The recommended precautions vary by country and, in some cases, by state and city:

• If you are healthy, do not leave your house except to breathe some fresh air, to attend your ultrasound visit, or if you are in labor
• If you are healthy and must go out of your house, stay at least 6 to 10 feet (2 to 3 meters) away from other people and wear a cloth mask. Do not leave home to go to a park, playground, beach, pool, nature reserve or other public spaces
• Where practical, appointments with your health care providers should be conducted on the telephone or using videoconferencing
• Some national health authorities and some hospital systems will recommend you wear a three-ply surgical mask when visiting the hospital or other high-risk area
• Social connections should be maintained by remote communication and avoid hosting friends and family who do not reside at the home
• Wash your hands frequently with soap and water. Wash for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
• Use natural-based hand sanitizers when soap and water are not available. Alcohol-based hand sanitizers are not recommended during pregnancy as their safety for your unborn baby when used very often is not known
• Avoid touching your eyes, nose, and mouth with unwashed hands
• Regularly clean surfaces like counters and your mobile phone
• Avoid community candy jars and buffets, where many people touch surfaces or utensils
• Sneeze and cough into a tissue or inside of your elbow rather than into your hand or the air. Throw used tissues in the trash. Immediately wash your hands with soap and water or use a hand sanitizer as explained above
• Avoid contact with anyone who is sick
• Ask delivery personnel to leave packages by the front door
• Clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection

Yes. It is very important that you continue to attend your scheduled routine care when you are well.

Maternity care is essential and has been developed over many years to reduce complications in mothers and babies. There is a potential risk of harm to you and your baby if you don’t attend your appointments, even in the context of COVID-19.

If you are well, you should be able to attend your antenatal care as normal. If you have symptoms of possible COVID-19, you should contact your health care professional to postpone routine visits until after the isolation period is over.

At this time, it is particularly important that you allow professionals to take care of you. If you have had an appointment cancelled or delayed and you are not sure of your next visit with your health care professional, call them.

The following suggestions may be helpful:

• If you have a routine ultrasound appointment or visit due in the coming days, contact your health care professional for advice and a plan. You will still need to attend but the appointment may change due to staffing requirements.
• Some appointments may be conducted on the phone or using videoconferencing, provided there is a reasonable expectation that observations such as an ultrasound, blood pressure, or other tests are not needed.
• If you are between appointments and in good health, please wait to hear from your health care professional.
• If you miss an appointment, contact your health care professional to rearrange it.

Whatever your personal situation, consider the following:

• If you have any concerns, contact your health care professional. Be aware that they may take longer to get back to you.
• If you have an urgent problem related to your pregnancy but not related to COVID-19, call your local emergency phone number immediately.
• If you have symptoms suggestive of COVID-19, call your health care professional and they will arrange the right place and time to come for your visits. You should not attend a routine clinic.
• You will be asked to keep the number of people with you at appointments to a minimum. This will include being asked to not bring children with you to your appointments and, on occasions, your health care professional may request that you attend your prenatal appointments alone to aid infection control and help keep staff safe from transmission.
• There may be a need to reduce the number of prenatal visits. You will be told if this is necessary. Do not reduce your number of visits without agreeing first with your health care professional.

• If you have fever (temperature higher than 37.8 Celsius or 100.04 Farenheit) with or without respiratory symptoms, you should go into home isolation and call your health care provider immediately.
• Avoid physical contact with your family members. You should stay in a specific “sick room” and use a separate bathroom, if available
• Avoid sharing personal household items (dishes, drinking glasses, cups, eating utensils, towels, or bedding)
• You should wear a facemask and gloves when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room.
• Avoid using public transportation, ride-sharing, or taxis.
• Limit contact with pets and animals, just like you would around other people
• Some women with COVID-19 close to their due date ensure they have a supply of formula in case they get sick and cannot breastfeed (see about breastfeeding with COVID-19 below)
• Plan ahead of time who will look after your other children when you go into labor

