“It felt like a life-or-death choice”: Pregnancy with Long COVID has many unknowns

A collage with two types of alternating images: First, in black and white, a fetal ultrasound with heartbeat. Second, with colorful overlays, photos of a woman in bed, a woman holding a baby directly after birth, and a woman getting an MRI. — Heather Hogan / The Sick Times

Key points you should know:

Little is known so far about how people with Long COVID experience pregnancy, but some insights can be gleaned from myalgic encephalomyelitis (ME) as well as several ongoing studies in this area.

Numerous studies point to ways in which SARS-CoV-2 infection can damage the reproductive system, including declines in ovarian health and increased risk for premature menopause. However, it is not clear how or if Long COVID itself impacts fertility.

Anecdotally, some Long COVID parents actually experienced improvements in their condition during IVF and pregnancy. A study found 30% of ME patients seem to experience the same, though for many these improvements are temporary and the reasons are not well understood.

Parents with ME seem to be at a higher risk for severe nausea and vomiting during the first trimester but otherwise often have fairly typical pregnancies and deliveries.

More research is still needed to help patients decide whether or not parenthood is right for them, but two key studies on pregnancy in Long COVID and ME respectively are likely to be released later this year.

When couples decide to have a child, conversations around birth plans, baby names, and day care are top of mind. But for those living with Long COVID, the concerns are often far graver.

“It felt like a life-or-death choice,” said Massachusetts resident Lauren Nichols. “The conversations with my husband were, ‘Would you be able to take care of this child on your own if I were to not make it through pregnancy?’”

Nichols contracted COVID-19 in March 2020, less than a month after she went off birth control with the intention of starting a family. That, however, was put on hold, as, over the next 10 months, Nichols developed postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis (ME), walking pneumonia, chronic migraine, and Epstein-Barr virus reactivation resulting in multiple bouts of eye shingles; suffered a stroke; and received a diagnosis for hypermobile Ehlers-Danlos syndrome (hEDS) — all which she believes were either exacerbated or instigated by her SARS-CoV-2 infection.

After some success with low-dose naltrexone, Nichols’s condition stabilized enough to begin in vitro fertilization (IVF) treatment. In 2023, she gave birth to a baby boy.

While having a child did not prove to be the fatal endeavor she had feared, Nichols’s journey was riddled with risks, both known and unknown.

Her experience with IVF, pregnancy, delivery, and parenthood even led to some surprising improvements in her symptoms for a time. But especially among people with Long COVID and related diseases, every person — and every pregnancy — is different.

While parents with Long COVID may encounter more difficulties conceiving, some may actually find their symptoms abate throughout pregnancy, sometimes leading to longer-term improvements postpartum. Still, others have reported a rapid decline in health.

The decision to have a child can carry with it the burden of financial stress. Kids are expensive, and for many with Long COVID, a reduced ability to earn a living, housing precarity, insufficient disability benefits, and few social safety nets have left many unable to support themselves, let alone children. For those with Long COVID who are able to work, the potential drains of pregnancy and child-rearing on their ability to remain in the workforce likewise weigh heavily. Financial barriers to parenthood can be even higher for racialized, queer and trans people living with Long COVID.

Six years after the start of the pandemic, there are few clear answers for would-be parents with Long COVID. But amid the layers of uncertainty, there is some guidance that can be gleaned from ME, and potentially valuable research on the way.

Conception and fertility with Long COVID

When Nichols and her husband decided to try again after her condition improved, testing revealed that her fertility had plunged in just a few short years.

“I had no known issues being able to conceive prior to contracting COVID,” Nichols said. But tests of her AMH (anti-Müllerian hormone) levels, a protein measurement that can approximate egg count and act as a rough estimate for fertility, found those levels had “absolutely plummeted to what you would imagine for an 82-year-old.”

