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COVID-19 and Women’s Health

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

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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)

CONCLUSION:

  • 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

Learn More – Primary Sources:

Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020

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Related ObG Topics:

Coronavirus and Pregnancy: CDC Guidance and Professional Recommendations
ICU Admission for COVID-19 and Maternal Outcomes
Pregnant Women with COVID-19 at Time of Delivery: NYC Cohort Characteristics and Outcomes
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital

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