Pregnant Women Hospitalized With COVID-19, March–August 2020

This page describes an early-pandemic CDC report. It reflects the data and guidance of 2020.

Pregnant women may be at higher risk of severe COVID-19, but data on those hospitalized in the United States were limited. CDC's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), which tracks lab-confirmed COVID-19 hospitalizations in 99 counties of 14 states, looked at pregnant women hospitalized from March 1 to August 22, 2020, using data from 13 of those states: California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee and Utah.

Who was hospitalized

COVID-NET identified 7,895 hospitalized women aged 15–49 with COVID-19; chart review was complete for 2,318. Of the 2,255 whose pregnancy status was known, 598 (26.5%) were pregnant — about one in four, compared with roughly 5% of women of reproductive age who are pregnant at any given time.

• Median age: 29.
• 42.5% were Hispanic and 26.5% Black, well above those groups' shares of women aged 15–49 in the surveillance area (15.3% and 19.5%).
• Most (87.4%) were in their third trimester; 10.2% were in the second and 2.3% in the first.
• Where the reason for admission was known (324 women), 74.7% were admitted for obstetric reasons such as labor and delivery, 18.8% for COVID-19 illness and 6.5% for other reasons. COVID-19 illness was the most common reason in the first two trimesters; obstetric care in the third.
• 20.6% had at least one underlying condition, most often asthma (8.2%) or high blood pressure (4.3%).

Symptoms and severity

More than half — 326 (54.5%) — had no symptoms at admission. The other 272 did; symptoms were much more common in women hospitalized in the first or second trimester (84.0%) than in the third (39.9%). The most common were fever or chills (59.6%) and cough (59.2%).

Symptoms at admission among symptomatic pregnant women, by trimester. CDC figure.

Among the 272 symptomatic women:

• 44 (16.2%) were admitted to intensive care;
• 23 (8.5%) needed invasive mechanical ventilation;
• two died.

None of the women without symptoms went to intensive care, needed a ventilator or died. Across all pregnant women, 7.4% went to intensive care — similar to two European studies — suggesting outcomes are worse for pregnant women admitted because of illness than for those admitted to give birth.

Birth outcomes

By discharge, 458 pregnancies had ended during the hospital stay:

• 448 (97.8%) live births and 10 (2.2%) pregnancy losses — four before 20 weeks, five at 20 weeks or later, one at an unknown stage. Losses occurred in women with and without symptoms.
• Of live births with known gestational age, 12.6% were preterm (before 37 weeks), higher than the 10.0% seen in the general U.S. population in 2018. Preterm birth was about three times as common among symptomatic women (23.1%) as among those without symptoms (8.0%).
• Two newborns died during the birth hospitalization; both mothers had symptoms and needed mechanical ventilation.

Pregnancy status, symptoms and birth outcomes among hospitalized women with COVID-19. CDC figure.

What it means

• The high share of pregnant women among hospitalized women may partly reflect a lower threshold for admitting pregnant women, admissions just to give birth, and more testing on admission — but pregnant women clearly made up a substantial part of these hospitalizations.
• The higher shares of Hispanic and Black women may reflect long-standing inequities, such as jobs and housing that make distancing hard.
• Because most pregnant women with COVID-19 had no symptoms, testing only people with symptoms may miss many infections. Identifying COVID-19 at birth hospitalizations helps staff use the right protective equipment and limit visitors to those essential to care.

Recommendations at the time: pregnant women should avoid close contact with people who have or may have COVID-19, keep 6 feet from people outside their household, wear masks and wash hands. CDC recommended testing newborns of mothers with COVID-19, separating mothers with COVID-19 and their newborns from other mothers and babies in hospital, and infection prevention for anyone caring for exposed newborns — including masks and hand hygiene for caretakers of preterm babies.

Limitations: chart reviews covered only a convenience sample of 29.4% of women; the women may not represent all pregnant women in the area; testing varied; the reason for admission was missing for 45.8%; prepregnancy obesity wasn't recorded; outcomes after discharge weren't captured; and only medically attended pregnancy losses were counted.

Sources

• Delahoy MJ, Whitaker M, O'Halloran A, et al. "Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020." Morbidity and Mortality Weekly Report 69(38), Centers for Disease Control and Prevention.