The goal was to report the severity of coronavirus disease 2019 (COVID-19) in pregnant individuals and to assess the relationship between disease severity and perinatal outcomes.

Researchers conducted an observational cohort analysis of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at one of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. The severity of the disease was determined using National Institutes of Health guidelines. Maternal, fetal, and neonatal outcomes were collected by perinatal research workers who had been centrally trained and accredited. They used multivariable modeling to examine changes in maternal characteristics and outcomes across COVID-19 severity classes, as well as correlations between severity and outcomes. 

A total of 1,219 individuals were included in the study: 47% were asymptomatic, 27% were mild, 14% were moderate, 8% were severe, and 4% were critical. Overall, 53% were Hispanic; there was no trend in the distribution of race–ethnicity by illness severity. COVID-19 has been linked to four maternal fatalities. There was no difference in the frequency of perinatal mortality or a positive neonatal SARS-CoV-2 test result based on severity. Adverse perinatal outcomes were more common in individuals with more severe disease, including a 6% incidence of venous thromboembolism in those with severe–critical illness compared to 0.2%  in those with mild-moderate illness and 0% in those with asymptomatic. When compared to asymptomatic individuals, severe–critical COVID-19 was linked with an elevated risk of cesarean delivery, hypertensive disorders of pregnancy, and preterm birth in adjusted analyses. When compared to asymptomatic individuals, mild-moderate COVID-19 was not related to worse perinatal outcomes.


Those with severe–critical COVID-19, but not those with mild-moderate COVID-19, were at an elevated risk of perinatal problems as compared to pregnant patients with SARS-CoV-2 infection without symptoms.