Pregnant Women At-Greater Risk From COVID-19

In a new analysis of approximately 400,000 women with symptomatic COVID-19, intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death were more likely in pregnant women than in non-pregnant women, reported the US Centers for Disease Control and Prevention (CDC).

Although the absolute risks for severe COVID-19–associated outcomes among women were low, pregnant women were at significantly higher risk for severe outcomes compared with nonpregnant women.

This CDC finding published on November 2, 2020, might be related to physiologic changes in pregnancy, including increased heart rate and oxygen consumption, decreased lung capacity, a shift away from cell-mediated immunity, and increased risk for thromboembolic disease.

Compared with the initial report of these data published on June 26, 2020, in which increased risk for ICU admissions and invasive ventilation among pregnant women was reported, this analysis includes nearly 5 times the number of symptomatic women and a higher proportion of women with known pregnancy status (36% versus 28%).

Further, to avoid including pregnant women who were tested as part of asymptomatic screening practices at the delivery hospitalization, this analysis was limited to symptomatic women.

In this analysis 5.7% of symptomatic women aged 15–44 years with COVID-19 were pregnant, corresponding to the anticipated proportion of 5% of the population at any point in time.

Whereas increased risk for severe disease related to pregnancy was apparent in nearly all stratified analyses, pregnant women aged 35–44 years with COVID-19 were nearly 4 times as likely to require invasive ventilation and twice as likely to die than were nonpregnant women of the same age.

This analysis highlights racial and ethnic disparities in both risk for infection and disease severity among pregnant women, indicating a need to address potential drivers of risk in these populations.

In comparison to influenza, a recent meta-analysis found no increased risk for ICU admission or death among pregnant women with seasonal influenza. However, data from previous influenza pandemics, including 2009 H1N1, have shown that pregnant women are at increased risk for severe outcomes including death and the absolute risks for severe outcomes were higher than in this study of COVID-19 during pregnancy.

In summary, understanding the risk posed by SARS-CoV-2 infection in pregnant women can inform clinical practice, risk communication, and medical countermeasure allocation. Pregnant women should be informed of their risk for severe COVID-19–associated illness and the warning signs of severe COVID-19.

To minimize the risk of acquiring SARS-CoV-2 infection, pregnant women should limit unnecessary interactions with persons who might have been exposed to or are infected with SARS-CoV-2, including those within their household.

The findings in this report are subject to various limitations.

Study acknowledgments: State, local, and territorial health department personnel; U.S. clinical, public health, and emergency response staff members; Kathleen E. Fullerton, Erin K. Stokes, CDC; CDC Epidemiology Studies Task Force Pregnancy and Infant Linked Outcomes Team; CDC Data, Analytics, and Modeling Task Force Case Surveillance Section.

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