Characteristics of Symptomatic Women of Reproductive Age With Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status

United States, January 22-October 3, 2020

Laura D. Zambrano, PhD; Sascha Ellington, PhD; Penelope Strid, MPH; Romeo R. Galang, MD; Titilope Oduyebo, MD; Van T. Tong, MPH; Kate R. Woodworth, MD; John F. Nahabedian III, MS; Eduardo Azziz-Baumgartner, MD; Suzanne M. Gilboa, PhD; Dana Meaney-Delman, MD


Morbidity and Mortality Weekly Report. 2020;69(44):1641-1647. 

In This Article

Abstract and Introduction


Studies suggest that pregnant women might be at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19).[1,2] This report provides updated information about symptomatic women of reproductive age (15–44 years) with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19. During January 22–October 3, CDC received reports through national COVID-19 case surveillance or through the National Notifiable Diseases Surveillance System (NNDSS) of 1,300,938 women aged 15–44 years with laboratory results indicative of acute infection with SARS-CoV-2. Data on pregnancy status were available for 461,825 (35.5%) women with laboratory-confirmed infection, 409,462 (88.7%) of whom were symptomatic. Among symptomatic women, 23,434 (5.7%) were reported to be pregnant. After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit (ICU) (10.5 versus 3.9 per 1,000 cases; adjusted risk ratio [aRR] = 3.0; 95% confidence interval [CI] = 2.6–3.4), receive invasive ventilation (2.9 versus 1.1 per 1,000 cases; aRR = 2.9; 95% CI = 2.2–3.8), receive extracorporeal membrane oxygenation (ECMO) (0.7 versus 0.3 per 1,000 cases; aRR = 2.4; 95% CI = 1.5–4.0), and die (1.5 versus 1.2 per 1,000 cases; aRR = 1.7; 95% CI = 1.2–2.4). Stratifying these analyses by age and race/ethnicity highlighted disparities in risk by subgroup. Although the absolute risks for severe outcomes for women were low, pregnant women were at increased risk for severe COVID-19–associated illness. To reduce the risk for severe illness and death from COVID-19, pregnant women should be counseled about the importance of seeking prompt medical care if they have symptoms and measures to prevent SARS-CoV-2 infection should be strongly emphasized for pregnant women and their families during all medical encounters, including prenatal care visits. Understanding COVID-19–associated risks among pregnant women is important for prevention counseling and clinical care and treatment.

Data on laboratory-confirmed and probable COVID-19 cases were electronically reported to CDC using a standardized case report form§ or NNDSS as part of COVID-19 surveillance efforts. Data are reported by health departments and can be updated by health departments as new information becomes available. This analysis included cases initially reported to CDC during January 22–October 3, 2020, with data updated as of October 28, 2020. Cases were limited to those in symptomatic women aged 15–44 years in the United States with laboratory-confirmed infection (detection of SARS-CoV-2 RNA in a clinical specimen using a molecular amplification detection test). Information on demographic characteristics, pregnancy status, underlying medical conditions, symptoms, and outcomes was collected. Pregnancy status was ascertained by a pregnancy field on the COVID-19 case report form or through records linked to the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) optional COVID-19 module**,††.[3] CDC ascertained symptom status either through a reported symptom status variable (symptomatic, asymptomatic, or unknown) or based on the presence of at least one specific symptom on the case report form. Outcomes with missing data were assumed not to have occurred. Crude and adjusted RRs and 95% CIs were calculated using modified Poisson regression. Overall and stratified risk ratios were adjusted for age (in years), race/ethnicity, and presence of diabetes, cardiovascular disease (including hypertension), and chronic lung disease. SAS (version 9.4; SAS Institute) was used to conduct all analyses. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§§

During January 22–October 3, a total of 5,003,041 laboratory-confirmed cases of SARS-CoV-2 infection were reported to CDC as part of national COVID-19 case surveillance, including 1,300,938 (26.0%) cases in women aged 15–44 years. Data on pregnancy status were available for 461,825 (35.5%) women aged 15–44 years, 30,415 (6.6%) of whom were pregnant and 431,410 (93.4%) of whom were nonpregnant. Among all women aged 15–44 years with known pregnancy status, 409,462 (88.7%) were symptomatic, including 23,434 pregnant women, accounting for 5.7% of all symptomatic women with laboratory-confirmed COVID-19, and 386,028 nonpregnant women. Pregnant women were more frequently Hispanic/Latina (Hispanic) (29.7%) and less frequently non-Hispanic White (White) (23.5%) compared with nonpregnant women (22.6% Hispanic and 31.7% White). Among all women, cough, headache, muscle aches, and fever were the most frequently reported signs and symptoms; most symptoms were reported less frequently by pregnant women than by nonpregnant women (Table 1).

Compared with nonpregnant women, pregnant women more frequently were admitted to an ICU (10.5 versus 3.9 per 1,000 cases; aRR = 3.0; 95% CI = 2.6–3.4), received invasive ventilation (2.9 versus 1.1 per 1,000 cases; aRR = 2.9; 95% CI = 2.2–3.8) and received ECMO (0.7 versus 0.3 per 1,000 cases; aRR = 2.4; 95% CI = 1.5–4.0). Thirty-four deaths (1.5 per 1,000 cases) were reported among 23,434 symptomatic pregnant women, and 447 (1.2 per 1,000 cases) were reported among 386,028 nonpregnant women, reflecting a 70% increased risk for death associated with pregnancy (aRR = 1.7; 95% CI = 1.2–2.4). Irrespective of pregnancy status, ICU admissions, receipt of invasive ventilation, and death occurred more often among women aged 35–44 years than among those aged 15–24 years (Table 2). Whereas non-Hispanic Black or African American (Black) women made up 14.1% of women included in this analysis, they represented 176 (36.6%) deaths overall, including nine of 34 (26.5%) deaths among pregnant women and 167 of 447 (37.4%) deaths among nonpregnant women.

Increased risk for ICU admission among pregnant women was observed for all strata but was particularly notable among non-Hispanic Asian (Asian) women (aRR = 6.6; 95% CI = 4.0–11.0) and non-Hispanic Native Hawaiian/Pacific Islander women (aRR = 3.7; 95% CI = 1.3–10.1). Risk for receiving invasive ventilation among pregnant women aged 15–24 years was 3.0 times that of nonpregnant women (95% CI = 1.6–5.7), and among pregnant women aged 35–44 years was 3.6 times that of nonpregnant women (95% CI = 2.4–5.4). In addition, among Hispanic women, pregnancy was associated with 2.4 times the risk for death (95% CI = 1.3–4.3) (Table 2).