SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics — Eight U.S. Health Care Centers, March 1–May 30, 2020

Abstract

On September 16, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19), possibly related to changes in their immune system and respiratory physiology* (1). Further, adverse birth outcomes, such as preterm delivery and stillbirth, might be more common among pregnant women infected with SARS-CoV-2, the virus that causes COVID-19 (2,3). Information about SARS-CoV-2 infection during pregnancy is rapidly growing; however, data on reasons for hospital admission, pregnancy-specific characteristics, and birth outcomes among pregnant women hospitalized with SARS-CoV-2 infections are limited. During March 1-May 30, 2020, as part of Vaccine Safety Datalink (VSD) † surveillance of COVID-19 hospitalizations, 105 hospitalized pregnant women with SARS-CoV-2 infection were identified, including 62 (59%) hospitalized for obstetric reasons (i.e., labor and delivery or another pregnancy-related indication) and 43 (41%) hospitalized for COVID-19 illness without an obstetric reason. Overall, 50 (81%) of 62 pregnant women with SARS-CoV-2 infection who were admitted for obstetric reasons were asymptomatic. Among 43 pregnant women hospitalized for COVID-19, 13 (30%) required intensive care unit (ICU) admission, six (14%) required mechanical ventilation, and one died from COVID-19. Prepregnancy obesity was more common (44%) among pregnant women hospitalized for COVID-19 than that among asymptomatic pregnant women hospitalized for obstetric reasons (31%). Likewise, the rate of gestational diabetes (26%) among pregnant women hospitalized for COVID-19 was higher than it was among women hospitalized for obstetric reasons (8%). Preterm delivery occurred in 15% of pregnancies among 93 women who delivered, and stillbirths (fetal death at ≥20 weeks' gestation) occurred in 3%. Antenatal counseling emphasizing preventive measures (e.g., use of masks, frequent hand washing, and social distancing) might help prevent COVID-19 among pregnant women, § especially those with *

Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…The higher frequency of SARS-CoV-2 among Hispanic women in our study is consistent with data on racial and ethnic disparities in COVID-19 cases and deaths reported nationwide. 19 Most studies in pregnancy published to date are case series [3][4][5][6]20,21 22,23 The major limitations in those reports are from the exclusion of pregnant women who receive their diagnoses in outpatient or ED settings and are never hospitalized. Our study includes these women in a comprehensive analysis and provides much needed evidence for counseling purposes.…”

Placental pathology and fetal demise at 35 weeks of gestation in a woman with SARS-CoV-2 infection: A case report

“…These values likely underestimate the reach of SARS-CoV-2 in pregnancy due to poor data collection and limited testing capacity early in the pandemic. Additionally, significant rates of asymptomatic women with SARS-CoV-2 infeciton have been discovered upon obstetric hospitalization [ 4 , 5 ]. Increased collection of COVID-19 data specific to pregnant women and their fetuses and infants is needed to increase knowledge and support research efforts, and can be utilized to create guidelines for clinical practice that will prevent potential negative outcomes and loss of life.…”

“…Though limited data exists regarding the effects of COVID-19 on fetal health and development, concern for and clinical reports of increased rates of miscarriage and stillbirth, growth restriction, and preterm births have been emerging since early in the pandemic [ [1] , [2] , [3] ]. More recently, reports from the CDC have shown stillbirth rates of 2.2%–3% in multistate surveillance studies [ 4 , 5 ]. When compared to the average US stillbirth rate of <1% before the pandemic, this data trend is alarming [ 6 ].…”

Community‐Based Doulas and COVID‐19: Addressing Structural and Institutional Barriers to Maternal Health Equity

“…Additionally, racial and ethnic disparities in the prevalence of SARS‐CoV‐2 were reported among pregnant women: Of those who tested positive for COVID‐19, 46% were Hispanic, 22% were Black and 23% were White, whereas of the women who gave birth in 2019, 24% were Hispanic, 15% were Black and 51% were white. The other two CDC reports, which were released in September 2020, provided further evidence that Black and Hispanic pregnant people were disproportionately affected by COVID‐19 39–41 . Importantly, one of the reports included evidence of the impact of medical comorbidities on COVID‐19 risk during pregnancy, as investigators found that pregnant people hospitalized for COVID‐19 were more likely than their counterparts who were not hospitalized to have prepregnancy obesity and gestational diabetes mellitus 41 …”