Maternal and Infant Characteristics Among Women with Confirmed or Presumed Cases of Coronavirus Disease (COVID-19) During Pregnancy

Limited information is available on the impact of the COVID-19 pandemic on pregnant women and their newborns. While national data were not available as of December 2020, 14 states vital records offices and the District of Columbia were routinely collecting information on confirmed or presumed COVID-19 cases among pregnant women who then gave birth and reporting this information to the National Center for Health Statistics (NCHS). The table below presents data for this select area on characteristics of women with COVID-19 at any time during pregnancy, and their newborns. These data are based on cases of COVID-19 reported to NCHS and linked to the standard birth record, allowing for an analysis of birth-related data by maternal COVID-19 status. Any additional jurisdictions that begin reporting maternal COVID-19 cases to NCHS and will be included in future updates. While these data are not representative of all births in the United States, they are currently the only multi-state birth certificate-based data available. Of note, not all of the 15 reporting areas provided information for the total reporting period (April–December). The information provided is based on 27.0% of all births during the reporting period and the characteristics of the mothers and their newborns reflect the jurisdictions reporting COVID status. States also differed in how information on COVID-19 status was obtained and reported to NCHS. See Technical Notes for more information.

Table 1. Presumed or confirmed cases of maternal COVID-19 during pregnancy, by selected maternal and infant characteristics and by race and Hispanic origin of the mother: 14 states and the District of Columbia, April-December, 2020
Number
Total 16,599 608,373 5,099 306,081 2,675 77,155 7,339 146,429
Percent distribution
COVID-19 case percent distribution5 100.0 30.7 16.1 44.2
Non-COVID-19 case percent distribution5 100.0 50.3 12.7 24.1
Maternal characteristics
Age of mother
Total5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.1
Under 20 5.9 4.4 3.4 3.5 7.0 6.7 7.6 6.0
20-24 22.7 18.4 20.0 17.3 24.1 23.8 24.7 21.5
25-29 30.2 28.1 32.3 28.7 32.3 29.2 28.6 29.2
30-34 25.1 29.4 28.8 31.4 22.1 24.1 22.7 25.2
35-39 13.0 16.0 13.2 15.9 11.5 12.8 12.9 14.4
40 or more 3.1 3.7 2.3 3.2 3.0 3.4 3.5 3.8
Educational attainment
Total5,6 100.0 100.1 100.0 99.9 100.0 100.1 100.2 99.96
Less than High School 21.0 11.6 6.8 7.1 11.9 11.3 35.7 23.5
High School graduate or GED 32.2 27.1 25.6 23.5 40.4 37.0 34.1 33.3
Some college 20.9 20.1 22.1 18.9 25.1 25.5 18.9 21.6
Associate degree 6.9 8.0 10.8 9.1 7.6 7.4 4.1 6.5
Bachelor's degree and higher 19.0 33.3 34.7 41.3 15.0 18.9 7.4 15.0
Percentage
Source of payment - Medicaid 56.5 41.6 33.9 31.2 68.1 63.0 69.6 58.0
ICU admission 0.9 0.1 0.6 0.1 1.2 0.2 0.9 0.2
Infant characteristics
Total preterm7 12.77 9.79 11.30 9.12 16.27 14.18 12.27 9.12
   34-36 weeks 9.38 7.19 8.43 6.86 11.56 9.44 9.14 6.86
   Less than 34 weeks 3.38 2.60 2.86 2.26 4.71 4.74 3.14 2.26
Low birthweight8 9.11 7.93 7.48 6.85 14.70 14.06 8.10 6.74
   Very low birthweight9 1.62 1.28 1.43 1.03 2.73 2.80 1.21 1.03
NICU admission 11.0 8.7 10.0 8.4 14.3 12.2 10.3 7.6
Infant living10 99.8 99.8 99.8 99.8 99.7 99.6 99.8 99.8
Table

 

 

Maternal or infant characteristic

Total1 Non Hispanic White2 Non-Hispanic Black2 Hispanic3
Yes
COVID-194
No
COVID-19
Yes
COVID-194
No
COVID-19
Yes
COVID-194
No
COVID-19
Yes
COVID-194
No
COVID-19

1 Includes births to race and origin groups not shown separately, such as non-Hispanic American Indian or Alaska Native, non-Hispanic Native Hawaiian or Other Pacific Islander, non-Hispanic multiple race and Hispanic origin not stated.
2 Race and Hispanic origin are reported separately on birth certificates; persons of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race categories are consistent with the 1997 Office of Management and Budget standards; see reference 1. Single-race is defined as only one race reported on the birth certificate.
3 Includes all persons of Hispanic origin of any race; see reference 1.
4 Confirmed or presumed COVID-19 during pregnancy.
5 May not add to 100.0 percent due to rounding error.
6 Includes women who may not have had time to complete their education.
7 Gestational age in completed weeks; based on the obstetric estimate of gestation.
8 Less than 2,500 grams
9 Less than 1,500 grams
10 Infant living at time of discharge or transfer from hospital.

