# Eighteen-Month Outcomes Among Pregnant and Nonpregnant Reproductive-Aged People Hospitalized for Coronavirus Disease 2019

## TL;DR

Pregnant individuals hospitalized with severe COVID-19 had lower long-term risks of readmission and death compared to nonpregnant individuals.

## Contribution

This study provides 18-month follow-up data on pregnant and nonpregnant individuals hospitalized with SARS-CoV-2, revealing lower long-term adverse outcomes in pregnant individuals.

## Key findings

- Nonpregnant participants had higher rates of complications, mechanical ventilation, and mortality during initial hospitalization.
- Pregnant participants had a lower 18-month readmission rate (7%) compared to nonpregnant participants (21%).
- No deaths occurred in the pregnant group over 18 months post-hospitalization.

## Abstract

Physiologic and immunologic adaptations in pregnancy may increase the risk of adverse outcomes from respiratory viral infections. However, data are limited on longer-term outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy prior to widespread vaccine availability.

Using electronic health record data, we retrospectively compared 6-, 12-, and 18-month outcomes including death and rehospitalization between pregnant and nonpregnant reproductive-aged individuals hospitalized for SARS-CoV-2 infection between 2020 and 2021 at 2 academic referral hospitals.

There were 190 nonpregnant and 70 pregnant participants. Mean age was 31 years for pregnant and 34 years for nonpregnant participants. For pregnant patients, mean gestational age at coronavirus disease 2019 (COVID-19) diagnosis was 36 weeks, 54% delivered by cesarean, and 97% delivered a live birth. Compared to pregnant participants, nonpregnant participants had a higher prevalence of baseline comorbidities and a higher proportion received mechanical ventilation (84% vs 55%). Index hospitalization complications (31% vs 17%) and mortality (3% vs 0%) were more common in nonpregnant participants. Over 18 months following index hospitalization, 39 (21%) nonpregnant and 5 (7%) pregnant participants were readmitted, most for infection (28/44 [64%]). Most readmissions occurred within 6 months. There were no posthospitalization deaths in the pregnant group.

Pregnant people with severe COVID-19 disease had a low rate of severe adverse outcomes after index hospitalization. The low readmission rate is reassuring that pregnant individuals may not be at higher risk for long-term severe adverse health outcomes after COVID-19 compared to the nonpregnant reproductive-aged population, possibly because any increased risk conferred by pregnancy resolves soon after delivery.