Physiologic adaptations and changes in immune regulation may increase the risk of morbidity and mortality in pregnant women with respiratory infections.1,2 The effects of coronavirus disease 2019 (COVID-19) in pregnancy have not been fully delineated. We compared the clinical characteristics and outcomes of hospitalized women who gave birth with and without COVID-19.


Women giving birth and discharged between April 1 and November 23, 2020, were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes within the Premier Healthcare Database, an all-payer database encompassing approximately 20% of US hospitalizations.3 Race and ethnicity were self-reported, and COVID-19 status (ICD-10 code U07.1), comorbidities, and in-hospital outcomes were identified using ICD-10 and billing codes (eTables 1 and 2 in the Supplement). Discharge disposition and in-hospital death were reported in all patients.

Data were collected and deidentified by Premier Inc, which curates the Premier Healthcare Database, then analyzed at Brigham and Women’s Hospital in Boston, Massachusetts. The Mass General Brigham Institutional Review Board approved the study protocol and waived the requirement for patient informed consent. Multivariable logistic regression was used to derive a propensity model estimating the probability of COVID-19 (eMethods in the Supplement). Associations between COVID-19 and in-hospital outcomes were examined using propensity score-adjusted regression. Factors associated with in-hospital death or mechanical ventilation use among pregnant women with COVID-19 were identified using forward stepwise logistic regression (eMethods in the Supplement). Analyses were conducted using Stata, version 15.0 (Stata Corp) with a 2-tailed P value less than .05 considered significant. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.4

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