Presbyterian Church in America affirms that Isaiah 7:14 is a messianic prophecy fulfilled in Jesus' virgin birth. The Hebrew term 'almah' is understood to mean 'virgin' in this context. Matthew 1:23 explicitly cites Isaiah 7:14 as fulfilled in the virgin conception of Jesus by Mary. The virgin birth is a cardinal doctrine in PCA theology, affirmed in the Westminster Shorter Catechism and confessional standards.

The PCA does not engage primarily with modern critical scholarship that treats Isaiah 7:14 as referring only to an 8th-century historical figure. Rather, the PCA holds to the traditional typological-prophetic reading: the prophecy had a near historical reference but also a far messianic fulfillment in Christ. The virgin birth establishes Jesus' unique divine status and sinlessness.

The PCA's Reformed tradition maintains that the Old Testament points to Christ throughout. Isaiah 7:14 is one of many prophecies that demonstrate the unity of Scripture and the continuity of God's redemptive purposes from the Old Testament through the New.