Pregnancy Status Video Download |VERIFIED|
Janae Nowinski
As of June 16, 2020, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 2,104,346 cases and 116,140 deaths in the United States.* During pregnancy, women experience immunologic and physiologic changes that could increase their risk for more severe illness from respiratory infections (1,2). To date, data to assess the prevalence and severity of COVID-19 among pregnant U.S. women and determine whether signs and symptoms differ among pregnant and nonpregnant women are limited. During January 22-June 7, as part of COVID-19 surveillance, CDC received reports of 326,335 women of reproductive age (15-44 years) who had positive test results for SARS-CoV-2, the virus that causes COVID-19. Data on pregnancy status were available for 91,412 (28.0%) women with laboratory-confirmed infections; among these, 8,207 (9.0%) were pregnant. Symptomatic pregnant and nonpregnant women with COVID-19 reported similar frequencies of cough (>50%) and shortness of breath (30%), but pregnant women less frequently reported headache, muscle aches, fever, chills, and diarrhea. Chronic lung disease, diabetes mellitus, and cardiovascular disease were more commonly reported among pregnant women than among nonpregnant women. Among women with COVID-19, approximately one third (31.5%) of pregnant women were reported to have been hospitalized compared with 5.8% of nonpregnant women. After adjusting for age, presence of underlying medical conditions, and race/ethnicity, pregnant women were significantly more likely to be admitted to the intensive care unit (ICU) (aRR = 1.5, 95% confidence interval [CI] = 1.2-1.8) and receive mechanical ventilation (aRR = 1.7, 95% CI = 1.2-2.4). Sixteen (0.2%) COVID-19-related deaths were reported among pregnant women aged 15-44 years, and 208 (0.2%) such deaths were reported among nonpregnant women (aRR = 0.9, 95% CI = 0.5-1.5). These findings suggest that among women of reproductive age with COVID-19, pregnant women are more likely to be hospitalized and at increased risk for ICU admission and receipt of mechanical ventilation compared with nonpregnant women, but their risk for death is similar. To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families.
If you are a job applicant or an employee who believes that an employer has discriminated against you because of your pregnancy or your pregnancy-related disability, you can file a charge of discrimination with the EEOC. Learn more about filing a charge of discrimination.
Background: Preclinical and clinical research has suggested the existence of pregnancy-associated analgesia, wherein responses to painful stimulation or pain from disease decrease during pregnancy. Materials and Methods: We combined data from multiple years (2012-2015) of the National Health Interview Survey to examine high-impact pain by Hispanic ethnicity and race in women with no prior pregnancy, during pregnancy, and previously pregnant. Results: High-impact pain was less common for women during pregnancy (10.3%; 95% confidence interval [CI]: 7.0%-13.7%) than it was for women who had never been pregnant (13.7%; 95% CI: 12.8%-14.5%) and for women who had previously been pregnant (19.8%; 95% CI: 16.0%-23.7%). However, when we examined the data by Hispanic ethnicity and race, we found that non-Hispanic White (NHW) women were less likely to report high-impact pain during pregnancy, but non-Hispanic Black (NHB) women and Hispanic White women were not. In women who reported no prior pregnancy, NHW women were most likely to report high-impact pain, followed by NHB women and Hispanic women. In post hoc analyses, we found that while menstrual problems were associated with increased odds of having high-impact pain, an interaction was not observed between menstrual problems and race/ethnicity (p = 0.48). Conclusions: This cross-sectional study presents a nationally representative examination of the prevalence of high-impact pain across pregnancy status. Using a nationally representative sample of women, we have demonstrated that the prevalence of high-impact pain varies across pregnancy status and that race/ethnicity and the presence of menstrual problems independently affect this prevalence.
The findings in this report are subject to at least three limitations. First, national case surveillance data for COVID-19 are voluntarily reported to CDC and rely on health care providers and jurisdictional public health agencies to share information for patients who meet standard case definitions. The mechanism used to report cases and the capacity to investigate cases varies across jurisdictions. Thus, case information is limited or unavailable for a portion of detected COVID-19 cases, and reported case data might be updated at any time. This analysis was restricted to women with known age; however, pregnancy status was missing for over one half (64.5%) of reported cases, and among those with known pregnancy status, data on race/ethnicity were missing for approximately 25% of cases, and information on symptoms and underlying conditions was missing for approximately one half. Second, when estimating the proportion of cases with severe outcomes, the observational data collected through passive surveillance might be subject to reporting bias, wherein preferential ascertainment of severe cases is likely (6,7); therefore, the frequency of reported outcomes incorporates a denominator of all cases as a conservative estimate. Finally, severe outcomes might require additional time to be ascertained. To account for this, a time lag was incorporated, such that data reported as of October 28, 2020, were used for cases reported as of October 3.
This analysis supports previous findings that pregnancy is associated with increased risk for ICU admission and receipt of invasive ventilation among women of reproductive age with COVID-19 (1,2). In the current report, an increased risk for receiving ECMO and death was also observed, which are two additional important markers of COVID-19 severity that support previous findings. In comparison to influenza, a recent meta-analysis found no increased risk for ICU admission or death among pregnant women with seasonal influenza (8). However, data from previous influenza pandemics, including 2009 H1N1, have shown that pregnant women are at increased risk for severe outcomes including death and the absolute risks for severe outcomes were higher than in this study of COVID-19 during pregnancy (9). Longitudinal surveillance and cohort studies among pregnant women with COVID-19, including information about pregnancy outcomes, are necessary to understand the full spectrum of maternal and neonatal outcomes associated with COVID-19 in pregnancy. CDC, in collaboration with health departments, has adapted SET-NET to collect pregnancy-related information and pregnancy and neonatal outcomes among women with COVID-19 during pregnancy (3).
Background: Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth.
Methods: In a longitudinal study, we studied 198 children born in 1991-92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass.
Findings: 49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r=0.21, p=0.0088) and lumbar-spine (r=0.17, p=0.03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p
Interpretation: Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.
Despite consistency of these findings with the literature with respect to the impact of age and relationship status on reproduction, important differences remained. For example, several studies have documented that knowledge and use of contraceptives is low in many sub-Saharan countries,25 and yet nearly half of participants in this study reported using modern contraceptives. These data were derived from a randomized controlled trial rather than a population-based survey; selfselection bias may account for the differences in observed contraceptive use. Likewise, findings from this investigation contrast with those of earlier studies suggesting that fertility is unaffected or reduced following HIV diagnosis.2,4,7,26 An important difference is that the present study examined intention to reproduce and revealed that serostatus and baseline intentions interact to influence postdiagnosis pregnancy status. Finally, these data depart from the literature in that women infected with HIV were found in multivariate analyses to be 3 times more likely to be pregnant at 6 months post-VCT than were uninfected women. This difference may be attributed to the relatively short interval between HIV serotesting and postintervention assessment; findings from studies conducting 12- to-24-month follow-up assessments suggest that this pattern of fertility may change with HIV disease progression.3,17
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