CDC MMWR Reports: Pregnant Women are at Increased Risk of Severe COVID-19

BACKGROUND AND PURPOSE:

Zambrano et al. (MMWR, 2020) provide updated information on clinical outcomes in symptomatic women of reproductive age (15–44 years)

Retrospective cohort study
Setting
- US from January 22 through October 3, 2020
Data sources
- National COVID-19 case surveillance
- National Notifiable Diseases Surveillance System (NNDSS)
Participants
- Women age 15 to 44
- Laboratory results indicative of acute infection with SARS-CoV-2
Statistical analysis
- Risk adjusted for age, race/ethnicity, and underlying medical conditions

Lab results available 1,300,938 women
Data on pregnancy status were available for 35.5% (461,825) women
- 88.7% of the ‘known pregnancy status’ cohort were symptomatic
- Among these symptomatic women, 5.7% (23,434) were pregnant

Increased Risks Associated with Pregnancy

ICU admission
- Pregnant: 10.5 per 1,000 cases
- Non-pregnant: 3.9 per 1,000 cases
- Adjusted risk ratio (aRR) 3.0 (95% CI, 2.6 to 3.4)
Invasive ventilation
- Pregnant: 2.9 per 1,000 cases
- Non-pregnant: 1.1 per 1,000 cases
- aRR 2.9 (95% CI, 2.2 to 3.8)
Extracorporeal membrane oxygenation (ECMO)
- Pregnant: 0.7 per 1,000 cases
- Non-pregnant: 0.3 per 1,000 cases
- aRR 2.4 (95% CI, 1.5 to 4.0)
Death
- Pregnant: 1.5 per 1,000 cases
- Non-pregnant: 1.2 per 1,000 cases
- aRR 1.7 (95% CI 1.2 to 2.4)

Impact of Race and Ethnicity

Black women made up 14.1% of women included in this analysis but represented 36.6% of overall deaths
- Pregnant: 26.5% of all deaths
- Non-pregnant: 37.4% of all deaths
Increased risk of ICU admission was higher for
- Non-Hispanic Asian women: aRR 6.6 (95% CI, 4.0 to 11.0)
- Non-Hispanic Native Hawaiian/Pacific Islander women: aRR 3.7 (95% CI, 1.3 to 10.1)
Among Hispanic women, pregnancy was associated with 2.4 times the risk for death (95% CI, 1.3 to 4.3)

Pregnant women were at an increased risk of severe COVID-19, even though absolute risks for severe outcomes for women were low
- There were disparities in risk by racial/ethnic group
The authors urge that measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters
Limitations of this study include but are not limited to the following
- National case surveillance data for COVID-19 are voluntarily reported to CDC with risk of missing or incomplete data
- Pregnancy status was missing for over one half (64.5%) of reported cases
- Observational data collected through passive surveillance might be subject to reporting bias | More severe cases are more likely to be reported

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