Covid-19 infection in pregnancy

The 5th wave of Covid-19 has hit Hong Kong in an unprecedented manner. Pregnant women and infants were not exempted in this wave. Many pregnant women have a lot of questions and anxiety towards the condition. Hence, some simple questions and answers were prepared for the readers here. Hope to help.

On Covid-19 infection in pregnancy:

1. Are pregnant women at high-risk for Covid-19 infection?

Yes, the weaker immunity of the pregnant women has made them more susceptible to infection, including Covid-19.

2. How did most pregnant women do with Covid-19 infection?

Most pregnant women with Covid-19 infection present with flu symptoms such as fever, runny nose, sore throat, headache and fatigue. This is especially true with the current Omicron variant, which causes relatively mild symptoms for 3-5 days only in the majority of patients. Most fully recover without any problem. However, a small proportion might develop severe complications such as pneumonia, requiring hospitalization or admission to intensive care unit. This risk of severe complications is estimated to be 2-3% for those without vaccination and it will drop to 0.2% following vaccination.

3. What should a pregnant woman do if she is found to have Covid-19 infection?

First of all, don’t panic! The 2 most important aspects are (1) to manage the infection and (2) to prevent the infection from passing to others. For the infection, most will recover by itself in a few days with rest and conservative management. One just needs to watch out for deterioration of conditions (see below). To prevent the spread of the infection, it is important to report to the Centre of Health Protection (CHP), Department of Health. It is a highly infectious disease and hence quarantine for the pregnant woman and her close contacts is crucial. The CHP should decide the appropriate schedule and place of quarantine.

4. After confirmed Covid-19 infection, what kind of medication are safe to use in pregnancy?

In general, paracetamol (Panadol) is safe to use in pregnancy and it can be used for fever. Apart from this, medication such as chlorpheniramine (piriton) and lozenges can be used for runny nose and sore throat respectivley. For dealing with cough, expectorant with Dextromethorphan and Cocillana compound are the safe options.  

5. What medication should be avoided in pregnancy?

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (nurofen), diclofenac (voltaren) and mefenamic acid (ponstan), a common type of medication for pain relief and anti-inflammation should be avoided in pregnancy. This is especially the case in the 3rd trimester of pregnancy (28-40 weeks) because this type of medication can affect the kidney function of the fetus causing reduced amniotic fluid volume.

6. If the quarantine is at home, when should one call the ambulance?

When there are signs of deterioration such as shortness of breath, chest pain, severe cough, persistent high fever > 38.5C and extreme lethargy, one would need admission for treatment.

7. What are the risks to the pregnancy and the baby if the mother has Covid-19 infection?

If the mother’s symptoms are mild and can recover quickly, the chance of having pregnancy complications or adverse effects with the fetus is very low. However, if the mother’s condition is serious or unstable, there is a higher chance of developing complications such as pre-eclampsia, intrauterine fetal growth restriction and preterm birth.

8. Which part of the pregnancy are the pregnant women more vulnerable if they get Covid-19 infection?

Mother’s infection in the 3rd trimester (28-40 weeks of gestation) is associated with higher chance of pneumonia, ICU admission, preterm birth and perinatal mortality. It is therefore advisable to receive the Covid-19 vaccination prior to the 3rd trimester for better protection.    

9. What is the infection risk to the baby if the pregnant woman is infected with Covid-19 around the time of delivery?


10. If the mother had Covid-19 infection during pregnancy, does the baby need to be tested for Covid-19 infection upon delivery? How?

If the infection occurred > 2 weeks prior to the delivery, no testing for infection is required for the baby after birth. However, if the infection occurred within 2 weeks of delivery, the baby would need testing for Covid-19 infection by combined nasal pharyngeal and throat swabs.

11. Can the mother breastfeed if she has Covid-19 infection?

If a pregnant woman has fully recovered, she can of course breastfeed as usual. However, if the pregnant woman has not recovered and remains contagious, the dilemma is that while direct breastfeeding has the risk of passing the virus to the baby through air droplets, breast milk provides the baby the best nutrition and the antibodies in the content also help to protect the baby. At present, the American Academy of Pediatrics recommends that pregnant women with Covid-19 infection can have direct breastfeeding, but they should take infection prevention measures, including wearing a mask, washing hands frequently, and disinfecting the places they have touched in the room, etc. One study has shown that these measures can minimize the chance of infecting the baby to negligible. If a pregnant woman does not want to breastfeed directly, she can still express breastmilk for a caregiver to feed her baby.

12. How can Covid-19 vaccination help in the pandemic?

Covid-19 vaccination has been shown to reduce the chance of infection and severe disease. Benefits to the newborn have also been demonstrated as antibodies are found in the cord blood at birth and breast milk. Covid-19 vaccination in pregnancy is also associated with reduced risk for COVID-19-associated hospitalization among infants aged <6 months. Hence, it does not only protect the pregnant women but also their babies.

This article is contributed by Dr. T.N. Danny Leung
Updated on 09.03.2022