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include:

Difficulty breathing or shortness of breath

Difficulty completing a sentence without gasping for air or needing to stop to catch breath frequently when walking across the room

Coughing up more than 1 teaspoon of blood

Persistent pain or pressure in the chest other than pain with coughing

Unable to keep liquids down

Signs of dehydration such as dizziness when standing

Confusion or inability to arouse

Bluish lips or face

Vaginal bleeding

Convulsions/fits

Severe headaches with blurred vision

Fever and too weak to get out of bed

Severe abdominal pain

Your water breaks

Data from pregnant women infected with COVID-19 are very limited. However, case series from China indicate that the signs of COVID-19 infection during pregnancy are similar to those of non-pregnant adults with COVID-19 infection.

Two other members of the Coronavirus family were responsible for serious diseases in recent years: Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Although there have been a small number of known pregnancies exposed to SARS or MERS, they provide a useful context to which pregnancies infected with COVID-19 can be reviewed.

To date, this is what is known:

Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date. However, this could be due to technical advances in caring for patients in intensive care rather than any characteristic of the disease course itself.

Preterm delivery occurs in approximately 50% of women hospitalized with COVID-19. This percentage is probably much lower among non-hospitalized women

An increase in the risk of miscarriage in women affected by COVID-19 cannot be ruled out at this stage, given the SARS data

In women affected by COVID-19 with ongoing pregnancy, it is recommended to assess for the presence of fetal growth restriction, given the SARS and MERS data

In COVID-19, if maternal illness is not as severe, a natural delivery may be indicated. In severe cases (for example, if the mother is intubated and put on a ventilator), a cesarean section may be required

There is some evidence that women with COVID-19 who deliver by cesarean section and babies delivered to mothers with COVID-19 by cesarean section are at greater risk for complications.

Infection with the virus could impede the blood flow between mother and fetus by inducing injury to the placenta. In a small cohort of pregnant patients who tested positive for COVID-19, placental injury included blood clots and abnormal blood vessels that affected how much blood was getting to the fetus. Furthermore, some of the placentas were found to be smaller than expected. There is concern that the placental injury caused by COVID-19 infection could lead to preeclampsia and hypertension in the mother and possibly miscarriage, intrauterine growth restriction, or preterm birth for the fetus, although this has not been the case in the small group of patients that have been studied.

Information on vertical transmission of COVID-19 is limited. Two articles recently reported from separate research teams in China (See Dong et al. 2020 and Zeng et al. 2020 here) present details of 3 newborns who may have been infected with SARS-CoV-2 in utero from mothers with COVID-19. Evidence for such transmission is based on elevated IgM (Immunoglobulin M) antibody values in blood drawn from the babies. It should be noted, however, that most congenital infections are not diagnosed based on IgM detection because these assays can be prone to false-positive and false-negative results. Although these 2 studies deserve careful evaluation, more definitive evidence is needed before the findings they report can be used to counsel pregnant women that their fetuses are at risk from congenital infection with SARS-CoV-2.

Yes, the amount of radiation dose to you and to your developing baby is negligible and safe for both. If you have COVID-19, chest imaging, especially computed tomography (CT) scan, is essential for the evaluation of your clinical condition.

We do not know at this time what, if any, risk is posed to your developing baby. None of the pregnancies affected with SARS that we are aware of resulted in a baby born with a birth defect. However, fever is common in COVID-19-infected patients. Data obtained before the COVID-19 pandemic have shown that maternal fever in early pregnancy may cause birth defects, especially neural tube defects, or miscarriage. Use of acetaminophen in pregnancy, including in the first trimester, has been shown overall to be safe and may attenuate the pregnancy risks associated with fever exposure. As with any pregnancy, consuming 400 micrograms (mcg) of folic acid every day may help prevent some of the birth defects.

