Obstet Gynecol. 2026 Jul 9. doi: 10.1097/AOG.0000000000006364. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the risks of severe coronavirus disease 2019 (COVID-19)-related outcomes among pregnant and postpartum individuals and nonpregnant women during the Delta variant period and after the pandemic emergency ended in the United States.
METHODS: We conducted a retrospective cohort study of 18- to 49-year-old women identified in a national U.S. commercial insurance claims database during the Delta variant (July 1-December 20, 2021) and postemergency periods (May 11, 2023-September 10, 2024). Pregnant and postpartum individuals unvaccinated for COVID-19 during the year before follow-up were propensity score-matched to four nonpregnant women. Primary outcomes were laboratory-confirmed or clinically diagnosed COVID-19 with subsequent COVID-19 hospitalization, pneumonia hospitalization, or a severe composite COVID-19 hospitalization such as acute respiratory failure, intensive care unit admission, acute respiratory distress syndrome, or respiratory support.
RESULTS: Among the individuals followed during the Delta variant (1,109,384) and postemergency (878,003) periods, hospitalization rates with COVID-19 were substantially higher among pregnant individuals than among postpartum individuals or nonpregnant women. In propensity score-matched analyses, the risks of all primary outcomes were elevated for individuals who were pregnant during the Delta period, compared with matched nonpregnant women. Although absolute risks of severe COVID-19 outcomes were lower during the postemergency period, the relative risks (RRs) of COVID-19 hospitalization (RR 4.09; 95% CI, 3.65-4.59) and pneumonia hospitalization (RR 2.78; 95% CI, 1.38-4.81) during pregnancy remained elevated. The RR for severe composite COVID-19 hospitalization (RR 2.17; 95% CI, 0.35-6.67) was imprecise, reflecting substantial uncertainty. Risks for severe COVID-19-related outcomes were also elevated postpartum. Sensitivity analyses reinforced these findings.
CONCLUSION: Higher risks of severe COVID-19-related outcomes among pregnant and postpartum individuals have persisted since the resolution of the pandemic emergency.
PMID:42424625 | DOI:10.1097/AOG.0000000000006364
