473. Trends among hospitalized pregnant patients with laboratory-confirmed SARS-CoV-2 — COVID-NET, 14 U.S. States, January 2021–January 2023
Authors: Havers Fiona P , Whitaker Michael , Milucky Jennifer , Patton Monica E , Chatwani Bhoomija , Chai Shua , Armistead Isaac , Meek James , Openo Kyle P , Weigel Andy , Ryan Patricia A , Nunez Val Tellez , Bye Erica , Rudin Dominic , Engesser Kerianne , Bushey Sophrena , Moran Nancy E , Sutton Melissa , Keipp Talbot H , Olsen Kirsten , Taylor Christopher 
Published: November 2023

Abstract

Background
Pregnant persons are at increased risk for adverse outcomes from COVID-19 infection. We describe trends and clinical outcomes among pregnant patients hospitalized with a positive SARS-CoV-2 test.

Methods
From January 2021–January 2023, hospitalized pregnant patients aged 15–49 years with a positive screening or clinician-directed SARS-CoV-2 test ≤ 14 days prior to or during hospitalization were identified from &gt; 300 hospitals across 99 counties in 14 states in the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET). Trained staff conducted chart abstractions on a representative sample of patients. We examined trends in the proportion of pregnant patients with COVID-19 respiratory symptoms and, among those with respiratory symptoms, trends in demographics and clinical outcomes from January–November 2021 (pre-Omicron), December 2021–June 2022 (early Omicron) and July 2022–January 2023 (later Omicron). Percentages presented were weighted to account for the probability of selection for sampled cases.

Results
Out of 1,637 hospitalized pregnant patients with SARS-CoV-2 infection, respiratory symptoms were recorded for 359 (21.9%). The proportion without respiratory symptoms increased from 73.4% (pre-Omicron) to 82.1% (later Omicron). Over the study period, among those with respiratory symptoms, the proportion with ≥1 underlying medical condition increased from 32.7% to 61.5% (Table 1), while the proportion requiring intensive care unit admission or mechanical ventilation decreased from 17.3% to 7.0% and from 7.2% to 0.0%, respectively (Table 2). During the later Omicron period, among patients with respiratory symptoms, 37.8% were unvaccinated, 35.7% had received a primary vaccination series only and 18.7% had received ≥1 booster doses (Table 2); a higher proportion (29.3%) of asymptomatic patients had received ≥1 boosters in the same period (Figure).Table 1.Characteristics of hospitalized pregnant patients (aged 15–49 years) with respiratory symptoms and a positive SARS-CoV-2 test, by pandemic period—COVID-NET, 14 U.S. States, January 2021–January 2023Table 2.Clinical characteristics among hospitalized pregnant patients (15–49 years) with respiratory symptoms and a positive SARS-CoV-2 test—COVID-NET, 14 U.S. States, January 2021–January 2023

Conclusion
The proportion of symptomatic pregnant patients hospitalized with COVID-19 who had severe clinical outcomes decreased over time, although adverse clinical outcomes continue to occur. Most symptomatic hospitalized pregnant patients were not up to date with COVID-19 vaccination during a period when COVID-19 booster doses were available.

Disclosures
All Authors: No reported disclosures