These Q&As were updated in March 2023, and relate to Coronavirus (COVID-19) infection in pregnancy – guidance for healthcare professionals published by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and Royal College of Paediatrics and Child Health (RCPCH), with input from the Royal College of Anaesthetists, the Obstetric Anaesthetists’ Association, UK Health Security Agency and Public Health Scotland.
The Royal College of Obstetricians and Gynaecologists (RCOG) provides this advice and guidance for your information purposes only. This information is not intended to meet your specific individual healthcare requirements and this information is not a clinical diagnostic service. If you are concerned about your health or healthcare requirements we strongly recommend that you speak to your clinician or other healthcare professional, as appropriate. The information in this FAQ is based on evidence as it emerges which we regularly review to maintain it as up to date as we are able.
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Studies from around the world show that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly, three-quarters of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. But people who are pregnant and unvaccinated or not fully vaccinated are at increased risk of becoming severely unwell if they catch COVID-19, which can lead to them needing intensive care, their baby being born prematurely, or their baby being born stillborn.
Vaccination is strongly recommended in pregnancy and pregnant women are considered a vulnerable group within the COVID-19 vaccination programme, emphasising the urgency of them being offered COVID-19 vaccination and booster doses. Those who are pregnant, as a minimum, should follow the same guidance on COVID-19 as the general population (for example about vaccination, testing or self-isolation if advised). Follow the latest advice on the government website.
Key advice for pregnant women:
- COVID-19 vaccination is strongly recommended at any stage of pregnancy. Receiving two doses of the vaccine and the booster dose is the safest and most effective way of protecting you and your baby from COVID-19 infection (read our Q&As about COVID-19 vaccines, pregnancy and breastfeeding for more information).
- Pregnant women are a priority group for the booster vaccination.
- Follow the government guidance on staying safe and preventing the spread of COVID-19.
- Pregnant women who are unvaccinated or not fully vaccinated may choose to limit close contact with people they don’t usually meet with to reduce the risk of catching or spreading COVID-19, particularly if they are in the third trimester or when COVID-19 disease levels in the general community are high.
- Keep mobile and hydrated to reduce the risk of blood clots in pregnancy.
- Stay active with regular exercise, a healthy balanced diet, and folic acid and vitamin D supplementation to help support a healthy pregnancy.
- Attend all of your pregnancy scans and antenatal appointments unless you are advised not to.
- Contact your maternity team if you have concerns about the wellbeing of yourself or your unborn baby.
- Follow the health guidance for pregnant employees to ensure you are safe in your workplace. See government guidance on Reducing the spread of respiratory infections, including Covid-19, in the workplace.
More information on pregnancy and COVID-19 is available on the NHS website.
- Symptoms of COVID-19 include:
- a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
- a loss or change to your sense of smell or taste
- shortness of breath
- feeling tired or exhausted
- an aching body
- a headache
- a sore throat
- a blocked or runny nose
- loss of appetite
- feeling sick or being sick. If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland for information and advice. Useful information can be found at https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19
- If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
- Seek medical advice as early as possible if you have any questions or concerns about you or your baby.
As above, evidence suggests that pregnant women are no more likely to get COVID-19 than other healthy adults but, if they are unvaccinated or not fully vaccinated, they are at increased risk of becoming severely unwell if they catch COVID-19 which can lead to admission to intensive care and premature birth of the baby. Roughly three-quarters of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms.
Studies have shown there are higher rates of admission to intensive care units for pregnant women with COVID-19 than for non-pregnant women with COVID-19. It is important to note this may be because clinicians are more likely to take a more cautious approach when deciding the best place to care for an unwell pregnant woman with COVID-19.
At present, it is unclear whether pregnancy will impact on the proportion of women who experience ‘long COVID’ or a post-COVID-19 condition.
In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity. Several international studies have also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high. The actual number of stillbirths in the UK however, remains low.
In the UK, information about all pregnant women requiring admission to hospital with COVID-19 was recorded in a registry called the UK Obstetric Surveillance System (UKOSS) until April 2022.
UKOSS studies and more recent publications have found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for COVID-19. Pregnant women over the age of 35, those who had a BMI of 25 kg/m2 or more, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital. Living in areas or households with greater social and economic disadvantages is also known to increase risk of developing severe illness.
Evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far. There has also been no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.
Transmission of COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a newborn baby gets COVID-19 is not affected by mode of birth (i.e. vaginal birth or caesarean), feeding choice, or whether the woman and baby stay together. It is important to emphasise that, in most of the reported cases of newborn babies developing COVID-19 very soon after birth, the babies remained well.
Studies have shown that there is a two- to three-times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. Women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely. In most cases these preterm births were recommended for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are. Babies of women with COVID-19 may be more likely to be admitted to the neonatal intensive care unit (NICU), but almost all do well.
Reviews of all published literature conducted by the RCOG, and a living systematic review have found that pregnant women with COVID-19 have a risk of stillbirth twice as high as pregnant women without COVID-19. The overall risk of stillbirths in the UK remains low.
The UK conducted near-real-time surveillance (observation) of women who were hospitalised and tested positive for COVID-19 during pregnancy up until April 2022, through well-established systems already used by all maternity units (UKOSS). Any new evidence published from this and other studies will be used to update our guidance.
Imperial College London also ran a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with COVID-19.
Pregnant women have been identified as being at higher risk of becoming seriously unwell from respiratory infections, including COVID-19. This is because, in a small proportion of women, pregnancy can alter how your body handles severe viral infections and some viral infections, such as flu, are known to be worse in pregnant women. Among pregnant women, the highest risk of becoming severely unwell (should you contract the virus) appears to be for those who are 28 weeks pregnant or beyond. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and they are used to caring for pregnant women in this situation.
