The Bottom Line

This pages serves to highlight the latest objective research, news, and professional guidance and recommendations regarding pregnancy-related health.

NEW: "Latest Page Updates" section added so you can quickly view which pages were updated within the past week. Actual updates on each page can be viewed by clicking on "All Updates" underneath the page title.

As of June 2021, COVID-19 (and its vaccines) is the current major health-related issue that can affect pregnant women. This page will highlight infection and vaccine-safety data as it is published/released. These details can also be viewed on the main COVID-19 page.

Additional highlights and research updates are also listed below. Women should talk to their health care provider (HCP) if they have any questions.

Note: Unless ongoing, highlights are kept on this page for approximately 30 days before being removed or added to a permanent Topic page.

Jump to:
Share on:
updated

Latest Research/Recommendations

June 18, 2021: Study examined factors that contribute to postpartum return-to-running and return to pre-pregnancy running level, as well as risk factors for postpartum running-related stress urinary incontinence (SUI). More than eight hundred postpartum women completed the questionnaire:

Median time to first postpartum run was 12 weeks. The authors concluded that running during pregnancy may assist women safely returning to this same exercise in the postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.

June 17, 2021: Falls are the second leading cause of injury among pregnant women and result in approximately 20% of pregnancy-associated injuries. A systematic review published on June 17 identified thirteen intrinsic risk factors and eleven extrinsic factors for falling during pregnancy.

Intrinsic (examples):

  • Third trimester (most falls occur during month 7)

  • First pregnancy

  • Multiple pregnancy (e.g. twins or higher)

  • Low back pain

  • Sedentary lifestyle

  • Age < 30 years

  • Ankle stiffness

  • Not wearing maternity support garments

  • Gestational Diabetes (low blood sugar; fainting)

  • Hyperemesis Gravidarum (dehydration, weakness, low blood sugar)

Extrinsic (examples):

  • Slippery floors* (most common reason)

  • Cluttered area

  • Walking on stairs without holding a railing or on uneven grounds

  • Wearing inappropriate shoes

  • Carrying additional loads (e.g. a child)

  • Hurrying

  • Poor lighting or obstructed view

  • Sedentary lifestyle

  • Working in a physically demanding job

Exercise was identified as a possible prevention strategy as it helps pregnant women to learn how their bodies move and change as well as increases ankle stiffness. Maternity support belts can also provide stabilization support. Women are also advised to use visual cues for balance, make sure they have proper footwear, and take their time with movement. Slowing things down can help women have a general awareness of their surroundings to avoid tripping on clutter or slippery floors.

Photo by Mediamodifier on Unsplash

June 17, 2021: Study aimed to assess the knowledge and awareness regarding pelvic floor disorders (PFDs) among pregnant women; knowledge and awareness were low among women in all trimesters. Education programs involving pelvic floor training should be organized for pregnant women by their providers so women can avoid complications.

June 17, 2021: Study on diet and fertility revealed a lack of evidence to exclude gluten from the diet of every woman trying to become pregnant in the absence of celiac disease. Furthermore, there are no data concerning adverse effects of alcohol on female fertility, and caffeine consumption in the recommended amounts also does not seem to affect fertility. Further, women should aim to have appropriate amounts (to avoid deficiency) of folic acid, iodine, and vitamin D.

June 8, 2021: Use of second-generation antipsychotics (S-GA) during early pregnancy was not associated with an increased risk of overall major congenital malformations (birth defects) compared to unexposed or to first-generation use. However, olanzapine use was associated with an increased risk of major birth defects, specifically, musculoskeletal malformations when compared to unexposed.

June 8, 2021: Moderate to heavy drinking of alcohol during the luteal phase, and heavy drinking in the ovulatory window, could disturb the delicate sequence of hormonal events, affecting chances of a successful conception.

June 8, 2021: A new animal study identified maternal iron deficiency as a completely new risk factor for congenital heart defects. Researchers were able to determine the molecular pathway involved, and also showed that iron supplementation in early pregnancy could prevent these defects [in mice]. However, this has not yet been replicated in humans, and clinical guidance regarding iron supplementation remains the same until more research is completed. Read more about iron and anemia.