NOTES: Reporting area includes Alabama, Alaska, Arkansas, California, District of Columbia, Idaho, Maine, Maryland, New Hampshire, North Dakota, Ohio, Oklahoma, Oregon, Tennessee, and West Virginia. See Technical notes for numbers and distributions of cases by state and details on state maternal COVID-19 reporting.

Technical Notes

A subset of states is providing information to the National Center for Health Statistics (NCHS) on reported cases of COVID-19 occurring during pregnancy for pregnancies ending in a live birth. The number of states reporting has increased from eight states and the District of Columbia (DC) in April to 14 states and DC in June through October. The information from the reporting states is not representative of all women giving birth given that the incidence of COVID-19 cases varies substantially by state and by reporting period and that the reporting states are not a random sample of states. It is also important to note that states have varying approaches to capturing information on maternal COVID-19 and different time requirements for reporting birth information (see Table I below for more information).

Nature and sources of data

National data on maternal COVID-19 are currently not available. Although a specific reporting item for maternal COVID-19 is not included on the U.S. Standard Certificate of Live Birth, a number of states are collecting information on maternal COVID-19 as part of the birth registration process and through other methods and are reporting this supplemental information to NCHS. The information presented for April through December 2020 represents 27.0% of all births during this period. Data for any additional jurisdictions that begin reporting maternal COVID-19 cases to NCHS will be included in future updates.

Maternal COVID-19 information is sent by the states to NCHS on a recurring basis independently of the standard birth record and of the standard birth record data transmission process. This information is then linked to the standard birth record using a unique identifier, which allows for detailed analysis of information on the birth record (1) by maternal COVID-19 status. The vast majority (99.5%) of cases of maternal COVID-19 reported for April-December were linked to the corresponding birth record. Unlinked cases are those for which the standard birth record had not been received by NCHS at the time the linkage was performed.

It is important to note that:

  • Since reporting states are not a random sample of states, the statistical information shown in this report reflects the characteristics of the reporting states. For example, California accounts for 37.8% of  births in the Maternal COVID-19 reporting area in the current reporting period while only 11.6% of all U.S. births occurred in California during this period. The characteristics of mothers in California will be disproportionately reflected in the data for the reporting area compared to the total U.S. See Table II for the distribution of maternal COVID-19 cases by state for all reporting areas and for the reporting areas excluding California, and Table III for comparisons of selected results for three different reporting areas: the full reporting area, the reporting area excluding California, and California alone.
  • The information on COVID-19 cases shown may not include all cases of maternal COVID-19 that occurred in the reporting area during the time period indicated, that is, information on some cases may not have been provided to the state prior to the submission of monthly data to NCHS..
  • States have different methods for collecting maternal COVID-19 information. Some states have modified their state birth certificates to include a COVID-19 data item. Other states are identifying cases through infectious disease surveillance; still others are using a combination of these two methods (see Table I below).
  • These data are reported to NCHS outside of the usual process for submission of standard birth certificate data and do not undergo standard NCHS review prior to posting.

Maternal COVID-19 reporting area

Fourteen states and the District of Columbia have provided data as of 2/24/21, although it is important to note that the number of reporting areas was not constant over the time period for which these data are shown. Eight states and DC reported maternal COVID-19 to NCHS for April 2020, ten states and DC for May, and 14 states and DC for June–December. Characteristics of the reporting area are a function of the states participating and the length of time that they have been reporting. Table 1 includes data for all cases reported by these states over the April–December time period since the purpose of this analysis was not to examine trends over time, but rather to compare the characteristics of births to women with, and without, COVID-19 during pregnancy. A comparison of results for the full reporting area/period shown in Table 1 with those for a consistent eight-state and DC reporting area for April–December shows essentially similar results in terms of maternal characteristics and birth outcomes (data available upon request).

If additional states begin collecting and reporting information on maternal COVID-19, their data will be added to future updates.

Table I. Reporting specifications for maternal COVID-19 by state: 14 states and the District of Columbia, April-December, 2020

 

 

Jurisdiction
 

Date data collection began

 

 

