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The world is a very different place than it was in March 2020. We know far more about COVID than ever before, we have effective tools to prevent and treat it (for those of us who can access them), and most of us have developed some level of immunity against the virus. But that doesn’t mean that COVID is “over.”
In the United States, thousands of people test positive for COVID every day. You don’t need to be a mathematician (I’m certainly not!) to recognize that some of those who test positive will also be pregnant. These days, thankfully, we have a pretty substantial body of research in this very area.
In early pregnancy, one of the biggest stressors is making it through the first trimester. So, what do we know about COVID and pregnancy loss? Does it increase the chances of a loss? And are there any other risks worth knowing about?
“We don’t have a lot of data on COVID and miscarriage, but from what we do it does not appear that COVID increases miscarriage rates,” explains Dr. Temeka Zore, MD, a fertility specialist and board-certified OB-GYN at Spring Fertility. “However, we still need more high-quality studies.”
We reviewed the best evidence available to learn more. Here’s what we found.
First: How common is miscarriage?
Miscarriage is, unfortunately, very common in early pregnancy. Early pregnancy loss (a miscarriage in the first 12 weeks and 6 days of pregnancy) impacts about 10% of all pregnancies confirmed by healthcare providers. Since not all pregnancies are confirmed by a professional, that percentage is an underestimate. Some stats put the number as high as 26%.
Most people don’t realize how common pregnancy loss is because we don’t talk about it nearly often enough. But things are starting to change. More and more celebrities are opening up about their experiences — and, no matter where you’re located, there’s a virtual support group ready to embrace you.
So, does COVID-19 increase the risk of miscarriage?
Although we’re three-plus years into COVID’s existence, new circulating variants mean we’re still learning more about the virus as time goes on. Based on the most recent and largest review of the data we could find, COVID infection does not appear to increase the risk of miscarriage.
In January 2023, the Journal of Obstetrics and Gynaecology published a systematic review and meta-analysis (research designs that top the evidence pyramid) that included data from hundreds of studies and over 1.8 million pregnant people.
The researchers found that COVID during pregnancy was associated with higher rates of preterm delivery (delivery before 37 weeks of pregnancy), admission to the neonatal intensive care unit, neonatal mortality, and maternal mortality. (The prevalence of neonatal and maternal mortality was less than 1% among infected and non-infected pregnant people.)
In terms of miscarriage specifically, among the participants who experienced pregnancy loss, there were more COVID-positive fetuses in lower-middle-income groups than there were in higher-income groups. However, across the studies included, there wasn’t a statistically significant difference in the frequency of pregnancy loss.
Although this may be one of the largest reviews we have to date, there are quality issues with the studies included. Also of note, the researchers didn’t clarify what percentage of studies included vaccinated or unvaccinated people. They also weren’t able to identify what caused the negative outcomes — just that they were associated with COVID infection.
Still, “from what we know in general,” says Dr. Zore, having COVID “doesn’t seem to increase the risk of miscarriage.” The paper, though flawed, backs that up. COVID and pregnancy resources published by prominent medical organizations like the American College of Obstetricians and Gynecologists (ACOG, the leading body of OB-GYNs) or the Centers for Disease Control and Prevention (the CDC, aka the public health organization in charge of national pandemic guidelines) also don’t list increased miscarriage risk as a known outcome.
According to ACOG and the CDC, published data have demonstrated a link between COVID infection and both preterm birth and stillbirth. Stillbirth is defined as pregnancy loss after 20 weeks of pregnancy. However, in the paper we cited above, stillbirth wasn’t a common enough event to include it as one of the most consistently associated outcomes.
What to do if you’re pregnant and get COVID
The CDC recommends reaching out to your healthcare provider within 24 hours of having COVID symptoms.
People with COVID have reported experiencing many different symptoms, but common ones include:
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Fever or chills
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Cough
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Shortness of breath or difficulty breathing
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Fatigue
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Muscle or body aches
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Headaches
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New loss of taste or smell
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Sore throat
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Congestion or runny nose
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Nausea or vomiting
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Diarrhea
If you test positive for COVID at home or with your healthcare provider, start following the CDC’s isolation guidelines right away. In some cases, adds Dr. Zore, additional ultrasounds or fetal testing may be recommended.
Get emergency medical care if you experience any of the following warning signs:
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Trouble breathing
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Persistent pain or pressure in the chest
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New confusion
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Inability to wake or stay awake
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Pale, gray, or blue-colored skin, lips, or nail beds (depending on skin tone)
Any concerning symptoms during pregnancy, whether or not they’re because of COVID, are worth bringing up with your healthcare provider.
Vaccination guidelines for pregnant people
The CDC recommends COVID vaccination and boosters for all people six months and older to reduce the likelihood of severe illness, hospitalization, and death. This includes pregnant people, people who are nursing, and people who are trying to get pregnant or might become pregnant.
There’s a growing body of clinical evidence that demonstrates the safety and effectiveness of COVID vaccination in pregnancy. Per the CDC, the benefits of vaccination outweigh the potential risks (which don’t include miscarriage). ACOG and the Society for Maternal-Fetal Medicine strongly endorse the CDC’s guidance.
Have questions about getting vaccinated in pregnancy? Your healthcare provider can help. You can also reach out to MotherToBaby, a government-funded resource, for answers.
Protecting yourself against COVID matters
While there’s no solid evidence that getting COVID during pregnancy increases the risk of miscarriage, it has been linked with other adverse pregnancy and birth outcomes. Plus, getting infected at any time makes you susceptible to long COVID — a post-viral illness scientists are still wrapping their heads around.
Even though newer variants of COVID have been shown, for many people, to cause less severe illness, it’s still important to take measures to protect ourselves and the people around us.
Staying up to date with vaccines and boosters, getting tested when you’ve been exposed or feel sick, staying home when sick, and masking in crowded indoor spaces remain the best steps you can take to prevent getting and spreading COVID.
Sarah duRivage-Jacobs is a sexual and reproductive health writer, educator, and communicator. In addition to Rescripted, her words can be found on the blogs of reproductive health and mental health companies like Modern Fertility, Hey Jane, Millie, Carrot, Origin, O.school, and Charlie Health. You can visit her website here.
