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Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020
Open accessAbstract
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.
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“Pregnant women with COVID-19 experienced increased likelihood of admission to intensive care units, and increased morbidity and mortality (Zambrano et al., 2020).”
From Over a Century of Leadership for Maternal and Child Health in the United States: An Updated History of the Maternal and Child Health Bureau (2025) · cites this paper as Zambrano et al., 2020
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“SARS-CoV-2 infection is more severe in pregnant women compared to their non-pregnant counterparts, with an increased risk of hospital admission, ICU stay, and death 2 .”
From Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study (2021) · cites this paper as [2]
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The Effects of COVID-19 on the Placenta During Pregnancy
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The coronavirus disease 2019 vaccine in pregnancy: risks, benefits, and recommendations
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COVID-19 vaccines: Considering sex differences in efficacy and safety
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Drug development research in pregnant and lactating women
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Perinatal SARS-CoV-2 Infection and Neonatal COVID-19: A 2021 Update
Sankaran, D., Nakra, N. A., Cheema, R., Blumberg, D. A., & Lakshminrusimha, S. (2021) · NeoReviews · doi:10.1542/neo.22-5-e284 · Cited by 85
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Jin, L., Li, Z., Zhang, X., Li, J., & Zhu, F. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2096970 · Cited by 83
The association between pregnancy and COVID-19: A systematic review and meta-analysis
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Pregnancy, Postpartum Care, and COVID-19 Vaccination in 2021
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Viral Infections During Pregnancy: The Big Challenge Threatening Maternal and Fetal Health
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Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy Outcomes in a U.S. Population
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COVID-19 vaccination among pregnant people in the United States: a systematic review
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Self-protection as an adaptive female strategy
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Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression
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The Epidemiology of COVID-19 in Pregnancy
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Coronavirus disease 2019 vaccines in pregnancy
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Counseling in maternal–fetal medicine: SARS‐CoV ‐2 infection in pregnancy
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Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study
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Pregnancy and COVID: what the data say
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Metadata
- Authors
- Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T., Woodworth, K. R., Nahabedian, J. F., Azziz-Baumgartner, E., Gilboa, S. M., Meaney-Delman, D., CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team, CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team, Akosa, A., Bennett, C., Burkel, V., Chang, D., Delaney, A., Fox, C., Griffin, I., Hsia, J., Krause, K., Lewis, E., Manning, S., Mohamoud, Y., Newton, S., Neelam, V., Olsen, E. O., Perez, M., Reynolds, M., Riser, A., Rivera, M., Roth, N. M., Sancken, C., Shinde, N., Smoots, A., Snead, M., Wallace, B., Whitehill, F., Whitehouse, E., & Zapata, L.
- Affiliations
- CDC COVID-19 Response Team.
- Oak Ridge Institute for Science and Education (US)
- Corresponding author
- Zambrano, Laura D.
- ORCID
- Zambrano, Laura D.
- Ellington, Sascha
- Strid, Penelope
- Galang, Romeo R.
- Tong, Van T.
- Woodworth, Kate R.
- Nahabedian, John F.
- Gilboa, Suzanne M.
- Burkel, Veronica
- Chang, Daniel
- Delaney, Augustina
- Griffin, Isabel
- Hsia, Jason
- Lewis, Elizabeth
- Manning, Susan
- Mohamoud, Yousra
- Newton, Suzanne
- Neelam, Varsha
- Olsen, Emily O’Malley
- Reynolds, Megan
- Riser, Aspen
- Rivera, Maria
- Roth, Nicole M.
- Sancken, Christina
- Snead, Margaret
- Wallace, Bailey
- Whitehill, Florence
- Whitehouse, Erin
- Zapata, Lauren
- Venue
- MMWR Morbidity and Mortality Weekly Report
- Published
- 2020-11-06
- Volume
- 69
- Issue
- 44
- Pages
- 1641-1647
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC7643892
- OpenAlex
- W3095574656
- Cited by
- 1,207
- References
- 8
- Citations by year
- 2026: 25 · 2025: 49 · 2024: 127 · 2023: 226 · 2022: 353 · 2021: 412 · 2020: 14
- FWCI
- 154.02
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, SARS-CoV-2, pregnancy, pregnant women, women of reproductive age, severe illness, intensive care unit admission, invasive mechanical ventilation, extracorporeal membrane oxygenation, mortality, racial and ethnic disparities, age disparities, health disparities, risk factors, sex differences, maternal health, case surveillance, notifiable diseases
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Testing, Adolescent, Adult, Female, Humans, Laboratories, Pneumonia, Viral, Pregnancy, Pregnancy Complications, Infectious, Severity of Illness Index, United States, Coronavirus Infections, Risk Assessment, Clinical Laboratory Techniques, Young Adult, Pandemics, Symptom Assessment
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