during pregnancy or delivery. The risk is particularly low if steps are taken to prevent spread of the infection, such as wearing a mask and washing your hands frequently when caring for your baby.
Even when newborns do test positive for COVID-19, most have mild or no symptoms. If you have COVID prior to delivery or during, your baby will have some protection by the transfer of maternal antibodies across the placenta before delivery and through breast milk after delivery. A few babies have developed severe COVID-19 infections. Learn more about coronavirus in babies and kids.
To avoid passing COVID virus to your baby, get vaccinated once you’re passed your isolation period (see below). Providing your baby with antibodies is the best way to keep them healthy after delivery.
Also take the following precautions until you’ve been fever-free for 24 hours without taking any fever medication, it’s been at least 10 days since your symptoms started, and all of your symptoms have improved. If you don’t have symptoms, wait at least 10 days after your positive test result.
- Wash your hands before touching the baby and any breast pump or bottle parts. Clean all pump and bottle parts after using them.
- Wear a face mask while holding your baby. Don’t put a mask or any covering on your baby’s face.
- Keep your baby at least 6 feet away from you as much as possible.
- Enlist the help of someone who is healthy to help you take care of your baby. Have them wear a mask and keep their hands washed.
Contact your baby’s provider if your baby develops any signs or symptoms of COVID-19, including:
Will I be able to breastfeed my baby if I test positive for COVID-19?
Yes, if you choose to. Even if you’ve tested positive for COVID-19, it’s still safe and important for your baby to receive breast milk. In addition to providing optimal nutrition, breast milk protects your baby from infections. There’s currently no evidence that babies can get COVID-19 through breast milk, but there is good evidence that antibodies – from vaccines, as a response to infection, or both – get passed on to your baby.
If you have coronavirus, you’ll need to take care to minimize the risk of transmission when you’re near your baby. This means washing your hands before touching your child and wearing a mask while nursing.
Again, another option is to pump your milk and have someone else bottle feed it to your baby until you’re out of the quarantine period. Wear a mask when you express your milk, and clean the pump well after each use.
Should I still get the COVID-19 vaccine if I’ve already had COVID?
Yes, you should still get the COVID-19 vaccine if you’ve already had COVID. You may have heard that natural immunity is better than getting vaccinated, but that’s not true. Having had COVID doesn’t mean you can’t get it again, and doesn’t protect against severe repercussions like hospitalization. Being vaccinated after having COVID gives you added immunity and protection from moderate to severe complications.
How well you’re protected from COVID after having an infection depends on a number of factors, including the severity of your illness, how long it’s been since you were infected, and your age. In fact, those who aren’t vaccinated after recovering from COVID are twice as likely to contract the virus again than those who got fully vaccinated after recovery. And there’s no test to tell for sure if you’re protected from infection.
You should not get the vaccine (or booster) while you have a COVID infection, however. To protect others, whether or not you have symptoms, you should wait to be vaccinated until you’ve passed your isolation period. You also need to wait until your quarantine period is over to be vaccinated or boostered if you know you’ve recently been exposed to COVID. The CDC provides detailed directions for when and how long to quarantine and isolate.
Can I use an COVID antibody test to tell if I’m immune to COVID-19?
No, an antibody test isn’t a reliable indication that you’re immune to COVID-19. Get your vaccination and booster whether or not you have a positive antibody test. Here’s why:
- We don’t know what level of antibodies you need for protection against simple infection or against moderate to severe disease (which can cause hospitalization, ICU admission, and death).
- We don’t know how long antibodies provide protection, though some studies show that your risk of infection is low for at least 6 months after having the illness. Once your level of protection wanes low enough over time, you’re more vulnerable to infection, including severe illness.
- We don’t know how strong previously made antibodies are against new variants. In fact, it looks like new variants such as Omicron put you at higher risk of infection, whether or not you show the presence of antibodies on a blood test.
You also can’t use an antibody test to tell if you have a current COVID infection. That’s because it takes the body 1 to 3 weeks to make antibodies after you’ve been infected. And if you’ve previously been immunized, you’ll have antibodies already.
The test also won’t determine if you’re immune to COVID-19 after being vaccinated. That’s because we don’t yet understand exactly how antibody levels correlate with immunity and protection from infection and moderate or severe illness. In addition, every antibody test is different. Some only detect antibodies from infection, others from vaccination, and still others from both.
In general, antibody testing isn’t something you’ll benefit from doing on your own. Doctors sometimes use the test in very specific clinical circumstances.