Characteristics of Women of Reproductive Age with Laboratory …

Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775. DOI: http://dx.doi.org/10.15585/mmwr.mm6925a1external icon

As of June 16, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 2,104,346 cases and 116,140 deaths in the United States.* During pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections (1,2). To date, data to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women are limited. During January 22–June 7, as part of COVID-19 surveillance, CDC received reports of 326,335 women of reproductive age (15–44 years) who had positive test results for SARS-CoV-2, the virus that causes COVID-19. Data on pregnancy status were available for 91,412 (28.0%) women with laboratory-confirmed infections; among these, 8,207 (9.0%) were pregnant. Symptomatic pregnant and nonpregnant women with COVID-19 reported similar frequencies of cough (>50%) and shortness of breath (30%), but pregnant women less frequently reported headache, muscle aches, fever, chills, and diarrhea. Chronic lung disease, diabetes mellitus, and cardiovascular disease were more commonly reported among pregnant women than among nonpregnant women. Among women with COVID-19, approximately one third (31.5%) of pregnant women were reported to have been hospitalized compared with 5.8% of nonpregnant women. After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit (ICU) (aRR = 1.5, 95% confidence interval [CI] = 1.2–1.8) and receive mechanical ventilation (aRR = 1.7, 95% CI = 1.2–2.4). Sixteen (0.2%) COVID-19–related deaths were reported among pregnant women aged 15–44 years, and 208 (0.2%) such deaths were reported among nonpregnant women (aRR = 0.9, 95% CI = 0.5–1.5). These findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar. To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families.

Data on laboratory-confirmed and probable COVID-19 cases† were electronically reported to CDC using a standardized case report form§ or through the National Notifiable Diseases Surveillance System¶ as part of COVID-19 surveillance efforts. Data are updated by health departments as additional information becomes available. This analysis includes cases reported during January 22–June 7 with data updated as of June 17, 2020. Included cases were limited to laboratory-confirmed infections with SARS-CoV-2 (confirmed by detection of SARS-CoV-2 RNA in a clinical specimen using a molecular amplification detection test) among women aged 15–44 years from 50 states, the District of Columbia, and New York City. Data collected included information on demographic characteristics, pregnancy status, underlying medical conditions, clinical signs and symptoms, and outcomes (including hospitalization, ICU admission, receipt of mechanical ventilation, and death). Outcomes with missing data were assumed not to have occurred (i.e., if data were missing on hospitalization, women were assumed to not have been hospitalized). Crude and adjusted risk ratios and 95% CIs for outcomes were calculated using modified Poisson regression. Risk ratios were adjusted for age (as a continuous variable), presence of underlying chronic conditions (yes/no), and race/ethnicity. All analyses were performed using SAS (version 9.4; SAS Institute).

During January 22–June 7, among 1,573,211 laboratory-confirmed cases of SARS-CoV-2 infection reported to CDC as part of national COVID-19 surveillance, a total of 326,335 (20.7%) occurred among women aged 15–44 years. Data on pregnancy status were available for 91,412 (28.0%) of these women; 8,207 (9.0%) were pregnant (Table 1). Approximately one quarter of all women aged 15–44 years were aged 15–24 years. A total of 54.4% of pregnant women and 38.2% of nonpregnant women were aged 25–34 years; 22.1% of pregnant women and 38.3% of nonpregnant women were aged 35–44 years. Information on race/ethnicity was available for 80.4% of pregnant women and 70.6% of nonpregnant women. Among pregnant women, 46.2% were Hispanic, 23.0% were non-Hispanic white (white), 22.1% were non-Hispanic black (black), and 3.8% were non-Hispanic Asian compared with 38.1%, 29.4%, 25.4%, and 3.2%, respectively, among nonpregnant women.

Symptom status was reported for 65.2% of pregnant women and 90.0% of nonpregnant women; among those with symptom status reported, 97.1% of pregnant and 96.9% nonpregnant women reported being symptomatic. Symptomatic pregnant and nonpregnant women also reported similar frequencies of cough (51.8% versus 53.7%) and shortness of breath (30.1% versus 30.3%). Pregnant women less frequently reported headache (40.6% versus 52.2%), muscle aches (38.1% versus 47.2%), fever (34.3% versus 42.1%), chills (28.5% versus 35.6%), and diarrhea (14.3% versus 23.1%) than did nonpregnant women.

Data were available on presence and absence of underlying chronic conditions for 22.9% of pregnant women and 35.0% of nonpregnant women. Chronic lung disease (21.8% pregnant; 10.3% nonpregnant), diabetes mellitus (15.3% pregnant; 6.4% nonpregnant), and cardiovascular disease (14.0% pregnant; 7.1% nonpregnant) were the most commonly reported chronic conditions. Data were not available to distinguish whether chronic conditions were present before or associated with pregnancy (e.g., gestational diabetes or hypertensive disorders of pregnancy).

Hospitalization was reported by a substantially higher percentage of pregnant women (31.5%) than nonpregnant women (5.8%) (Table 2). Data were not available to distinguish hospitalization for COVID-19–related circumstances (e.g., worsening respiratory status) from hospital admission for pregnancy-related treatment or procedures (e.g., delivery). Pregnant women were admitted more frequently to the ICU (1.5%) than were nonpregnant women (0.9%). Similarly, 0.5% of pregnant women required mechanical ventilation compared with 0.3% of nonpregnant women. Sixteen deaths (0.2%) were reported among 8,207 pregnant women, and 208 (0.2%) were reported among 83,205 nonpregnant women. When stratified by age, all outcomes (hospitalization, ICU admission, receipt of mechanical ventilation, and death) were more frequently reported among women aged 35–44 years than among those aged 15–24 years, regardless of pregnancy status. When stratified by race/ethnicity, ICU admission was most frequently reported among pregnant women who were non-Hispanic Asian (3.5%) than among all pregnant women (1.5%) (Table 2).

After adjusting for age, presence of underlying conditions, and race/ethnicity, pregnant women were 5.4 times more likely to be hospitalized (95% CI = 5.1–5.6), 1.5 times more likely to be admitted to the ICU ( 95% CI = 1.2–1.8), and 1.7 times more likely to receive mechanical ventilation (95% CI = 1.2–2.4) (Table 2). No difference in the risk for death between pregnant and nonpregnant women was found (aRR = 0.9, 95% CI = 0.5–1.5).

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