Pregnancy and risk of COVID-19

Magnus, M.; Oakley, L.; Gjessing, H. K.; Stephansson, O.; Engjom, H. M.; Macsali, F.; Juliusson, P. B.; Nybo Andersen, A.-M.; Haberg, S. E.

Background: Studies report that pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, intensive-care and death. Whether pregnant women in general are more susceptible of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. Methods: Linked registry-data on all women ages 15 to 45 living in Norway on March 1st, 2020 (N=1,033,699) were used in Cox regression models to estimate hazard ratios (HR) comparing pregnant to non-pregnant women, of having a positive test for SARS-CoV-2, a diagnosis of COVID-19 in specialist healthcare, or hospitalization with COVID-19, adjusting for age, marital status, education, income, country of birth and underlying medical conditions. Results: Compared to non-pregnant women, pregnant women had a similar risk of a positive SARS-CoV-2 test (adjusted HR, 0.99; 95% confidence interval [CI], 0.92 to 1.07), a higher risk of a COVID-19 diagnosis in specialist care (HR, 3.46; 95% CI, 2.89 to 4.14), and to be hospitalized (HR, 4.70; 95% CI, 3.51 to 6.30). Pregnant women were in general not more likely to be tested for SARS-CoV-2. Pregnant women born outside Scandinavia were less likely to be tested, but at higher risk of a positive test (HR, 2.37; 95% CI, 2.51 to 8.87) and of hospitalization with COVID-19 (HR, 4.72; 95% CI, 2.51 to 8.87) than pregnant Scandinavian born women. Conclusion: Pregnant women were not more likely to be infected with SARS-CoV-2. However, pregnant women with COVID-19, especially those born outside of Scandinavia, were more likely to receive specialist care and to be hospitalized.