Acute SARS-CoV-2 infection during pregnancy has been linked with increased risk of preterm birth, preeclampsia, and stillbirth as well as higher rates of neurodevelopmental conditions in children exposed in utero. Yet little is known about how Long COVID specifically impacts fertility.

When SARS-CoV-2 enters the body, it binds to an important receptor called angiotensin-converting enzyme II (ACE2). Among many other functions, ACE2 plays a role in reproduction and, according to one study, could impact the balance of hormones involved in controlling blood flow and inflammation across the reproductive system.

SARS-CoV-2 infection can be associated with long-term decline of ovarian health, including a loss of normal ovary function before age 40. Case reports noted changes in the ovarian fluid surrounding the egg in the months after infection as well as increased risk for premature menopause.

Additionally, research on ME (which many people with Long COVID develop) suggests that those with ME are more likely to also have other conditions like polycystic ovary syndrome (PCOS) and endometriosis, which can make it harder to conceive.

Some prospective parents may be concerned that underlying viral infections could pass from them to a fetus. While this is theoretically possible, it is unlikely, at least in ME, according to Charles Shepherd, medical advisor to the U.K.-based ME Association. “We see immune system activation … but there’s no robust or consistent evidence from the studies that have been done that this is due to persistent viral infection [in ME],” he said, referencing a 2018 Journal of Translational Medicine study on ME disease mechanisms.

While there is evidence of persistent viral reservoirs in some people with Long COVID, Shepherd added, it is still not clear if this would pose direct harm to a developing fetus. It is possible, however, that there is a genetic predisposition at play in both ME and Long COVID.

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Pregnancy: A wild card for Long COVID symptoms

Would-be parents with Long COVID might assume that their bodies would struggle with the Herculean task of gestation and childbirth. But the reality is much more complex.

When Nichols underwent IVF, she was surprised to find that the process made her feel physically “phenomenal.”

“Being on those very high doses of hormones, I felt better than I’d ever felt in my entire life.” She expected her fatigue would worsen under IVF; instead, it almost completely dissipated. “It was like … a giant pause button had been pressed on all my neurological symptoms.”

While Nichols still had uncomfortable pregnancy symptoms, like bloating, ultimately she said “pregnancy was a cake walk” compared to the prior four years of Long COVID.

For many people with ME, symptoms “quite significantly improve during pregnancy,” said Shepherd. “We don’t fully understand why this is,” but added that it’s likely due to pregnancy’s role as an “immunosuppressive condition.”

Studies suggest people with Long COVID and ME have overly active immune systems. However, during the second trimester, the immune system naturally becomes suppressed to protect the fetus during development — which might explain why some people “sometimes quite significantly improve and feel a lot better during pregnancy,” Shepherd said.

For many people with ME, symptoms “quite significantly improve during pregnancy,” said Shepherd. “We don’t fully understand why this is,” but added that it’s likely due to pregnancy’s role as an “immunosuppressive condition.”

Katrina Pears, a U.K.-based mom and research correspondent, said that after living with ME for 13 years, her symptoms greatly improved during pregnancy. Despite occasional setbacks, largely due to raising two “terrible sleepers,” her condition has remained “mild” even years after the birth of her daughters.

“Some people are better, some are so much worse, and some people have ME/CFS triggered by pregnancy as well,” she said. “You just don’t know what you’re going to get.”

Similarly, people with autoimmune conditions such as rheumatoid arthritis, multiple sclerosis, and Graves’ disease sometimes show signs of improvement, at least temporarily, during pregnancy.

As Nichols suspected, it is possible that hormonal changes are also at play. Several studies that looked at sex hormones in women with Long COVID have suggested that hormones play a key role in symptoms.

But everyone is different, Shepherd added. One of the few existing studies on ME and pregnancy shows that nearly a third of pregnant people with ME experience a worsening of their symptoms. While this study was limited to a small number of participants, experts have generally observed higher rates of nausea and morning sickness among those with ME during the first trimester.

This was the case for art therapist turned new Long COVID mom Amanda Bravo, who was hospitalized shortly after she became pregnant with her son because she was unable to eat.