Evidence suggests that hospital admission may be more common in pregnant women with COVID-19 than in non-pregnant women of the same age, however this is partly because pregnant women are also admitted to hospital for reasons unrelated to COVID-19. In the UKOSS study, which examined women with COVID-19 in pregnancy between March and September 2020, the majority of pregnant women with COVID-19 admitted to hospital were in the third trimester of pregnancy. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and this is particularly important at 28 weeks pregnant and beyond. It also strongly encourages pregnant women to be vaccinated against COVID-19.
Vitamin D supplementation is recommended to all women during pregnancy.
There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop COVID-19. However, there is not enough evidence to show that taking vitamin D prevents COVID-19 infection or is an effective treatment.
Most people living in northern hemispheres will have low levels of vitamin D. Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D. We therefore advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep their bones and muscles healthy.
Vitamin D supplements are available from most pharmacies and supermarkets and for eligible families through the NHS Healthy Start scheme.
Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.
Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.
Vaccination against COVID-19 is recommended in pregnancy and is the safest and most effective way of protecting pregnant women and their babies from coronavirus infection.
We have developed a range of information for healthcare professionals and pregnant women about COVID-19 vaccination, including FAQs on vaccines, pregnancy, fertility and breastfeeding.
All pregnant women are encouraged to get a free flu vaccination, which is safe at any stage in pregnancy from the first few weeks up until your due date. Most people recover quickly from flu, but developing flu during pregnancy can be serious for a small number of women and their babies. This is because pregnancy can alter how your body handles viral infections.
Taking up the offer of flu vaccination is particularly important when rates of COVID-19 are high. Some of the symptoms of flu including fever, cough, shortness of breath and fatigue, are similar to those of COVID-19. It is possible to be infected with flu and COVID-19 at the same time, and research shows that if you get both at the same time you may be more seriously ill than if you are infected with one virus alone. The RCOG and RCM therefore strongly recommend that pregnant women be vaccinated against flu in the winter season.
You can have a COVID-19 vaccine or booster at the same time as other vaccines such as the flu jab or the whooping cough vaccine. Sometimes it will not be possible to have the vaccines together for logistical reasons. If they aren’t given together then they can be administered at any time.
Speak to your midwife, GP or local pharmacist for information on where you can get the flu vaccination.
The COVID-19 pandemic increased the risk of domestic abuse, including financial, emotional and physical abuse or violence. You can find more information on types of domestic abuse here.
If you are experiencing domestic abuse or violence:
- Tell a healthcare professional (for example, your GP, health visitor or midwife) who can provide information and support to keep you and your baby safe.
- You can also seek support and advice from the National Domestic Abuse helpline on 0808 2000 247 or the Women’s Aid COVID-19 resource hub.
- If you are in immediate danger or it is an emergency, call 999.
- Information for pregnant women with suspected or confirmed COVID-19
If you test positive for COVID-19 outside of a hospital setting, you should contact your midwife or maternity team to make them aware of your diagnosis. They may wish to rearrange appointments if it safe to do so, or take additional precautions when you attend the hospital or other healthcare setting. This may be necessary to protect other vulnerable patients and staff.
Useful information outlining what you should do if you test positive can be found at https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19. This link will also provide advice if you think you may have symptoms of a respiratory infection, including COVID-19 and have not taken a COVID-19 test. Free rapid lateral flow testing is no longer available for most people. You are no longer legally required to self-isolate if you have COVID-19 in England but the above link will give further advice regarding steps to reduce the risk of spread within your household and the wider community.
If you feel your symptoms are worsening or if you are not getting better, this may be a sign you are developing a more severe infection that requires specialised care and you may need to be treated in hospital.
You should contact your maternity care team, your GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
This advice is important for all pregnant women, but particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. This includes women who are in the third trimester, from a Black, Asian or minority ethnic background, over the age of 35, overweight or obese, or have a pre-existing medical problem, such as high blood pressure or diabetes.
If you have concerns about the wellbeing of yourself or your unborn baby during your illness, contact your midwife or, if out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.
If you have concerns about the wellbeing of yourself or your unborn baby, contact your midwife or, if out-of-hours, your maternity unit. They will provide further advice, including whether you need to attend hospital.
If you are advised to go to the maternity unit or hospital, you will be asked to travel by private transport, or arranged hospital transport and to alert the maternity unit reception once on site before going into the hospital. You will be required to wear a mask or face covering.
If you have suspected or confirmed COVID-19, a discussion about the benefits and risks of infant feeding, including breastfeeding should take place between you, your family and your maternity team.
There is no strong evidence to show that the virus can be carried or passed on in breastmilk.
The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of the transmission of COVID-19 through breastmilk.
Provided your baby is well and does not require care in the neonatal unit, you will stay together after you have given birth, so skin-to-skin contact and breastfeeding can be started and supported if you choose.
If you are too unwell to care for your baby, or if direct breastfeeding is not possible, you should be offered support to express your breastmilk by hand or using a breast pump, and/or be offered access to donor breast milk. A dedicated breast pump for you should be used while you are in hospital.
Formula feeding is entirely acceptable if this is your choice.
Taking care when feeding
The main risk of feeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets that are infected with the virus, leading to infection of the baby after birth.
If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilisation guidelines.
However you choose to feed your baby, the following precautions are recommended:
- Wash your hands before touching your baby, breast pump or bottles
- Try to avoid coughing or sneezing on your baby while feeding at the breast or from a bottle.
- Consider wearing a mask or face covering while feeding.
- Follow recommendations for pump/bottle cleaning after each use.
- Consider asking someone who is well to feed your expressed breastmilk or formula milk to your baby.
- Babies should not wear face masks as this risks suffocation.
Further information on infant feeding during the COVID-19 pandemic is available from UNICEF.