June 8, 2021: Using an animal model, researchers believe they have mapped hormones/proteins in the placenta and how these proteins may change when a disorder is present (such as gestational diabetes). It may therefore be possible, in the future, to test for these hormones/proteins early in pregnancy to predict if certain pregnant individuals may experience complications.

June 7, 2021: New study suggests no association between anti-seizure drugs used during pregnancy and neurodevelopmental problems in children at age 2; however, high levels of medication in the third trimester may adversely impact motor & general adaptive (early life skills) domains of offspring. Pregnant individuals in the study were mostly taking the medications lamotrigine and/or levetiracetam.

June 1, 2021: Small study investigated the possible impact of Pfizer-BioNTech's mRNA COVID-19 vaccine on women's fertility; only Intracytoplasmic Sperm Injection (ICSI) patients currently being treated with an ICSI cycle and had an earlier ICSI cycle available were included in the study. A final total of 47 women were eligible for inclusion:

The number and percentage of clinical pregnancies did not significantly differ between the PRE and POST vaccination groups (n=15). "From our findings, the vaccine appears to have no impact on women's fertility."

May 25, 2021: The United Kingdom's National Institute for Health and Care Excellence (NICE) issued updated Labor Induction Guidelines (last previous update was 2008). The draft guideline recommends that women with uncomplicated singleton pregnancies should be offered induction at 41 weeks and the induction should take place as soon as possible. Recent research which compared induction times and outcomes showed higher infant mortality after 42 weeks if the woman had not been induced. Read more at Induction and Augmentation of Labor.

Photo by Flávio Nunes on Unsplash

May 25, 2021: As of May 17 (although data collection is limited), COVID-19 cases among pregnant women in the U.S. is at its lowest point since February 29, 2020. CDC also held a partner call on May 24, 2021 with updated information on pregnancy and COVID-19 infection and vaccinations. See the case data chart and our summary of the information from the CDC call on our COVID-19 page.

May 20, 2021: New study that assessed antibodies in babies after the mother was COVID-19 vaccinated during pregnancy shows evidence the vaccine itself does not cross the placenta, only the mother's antibodies (IgG). If the vaccine had crossed the placenta, researchers should have seen IgM antibodies, but none of the infants from vaccinated mothers had this type of antibody.

May 19, 2021: "Cesarean Delivery Upon Maternal Request" has become the main reason for cesarean in at least one very large municipality in Chongqing, China (population 31 million+). It is very important that women have full access to the risks and benefits of both cesarean and vaginal delivery so they can make an informed choice about the option best for them. Learn more.

May 18, 2021: An updated Cochrane review indicates that 5‐HT3 antagonists (such as ondansetron), dopamine antagonists, corticosteroids, sedatives and acupressure "probably or possibly have efficacy in reducing nausea and vomiting in women undergoing regional anesthesia for caesarean section." Women should tell their health care provider if they are concerned about nausea during or after the procedure.

May 15, 2021: May 15 is Hyperemesis Gravidarum Awareness Day. Learn more about the condition here, and visit the HER Foundation, the global voice for HG awareness support and research.

May 13, 2021: In this cohort study involving 103 women who received a COVID-19 mRNA vaccine, 30 of whom were pregnant and 16 of whom were lactating, immunogenicity was demonstrated in all, and vaccine-elicited antibodies were found in infant cord blood and breast milk. Further, pregnant and nonpregnant vaccinated women developed cross-reactive immune responses against SARS-CoV-2 variants of concern.

updated

COVID-19 and Vaccines

Background: In March 2020, the World Health Organization officially declared a worldwide pandemic of a new respiratory infection called coronavirus 2019 (COVID-19), more formally “severe acute respiratory syndrome coronavirus 2” or SARS-CoV-2.

As of June 18, 2021, the U.S. Centers for Disease Control and Prevention (CDC) estimates the virus has caused approximately 33,327,096 illnesses and 598,301 deaths.