Infected women, especially those who develop pneumonia, appear to have an increased frequency of preterm labor, prelabor rupture of membranes, preterm birth, preeclampsia, and cesarean delivery for abnormal fetal heart rate tracings, which is likely related to severe maternal illness. In 41 COVID-19 pregnant patients, a systematic review reported the following rates of complications: preterm birth <37 weeks (41.1%), preterm prelabor rupture of membranes (18.8%), preeclampsia (13.6%), cesarean delivery (91.1%), miscarriage (not reported); and for the baby: stillbirth (2.4%), admission to a neonatal ICU (10%), and neonatal death (2.4%). It is important to emphasize these data reflect small numbers and women mostly intubated with COVID-19 pneumonia, and the perinatal deaths were not directly due to fetal /neonatal infection with the coronavirus. In addition, in women with severe COVID-19 in the third trimester, there may be a bias to intervene that is catalyzed by the belief that management of the mother's respiratory disease will be improved by delivery; this is still unclear.

Additionally, it has been shown that because SARS-CoV-2 invades the blood vessels, infection with the virus could impede the blood flow between mother and fetus by inducing injury to the placenta. In a small cohort of pregnant patients who tested positive for COVID-19, placental injury included blood clots and abnormal blood vessels that affected how much blood was getting to the fetus. Furthermore, some of the placentas were found to be smaller than expected. There is concern that the placental injury caused by COVID-19 infection could lead to preeclampsia and hypertension in the mother and possibly miscarriage, intrauterine growth restriction, or preterm birth for the fetus, although this has not been the case in the small group of patients that have been studied.

Because of the concern for the health of both mother and fetus, extra monitoring for pregnant women diagnosed with COVID-19 should be considered. Options include: non-stress test to monitor whether or not a fetus is getting a sufficient oxygen supply and frequent ultrasounds to monitor fetal growth.

At this point, there is little evidence to suggest that pregnant women infected with COVID-19 could transmit the virus to their baby during pregnancy or delivery (medically referred to as ‘vertical transmission’). Information on vertical transmission of COVID-19 is limited. Two articles recently reported from separate research teams in China (See Dong et al. 2020 and Zeng et al. 2020 here) present details of 3 newborns who may have been infected with SARS-CoV-2 in utero from mothers with COVID-19. Evidence for such transmission is based on elevated IgM (Immunoglobulin M) antibody values in blood drawn from the babies. It should be noted, however, that most congenital infections are not diagnosed based on IgM detection because these assays can be prone to false-positive and false-negative results. Although these 2 studies deserve careful evaluation, more definitive evidence is needed before the findings they report can be used to counsel pregnant women that their fetuses are at risk from congenital infection with SARS-CoV-2.

It should be, although that depends on where you will deliver. Some hospitals have a designated section (an entire floor, a wing) for COVID-19 and the rest of the facility is isolated from it. In smaller hospitals and clinics, this may be difficult to do.

Bear in mind that family and friends of hospitalized people with COVID-19 may be in the hospital’s waiting areas, restaurant, gift shop, etc. They may look healthy to you but be infected with COVID-19. Stay at a distance of at least 6 to 10 feet (2 to 3 meters) from them. Partners of women going into labor should probably stay at home or go to an open area, as much as possible. You should call your hospital to check if there are any regulations to be aware of. Some hospitals ban visits to maternity wards and restrict the number of people who can accompany a pregnant person during childbirth to one, which means that a doula and a partner are not allowed at the same time.

Every health care facility is making different plans for dealing with this scenario. Talk with your doctor or midwife as soon as possible.

This is a personal decision that should consider the benefits and the risks of getting pregnant and having a baby at this time. Considerations include: whether or not you are comfortable with telehealth physician visits, possibly limited options for fertility treatments, mental health, available support system, and financial well-being in this uncertain time.

Yes. You are highly discouraged, from traveling for leisure at this time. Check your local health agency recommendations for instructions on people movement.