“[During my first trimester] it got to the point where I couldn’t drink water, I couldn’t put a chip in my body,” she said.

Bravo was diagnosed with hyperemesis gravidarum, a condition characterized by severe nausea and vomiting during pregnancy that often requires hospitalization.

Delivery, postpartum, and beyond

Delivery went smoothly for both Bravo and Nichols, with a few accommodations like keeping lights low and holding off on an epidural for as long as possible in Bravo’s case.

Nichols had significant tearing during delivery and struggled to receive sufficient care once the baby was born, despite her positive experience during IVF. “As soon as the baby’s out, you’re back in the middle of going through the healthcare system being disbelieved.”

For Nichols, the marked physical improvements that followed IVF and pregnancy have since come to a grinding halt.

Many people with ME experience a gradual return to previous symptoms or a more severe crash at three to six months postpartum. Though the reasons are not well understood, some experts have attributed this shift to changes in blood volume, hormonal and immune changes, and sleep disruption.

“I feel like we’re back in month one of Long COVID … and now there’s a toddler to tend to on top of that,” Nichols said.

For now, she is trying to get readmitted to another Long COVID clinic, hopeful she will again have success with low-dose naltrexone. Nichols initially planned to have only one child, but given the relief she experienced during pregnancy, she joked, “I’m just gonna quit my job and become a surrogate.”

I feel like we’re back in month one of Long COVID … and now there’s a toddler to tend to on top of that.
Lauren Nichols, mother with Long COVID

For researchers studying Long COVID and ME, more information to help doctors treat their patients — and help patients make decisions about their health — is a priority.

These decisions are “really complicated” due to limited scientific evidence, said Mark Pearce, epidemiologist and lead researcher of an ongoing study in the U.K. on ME and pregnancy. Pearce and his team started doing a systematic review on the topic, which soon ballooned into an ongoing mixed-methods pilot study of nearly 350 participants.

Once completed, this will be the first study of its scale that dives into the experiences of pregnancy for people with ME. Pearce added that he hopes to publish results later this year.

The National Institutes of Health’s RECOVER program has also studied pregnancy and Long COVID as part of the initiative’s extensive observational research. The first phase wrapped up in October 2025, and the second phase of the study commenced in January. So far, findings on the neurodevelopment of children exposed to SARS-CoV-2 in utero have been released, with more research anticipated later this year.

For those who take the leap into pregnancy despite the many unknowns, Nichols, Bravo and Pears all echoed a similar refrain: Make sure to have adequate support in place.

Pears’s mother comes by several times a week to help. Pears also limits activities to the first part of the day, when her energy is at its best. Nichols and her husband, whose family is far away, have sprung for the “luxury” that is hired in-home care.

While all the parents that The Sick Times spoke with are able to take care of their healthy children, there are still ample worries about the future.

Nichols said she is dreading the bugs that her son may bring home from preschool once he starts. “I’m terrified he is going to grow up without a mother, whether that’s me bedridden like I was for years or me not being in this world because I contract something.”

Bravo is concerned about the implications that parenthood could have for Long COVID disability claimants, noting that she has friends who have been denied disability support or contacted by social workers regarding their children following disability applications.

While there is no shortage of hardship baked into parenthood, some people with Long COVID and ME may still be able to start families. However, Pears stressed that, though it’s “still possible” to become a parent with chronic illness, it is important to plan how to cope if symptoms worsen as a result of pregnancy and child rearing. “You just can’t really tell what you’re going to get, can you?”

Pears stressed that, though it’s “still possible” to become a parent with chronic illness, it is important to plan how to cope if symptoms worsen as a result of pregnancy and child rearing. “You just can’t really tell what you’re going to get, can you?”

Maddi Dellplain is an award-winning multimedia journalist and the deputy managing editor and staff reporter for Healthy Debate. Her work focuses on health, disability, and drug policy.

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