Impact of COVID-19 respiratory conditions on pregnancy outcomes in California.

OBJECTIVES

The objective of this study is to identify the populations at greatest risk for COVID-19 complications during pregnancy and determine their adverse maternal and neonatal outcomes in a time period prior to vaccine availability.

STUDY

DESIGN

Cohort study using delivery hospitalization discharge data linked to vital records for all births in California during the baseline pre-COVID-19 period and for all births during the COVID-19 Study period.

RESULTS

Among 344,894 deliveries, a total of 7181 (2.08%) hospitalized patients tested positive for COVID-19 during pregnancy. Of these, 571 (0.17%) patients were hospitalized with severe respiratory illness. Rate of severe maternal morbidity (242/571, 42%) and maternal death (10/571, 1.8%) were markedly elevated in those hospitalized patients with COVID-19 related respiratory disease compared to both uninfected parturients and infected parturients with less severe disease. Higher rates of COVID-19 related respiratory conditions were associated with Hispanic ethnicity, Native American race, state-funded insurance, and lower education levels.

CONCLUSION

In pregnancies complicated by COVID-19, the excess risks of maternal mortality, SMM, and adverse neonatal outcomes were restricted to the patients with COVID-19 related respiratory conditions. Significant disparities were noted for respiratory conditions, mortality and SMM related to race-ethnicity and socioeconomic status.