Temporary separation of mothers with known or suspected COVID-19 from their newborns has been proposed to reduce the risk of mother-baby transmission, but may also have adverse consequences. For example, not rooming-in and avoiding skin-to-skin contact can be stressful for mothers, disrupt breastfeeding, and have negative effects on newborn stress, feeding, and bonding.

The World Health Organization (WHO) recommends that mothers who have suspected, probable, or confirmed COVID-19 virus infection should be enabled to remain together and practice skin-to-skin contact. The CDC advise determining whether to separate a mother with known or suspected COVID-19 and her infant on a case-by-case basis, using shared decision making between the mother and the clinical team. Factors to consider include:

• The mother's and infant's clinical conditions.
• Whether the mother's infection is suspected (no SARS-CoV-2 test result) or confirmed, and the infant's SARS-CoV-2 testing result (separation is not necessary if the infant has a positive test).
• The mother's desire to breastfeed.
• The facility's ability to accommodate mother-baby separation or colocation.
• The mother's ability to maintain separation when she goes home, if she has not met criteria to discontinue temporary separation.
• Other risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant.

If mother-baby separation is implemented, the following should be considered:

• Infant COVID-19 suspects should be isolated from other healthy infants and cared for according to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.
• If another healthy family is providing infant care (eg, diapering, bathing, feeding), they should use appropriate personal protective equipment (healthy family members should wear a gown, gloves, face mask, and eye protection).

If separation is indicated (mother is on transmission-based precautions) but not implemented, other measures may be utilized to reduce potential mother-to-infant transmission and include:

• Physical barriers (eg, a curtain between the mother and newborn) can be constructed, and the newborn can be kept ≥6 feet away from the mother.
• The mother can wear a face mask and practice hand hygiene when in close contact with her infant, particularly when feeding.
• If another healthy adult is in the room, they can care for the newborn.

After hospital discharge, the American Academy of Pediatrics advises:

• A mother with COVID-19 infection should maintain a distance of at least six feet from the newborn and use a mask and hand hygiene for newborn care until (1) she has no fever for 72 hours without use of antipyretics, and (2) at least seven days have passed since symptoms first appeared.
• A mother with COVID-19 infection whose newborn requires ongoing hospital care should maintain separation until (1) she has no fever for 72 hours without use of antipyretics, and (2) her respiratory symptoms are improved, and (3) at least two consecutive SARS-CoV-2 nasopharyngeal swab tests collected ≥24 hours apart are negative.

• During the COVID-19 pandemic, all hospitals are restricting visitors but there are exceptions for a birthing partner during active labor and birth
• Every woman should be able to have one birth partner stay with her through labor and birth, unless the birth occurs under a general anaesthetic.
• To help prevent spread of COVID-19 to other mothers, their babies, and to key front-line healthcare staff, it is very important that you do not attend the maternity unit if you have any symptoms of COVID-19 or have had any in the previous 7 days.
• If you are unwell, protect your family and the medical staff and stay at home. To prepare for this, women and their partners are being encouraged to think about an alternative birth partner, if required.
• If you are supporting a woman during labor and birth, please be aware of the strict infection control procedures in place to prevent the spread of COVID-19 to pregnant women and their babies, as well as other vulnerable people within the hospital and the maternity staff.
• Please, wash your hands regularly with soap and water and use hand sanitizer gel in clinical areas, as available.
• If you cough or sneeze, please cover your mouth with a tissue and dispose of this in a bin immediately.
• Stay in the labor room with your partner. Do not move /walk around the Labor Ward unaccompanied – call for assistance, if you need it.
• If you are asked to a wear a mask or any personal protective equipment (PPE) during the labor or birth, it is very important so please follow the instructions carefully, and to take it off before you leave the clinical area.
• If you are accompanying a woman to her cesarean birth, please be aware that operating room staff will be wearing PPE and it may be more difficult for them to communicate with you:
• A staff member will probably be allocated to support you; carefully follow their instructions and approach them if you have any questions.
• To enable the clinical staff to do their job, it is very important that you do not move around the operating room, as you risk de-sterilizing sterile areas and spreading the virus.
• The maternity team will do everything they can to enable you to be present for the birth. However, if there is a particular safety concern, they may ask that you are not present in the operating room. If this is the case, the team should discuss this with you and explain their reasons, unless it is an emergency.