General COVID-19 information and pregnancy health: According to currently available case series and cohorts as of June 2021, data indicates pregnant women are not more susceptible to the disease than non-pregnant women, and fetal and symptomatic neonatal infection appear to be rare events.

Weekly COVID-19 Pregnancy Data from CDC:

  • Total Cases: 97,293

  • Hospitalized: 16,554 (data only available for 77,608)

  • Total Deaths: 106

*As of June 16, 2021

These numbers likely do not include all pregnant women with COVID-19 in the United States and must be interpreted with caution.

However, according to two large CDC reports (September and November 2020), pregnant women who contract COVID-19 appear to be at higher risk of complications from the disease than non-pregnant women of reproductive age. These complications include Intensive Care Unit admission, the need for mechanical ventilation, and the need for extracorporeal membrane oxygenation (ECMO).

There are currently three COVID-19 vaccines in the United States that have been given Emergency Use Authorization by the FDA: Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen.

Photo by Mufid Majnun on Unsplash

The FDA does not have a specific recommendation regarding whether one vaccine is more preferable over another, to include during pregnancy and lactation. It is recommended by numerous expert panels and obstetric organizations that women choose for themselves whether they would like to be vaccinated, after consultation with their HCP.

In the U.K., the Pfizer-BioNTech, Moderna, and Vaxzevria (formerly Oxford-AstraZeneca) vaccines are currently authorized by its vaccine regulator, the Medicines and Healthcare products Regulatory Agency.

Read more on COVID-19, pregnancy, and more detailed vaccine information and guidance from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, and the Royal College of Obstetricians and Gynaecologists here.

Action

Women should talk to their HCP if they any questions related to any of the updates above. Not all pregnant women who contract COVID-19 will have serious illness. However, there is currently no way to determine which women may experience a more severe course of either infection.

It is recommended that pregnant women:

  • Seek care immediately or dial 911 if experiencing a medical emergency. Emergency symptoms can include trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, or bluish lips or face. This is not an inclusive list, and women should always call their HCP or visit an emergency room when necessary.

  • Report any and all symptoms of a respiratory infection to their HCP, to include cough, fevershortness of breath, and diarrhea

  • Avoid unnecessary traveling, use of public transportation, and contact with sick people

  • Wear a mask (to protect others) in public settings

  • Follow personal and social distancing rules

  • Regularly wash hands for at least 20 seconds (if soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol)

  • Avoid touching their eyes, nose, and mouth with unwashed hands.

  • Do not skip prenatal care appointments or other health appointments that may be necessary

  • Make sure to have at least a 30-day supply of prescription medications

  • Learn about stress and coping

  • Get adequate sleep and physical exercise

  • Quit smoking (risk factor for infection)

  • Go outside in open areas for walks, fresh air, and a change of scenery

Any pregnant woman who has traveled in a state or country with a high rate of COVID-19 infection or who has had close contact with an individual with confirmed infection should be tested and quarantined.

Pregnant women are also advised to see their HCP immediately or call 911 if they experience:

  • Difficulty breathing or shortness of breath

  • Persistent pain or pressure in the chest or abdomen

  • Persistent dizziness, confusion, inability to arouse

  • Seizures

  • Not urinating

  • Severe muscle pain and/or weakness

  • Fever or cough that improves but then returns or worsens (may indicate pneumonia)

  • High fever that is not responding to acetaminophen or other anti-fever medication (acetaminophen is not an NSAID)

Women should refer to the CDC and ACOG COVID-19 web pages below for additional information.

Resources

Total cases in the United States/COVID tracker (U.S. Centers for Disease Control and Prevention)

COVID-19 Home Page (U.S. Centers for Disease Control and Prevention)

ACOG Statement on COVID-19 and Pregnancy (American College of Obstetricians and Gynecologists; June 2020)

Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients (American College of Obstetricians and Gynecologists)

The Management of Respiratory Infections During Pregnancy (Immunology and Allergy Clinics of North America; 2006)

References

Test ToolTip

    Sign up to read 3 pages for free or subscribe now for full site access.