Financial Disclosure Rachel G. Sinkey reports money was paid to her institution from GestVision and ProLab. Alan T. Tita reports money was paid to his institution from the NIH, CDC, and Pfizer for COVID-19 and RSV vaccine in pregnancy studies. Ashley N. Battarbee reports money was paid to her institution from the NIH and CDC for COVID-19 in pregnancy studies. Akila Subramaniam reports money was paid to her institution from the NIH. Jeff M. Szychowski reports money was paid to his institution from the NIH. Jodie Dionne-Odom currently receives grant funding from NIH/NICHD for an unrelated study on infection in pregnancy. Sixto M. Leal Jr. reports money was paid to his institution from the NIH, CDC, ADPH, CNINE, GenMark, mFluiDx, IMMY, SpeeDx, Abnova, Amplyx, IHMA, and JMI. Nitin Arora reports money was paid to his institution from the Congenital and Perinatal Infections Consortium,

Two years into the coronavirus disease 2019 (COVID-19) pandemic, we have now seen three main variant waves. We performed a retrospective cohort study of all pregnant patients with COVID-19 at our institution from March 22, 2020, to February 26, 2022, to evaluate disease severity and perinatal outcomes among the variants. Patients were

ImportanceExisting reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, with variable outcomes noted for the maternal-fetal dyad.ObjectiveTo examine maternal and perinatal outcomes associated with ECMO used for COVID-19 with respiratory failure during pregnancy.Design, Setting, and ParticipantsThis retrospective multicenter cohort study examined pregnant and postpartum patients who required ECMO for COVID-19 respiratory failure at 25 hospitals across the US. Eligible patients included individuals who received care at one of the study sites, were diagnosed with SARS-CoV-2 infection during pregnancy or up to 6 weeks post partum by positive nucleic acid or antigen test, and for whom ECMO was initiated for respiratory failure from March 1, 2020, to October 1, 2022.ExposuresECMO in the setting of COVID-19 respiratory failure.Main outcome and measuresThe primary outcome was maternal mortality. Secondary outcomes included serious maternal morbidity, obstetrical outcomes, and neonatal outcomes. Outcomes were compared by timing of infection during pregnancy or post partum, timing of ECMO initiation during pregnancy or post partum, and periods of circulation of SARS-CoV-2 variants.ResultsFrom March 1, 2020, to October 1, 2022, 100 pregnant or postpartum individuals were started on ECMO (29 [29.0%] Hispanic, 25 [25.0%] non-Hispanic Black, 34 [34.0%] non-Hispanic White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) during pregnancy, 21 (21.0%) within 24 hours post partum, and 32 (32.0%) between 24 hours and 6 weeks post partum; 79 (79.0%) had obesity, 61 (61.0%) had public or no insurance, and 67 (67.0%) did not have an immunocompromising condition. The median (IQR) ECMO run was 20 (9-49) days. There were 16 maternal deaths (16.0%; 95% CI, 8.2%-23.8%) in the study cohort, and 76 patients (76.0%; 95% CI, 58.9%-93.1%) had 1 or more serious maternal morbidity events. The largest serious maternal morbidity was venous thromboembolism and occurred in 39 patients (39.0%), which was similar across ECMO timing (40.4% pregnant [19 of 47] vs 38.1% [8 of 21] immediately postpartum vs 37.5% postpartum [12 of 32]; P > .99).Conclusions and RelevanceIn this multicenter US cohort study of pregnant and postpartum patients who required ECMO for COVID-19–associated respiratory failure, most survived but experienced a high frequency of serious maternal morbidity.

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