Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 - COVID-NET, 13 States, March 1-August 22, 2020

Abstract

Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19) (1,2). The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) (3) collects data on hospitalized pregnant women with laboratory-confirmed SARS-CoV-2, the virus that causes COVID-19; to date, such data have been limited. During March 1-August 22, 2020, approximately one in four hospitalized women aged 15-49 years with COVID-19 was pregnant. Among 598 hospitalized pregnant women with COVID-19, 54.5% were asymptomatic at admission. Among 272 pregnant women with COVID-19 who were symptomatic at hospital admission, 16.2% were admitted to an intensive care unit (ICU), and 8.5% required invasive mechanical ventilation. During COVID-19-associated hospitalizations, 448 of 458 (97.8%) completed pregnancies resulted in a live birth and 10 (2.2%) resulted in a pregnancy loss. Testing policies based on the presence of symptoms might miss COVID-19 infections during pregnancy. Surveillance of pregnant women with COVID-19, including those with asymptomatic infections, is important to understand the short- and long-term consequences of COVID-19 for mothers and newborns. Identifying COVID-19 in women during birth hospitalizations is important to guide preventive measures to protect pregnant women, parents, newborns, other patients, and hospital personnel. Pregnant women and health care providers should be made aware of the potential risks for severe COVID-19 illness, adverse pregnancy outcomes, and ways to prevent infection.

FIGURE 1

Pregnancy status, signs and symptoms, and birth outcomes^,, among hospitalized women aged 15–49 years with COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020 Abbreviations: COVID-19 = coronavirus disease 2019; COVID-NET = COVID-19-Associated Hospitalization Surveillance Network. * Symptomatic women were those who had one or more signs or symptoms (fever/chills, cough, shortness of breath, muscle aches, nausea/vomiting, headache, sore throat, abdominal pain, chest pain, nasal congestion/rhinorrhea, decreased smell, decreased taste, diarrhea, upper respiratory illness/influenza-like illness, wheezing, hemoptysis/bloody sputum, conjunctivitis, rash, altered mental state, and seizure) at hospital admission; asymptomatic women did not have any of these signs or symptoms at admission. ^† The 448 pregnancies resulting in live births resulted in the birth of 457 newborns; nine women had twins. Two newborns included in this category who were born alive subsequently died during the birth hospitalization. ^§ Ten completed pregnancies resulted in pregnancy losses. Pregnancy losses might include spontaneous abortion/miscarriage, therapeutic abortion, or stillbirth. ^¶ Pregnancies with known preterm status were those resulting in a live birth for which the gestational age at delivery was known. For three pregnancies resulting in live births, the gestational age at the time of birth was unknown. ** Women residing in the predefined COVID-NET surveillance catchment with a positive real-time reverse transcription–polymerase chain reaction (RT-PCR) test for SARS-CoV-2, during hospitalization or up to 14 days before admission. Among the 597 (99.8%) pregnant women for whom the COVID-19 test type was known, all had a positive RT-PCR test result; the COVID-19 test type for one pregnant woman with a positive COVID-19 test result was unknown. ^†† California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.

FIGURE 2

Signs and symptoms at hospital admission among symptomatic hospitalized pregnant women with COVID-19, by pregnancy trimester — COVID-NET, 13 states, March 1–August 22, 2020 Abbreviations: COVID-19 = coronavirus disease 2019; COVID-NET = COVID-19-Associated Hospitalization Surveillance Network. * Other signs and symptoms reported on the case report form were upper-respiratory illness/influenza-like illness (11 persons), wheezing (six), hemoptysis/bloody sputum (one), conjunctivitis (one), rash (one), altered mental state (one) and seizure (none). The symptoms decreased smell and decreased taste might not have been ascertained for cases admitted before April 1, 2020, when these symptoms were added as options on the case report form. ^† A total of 272 pregnant women with COVID-19 with at least one sign or symptom at the time of hospitalization were identified in COVID-NET. One hospitalized pregnant woman who was symptomatic at admission was not included in this figure because of missing pregnancy trimester. ^§ California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah.