Risk Factors for Illness Severity Among Pregnant Women With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Infection—Surveillance for Emerging Threats to Mothers and Babies Network, 22 State, Local, and Territorial Health Departments, 29 March 2020–5 March 2021
Authors: Galang Romeo R , Newton Suzanne M , Woodworth Kate R , Griffin Isabel , Oduyebo Titilope , Sancken Christina L , Olsen Emily O’Malley , Aveni Kathryn , Wingate Heather , Shephard Hanna , Fussman Chris , Alaali Zahra S , Silcox Kristin , Siebman Samantha , Halai Umme-Aiman , Lopez Camille Delgado , Lush Mamie , Sokale Ayomide , Barton Jerusha , Chaudhary Ifrah , Patrick Paul H , Schlosser Levi , Reynolds Bethany , Gaarenstroom Nicole , Chicchelly Sarah , Read Jennifer S , de Wilde Leah , Mbotha Deborah , Azziz-Baumgartner Eduardo , Hall Aron J , Tong Van T , Ellington Sascha , Gilboa Suzanne M ,   Centers for Disease Control and Prevention COVID-19 Response Pregnancy and Infant Linked Outcomes Team, Beauregard Jennifer , Hsia Jason , King Kellianne , Ko Jean , Lewis Elizabeth , Manning Susan , Neelam Varsha , Perez Mirna , Petersen Emily , Reynolds Megan , Riser Aspen , Rivera Maria , Roth Nicki , Simeone Regina , Sims John , Smoots Ashley , Snead Margaret , Strid Penelope , Valencia Diana , Wallace Bailey , Yowe-Conley Tineka , Zambrano Laura , Zapata Lauren , Akosa Amanda , Nahabedian John F , Rathore Amitsingh , Shinde Neha , Burkel Veronica , Cherry Dena , Chang Daniel , Fox Charise , Reeves Emily , Tannis Ayzsa , Trost Susanna 
Published: May 2021

Abstract

Background
Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods
Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during 29 March 2020–5 March 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics.

Results
Among 7950 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 25 years and older, healthcare occupation, prepregnancy obesity, chronic lung disease, chronic hypertension, and pregestational diabetes mellitus. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions.

Conclusions
Older age and having underlying medical conditions were associated with increased risk of moderate-to-severe or critical COVID-19 illness among pregnant women. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and can inform targeted public health messaging.