Impact of COVID-19 respiratory conditions on pregnancy outcomes in California prior to vaccine availability

Objectives: The objective of this study is to identify the populations of 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 344,894 births during the COVID Study period. Results: Those with COVID-19 related respiratory conditions experienced markedly elevated rates of Severe Maternal Morbidity (423.8 per 1,000) and maternal mortality (1,782 per 100,000). Conclusion: In pregnancies complicated by COVID-19, the excess risks of maternal mortality, SMM and adverse neonatal outcomes were restricted to the 0.17% with COVID-19 related respiratory conditions. Significant disparities were noted for respiratory conditions, mortality and SMM related to race-ethnicity and patients with lower socioeconomic status.