Every hospital has different policies. Contact your hospital or labor and delivery unit a week or so before delivery to get the most up-to-date restrictions.

In general, if your support person needs to leave, they would be allowed back unless they knew they were exposed to COVID-19 after leaving your company.

Yes, she should not leave her house unless necessary. If she is over 60 or has any serious chronic medical condition (such as heart disease, lung disease, or diabetes), she is at higher risk of serious illness from COVID-19 and should avoid all travel.

Not necessarily, as COVID-19 is not an indication to alter the route of delivery. Cesarean delivery is performed for standard obstetric indications.Even if vertical transmission is confirmed, this would not be an indication for cesarean delivery since it would increase maternal risk and would be unlikely to improve newborn outcome (reports of COVID-19 infection in newborn babies have generally described mild disease).

Pregnant health workers have additional concerns. A common, widely accepted human resources precautionary measure is that pregnant health workers in the third trimester, particularly ≥36 weeks, stop face-to-face contact with patients to help reduce their risk of acquiring infection and its consequences.

All clinicians with person-to-person contact should wear a surgical mask in the health care setting, under the assumption that every patient and health care colleague might be infected with COVID-19. Some institutions have asked all asymptomatic patients and their asymptomatic support persons (if allowed to be present) to wear masks as well.

Ideally, pregnant COVID-19 inpatients should be cared for in specially equipped (eg, negative-pressure) rooms in antepartum, intrapartum, and postpartum COVID-19-only units, similar to other adult COVID-19 inpatients who are usually placed in dedicated COVID-19-only units, halls, or hospitals. Patients with suspected or confirmed COVID-19 are normally instructed to wear a mask, including during labor and delivery, but this may be difficult during active pushing, and forceful exhalation may allow spread of the virus by respiratory droplets despite the mask. Infection control precautions regarding pregnant patients with confirmed or suspected infection are similar to those for other hospitalized patients and are reviewed separately.

Specific issues in pregnant patients include fetal monitoring in those who are at a viable gestational age. The need for and frequency of fetal testing depend upon gestational age, stability of maternal vital signs, other maternal comorbidities, and discussions with the patient and her family that consider the possibly increased risks of stillbirth and perinatal morbidities in the absence of testing as well as the possible risks from increased contact with health care personnel performing this testing.

Maternal oxygen saturation (SaO2) should be maintained at ≥95 percent during pregnancy, which is in excess of the oxygen delivery needs of the mother.

Several medications are being evaluated for treatment of COVID-19. Although some of them are clinically available for other indications (eg, hydroxychloroquine or chloroquine), their use for COVID-19 remains investigational. There are no high-quality studies documenting the role of hydroxychloroquine or remdesivir in the treatment of pregnant women with moderate or severe COVID-19 disease. At some hospitals, pregnant women with moderate COVID-19 are being treated with hydroxychloroquine, and those with severe COVID-19 are being offered remdesivir in a compassionate-use protocol.

Both hydroxychloroquine and chloroquine have been reported to inhibit SARS-CoV-2 in vitro, but their role in treatment of COVID-19 is under investigation. Hydroxychloroquine crosses the placenta. Accumulation in fetal ocular tissues has been observed in animal studies, but fetal ocular toxicity has not been observed in humans, which is reassuring given that the drug has been widely used by pregnant women for treatment of systemic lupus erythematosus or for prevention of malaria.

Remdesivir is a novel nucleotide analogue that has activity against SARS-CoV-2 in vitro and related coronaviruses (including severe acute respiratory syndrome [SARS] and Middle East respiratory syndrome-related coronavirus [MERS-CoV]) both in vitro and in animal studies. Compassionate use in nonpregnant adults has been suspended by the manufacturer, although there are plans for an expanded access program. It has been used without reported fetal toxicity in some pregnant women with Ebola and Marburg virus disease.

Investigational drugs for COVID-19 that are known to be teratogenic include ribavirin and baricitinib.

Use of medications to manage pregnancy complications:

• Antenatal betamethasone – For the general population, the Centers for Disease Control and Prevention (CDC) recommend avoiding glucocorticoids in COVID-19-positive persons because they have been associated with an increased risk for mortality in patients with influenza and delayed viral clearance in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. However, the CDC have not addressed use of antenatal glucocorticoids to reduce neonatal morbidity and mortality from preterm birth in pregnant COVID-19-positive patients. Because of the clear benefits of antenatal betamethasone administration between 24+0 and 33+6 weeks of gestation in patients at high risk of preterm birth within seven days, the American College of Obstetricians and Gynecologists (ACOG) continues to recommend its use for standard indications to pregnant patients with suspected or confirmed COVID-19. However, for pregnant patients with suspected or confirmed COVID-19 at 34+0 to 36+6 weeks of gestation and at risk of preterm birth within seven days, the benefits to the neonate are less clear, and ACOG has advised not administering a course of betamethasone to such patients. However, these decisions may need to be individualized, weighing the neonatal benefits with the risks of potential harm to the pregnant patient.
• Low-dose aspirin – For pregnant women without COVID-19, ACOG has stated that low-dose aspirin should continue to be offered as medically indicated (eg, prevention of preeclampsia). For those with suspected or confirmed COVID-19 for whom low-dose aspirin would be indicated, the decision to continue the drug should be individualized and is usually possible. For example, continuing preeclampsia prophylaxis is likely not worthwhile in severely or critically ill patients or near term. Concern about possible negative effects of nonsteroidal anti-inflammatory drugs (NSAIDs) was raised by anecdotal reports of a few young, nonpregnant patients who received NSAIDs (ibuprofen) early in the course of infection and experienced severe disease. However, there have been no clinical or population-based data that directly address the risk of NSAIDs. Given the absence of data, the European Medicines Agency and the World Health Organization do not recommend avoiding NSAIDs in COVID-19 patients when clinically indicated.
• Tocolysis (suppressing premature labor) – In women with known or suspected COVID-19, the preferred tocolytic is nifedipine. It is a suitable alterative to indomethacin, which is subject to the concerns discussed above, and to beta sympathomimetics, which can further increase the maternal heart rate.

At this time, there is no evidence to suggest that COVID-19 is transmissible from mother to baby via breastmilk. It is unknown whether the virus can be transmitted through breastmilk. The only report of testing found no virus in the maternal milk of six patients. However, droplet transmission could occur through close contact during breastfeeding. In addition to its many other benefits, breastmilk is a passive source of antibodies and other anti-infective factors and, thus, may provide passive antibody protection for your infant.

If you and your baby are separated, ideally, your baby should be fed expressed breastmilk by another healthy caregiver until you recovered or proven uninfected, provided that the other caregiver is healthy and follows hygiene precautions. In such cases, you should use strict handwashing before pumping and wear a mask during pumping. The CDC have issued guidance about cleaning breast pumps. If possible, the pumping equipment should be thoroughly cleaned by a healthy person.

If feeding by a healthy caregiver is not possible, you should take precautions to prevent transmission to your baby during breastfeeding (including assiduous hand hygiene, use of a face mask, and disinfecting shared surfaces that you contacted).

Ideally, if you choose to formula feed, another healthy caregiver should feed your baby. If this is not possible or desired, you must also take appropriate infection control precautions (including assiduous hand hygiene, use of a face mask, disinfection of shared surfaces) to prevent transmission through close contact when feeding.

If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breastmilk in a way possible, available, and acceptable to you. This could include:

• Pumping or expressing milk into a bottle
• Donor human milk
• Formula-feeding or supplementation
• Relactation (resuming breastfeeding after taking a break)