Data collection method

Table
Alabama 3/1/2020 Reports confirmed or presumed cases of maternal COVID-19 reported in the medical notes section of the electronic birth reporting system and birth database. Also matches birth file with COVID-19 positive tests from Alabama National Electronic Disease Surveillance System.
Alaska 4/16/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections of Interest” section of the birth certificate item “Infections present and/or treated during this pregnancy.”
Arkansas 5/21/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” item of the birth certificate.
California 6/10/2020 Reports confirmed or presumed cases of maternal COVID-19 reported in the “Complications and Procedures of Pregnancy and Concurrent Illnesses” item of the birth certificate.
District of Columbia 3/1/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” and “Characteristics of Labor and Delivery” items of the birth certificate. Cases are verified using hospital medical records.
Idaho 5/1/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” item of the birth certificate.
Maine 6/1/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Pregnancy Factors” section of the birth certificate item  “Obstetric Procedures”.
Maryland 4/8/2020 Developed a COVID-19 birth data collection form for completion by birthing facilities for mothers with confirmed (positive laboratory test) disease.
New Hampshire 4/8/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections” section of the birth certificate item “Infections present and/or treated during this pregnancy.”
North Dakota 3/1/2020 Requires birthing hospitals to submit paper-based monthly reports identifying COVID-19 positive mothers.
Ohio 3/1/2020 Links birth file with the Ohio Disease Reporting System to identify confirmed COVID-19 cases.
Oklahoma 6/19/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” item of the birth certificate.
Oregon 6/15/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Infections present and/or treated during this pregnancy” item of the birth certificate.
Tennessee 3/4/2020 Links birth file with the Tennessee National Electronic Disease Surveillance System Base System to identify confirmed COVID-19 cases during pregnancy.
West Virginia 4/13/2020 Indicates that confirmed or presumed COVID-19 was present during pregnancy in the “Other Infections” section on the birth certificate item “Infections present and/or treated during this pregnancy.”

Completeness and representativeness of data

Differences in reporting methods used by states to identify cases of maternal COVID-19 may result in varying levels of completeness by state. While most states report both confirmed or presumed COVID-19 during pregnancy, four states, Maryland, Ohio, North Dakota, and Tennessee, report confirmed COVID-19 only. Limited information is available on the quality of infection data reported on the birth certificate, however, underreporting of specific infections has been observed in some jurisdictions (2); accordingly, maternal COVID-19 may also be underreported and the cases reported to NCHS may not be representative of all maternal COVID-19 cases occurring in that jurisdiction.

The incidence of COVID-19 cases among the general population can vary substantially by state and by time period. Since the reporting states do not represent a random sample of states the results shown in Table 1 for the maternal COVID-19 reporting states are not representative of the total U.S., as is illustrated by comparing maternal characteristics from these states to the total U.S. For births occurring during April-December 2020 the maternal COVID-19 reporting states combined (taking into account the dates at which each state began reporting maternal COVID-19) had a larger percentage of Hispanic births than the total U.S. (25.3% compared with 24.3%), and a smaller percentage of non-Hispanic white (50.3% vs. 51.6%) and non-Hispanic black (13.2% vs. 14.7%) births. The preterm birth rate for the maternal COVID-19 reporting area was lower than that of the entire U.S. (9.83% compared with 10.03%).

State of Occurrence

Maternal COVID-19 cases are reported by state of occurrence, which is the state in which the birth took place. State of occurrence may not be the same as the state of residence. Birth data are typically reported by state of residence.

Table II. Distribution of cases of confirmed or presumed cases of Maternal COVID-19 during pregnancy for all reporting areas and for all reporting areas excluding California: April-December 2020
Alabama 10.0 1,657 17.4 1,657
Alaska 0.4 62 0.6 62
Arkansas1 3.6 596 6.2 596
California2 42.5 7,059 N/A N/A
District of Columbia 1.9 318 3.3 318
Idaho1 1.5 247 2.6 247
Maine2 0.5 76 0.8 76
Maryland 5.6 935 9.8 935
New Hampshire 0.2 35 0.4 35
North Dakota 0.4 61 0.6 61
Ohio 15.2 2,515 26.4 2,515
Oklahoma2 4.4 737 7.7 737
Oregon2 2.4 391 4.1 391
Tennessee 11.2 1,857 19.5 1,857
West Virginia 0.3 53 0.6 53
Total3 100.1 16,599 100.0 9,540
Table

 

 

 

Reporting area

All reporting areas Reporting area excluding California
April-December April-December
Percent distribution Number Percent distribution Number

N/A is not applicable
1Began reporting in May, 2020
2Began reporting in June, 2020
3May not add to 100.0 percent due to rounding error.

Table III. Confirmed or presumed cases of Maternal COVID-19 during pregnancy, by selected maternal and infant characteristics: Selected reporting areas and months, 2020
Number
Total 16,599 608,373 9,540 378,962 7,059 229,411
Maternal characteristics
Percent distribution
Race and Hispanic origin
Total2 99.9 100.0 100.1 100.0 100.0 100.0
Non-Hispanic white3 31.3 51.3 43.2 64.3 14.6 28.8
Non-Hispanic black3 16.4 12.9 24.9 17.3 4.6 5.4
Non-Hispanic Asian3 3.7 7.2 2.3 3.2 5.8 14.1
Non-Hispanic other4 3.5 4.1 4.3 4.5 2.4 3.3
Hispanic5 45.0 24.5 25.4 10.7 72.6 48.4
Age of mother in years
Total2 100.0 100.0 100.0 100.0 99.9 100.1
Under 20 5.9 4.4 6.0 5.1 5.8 3.2
20-24 22.7 18.4 23.4 20.8 21.7 14.5
25-29 30.2 28.1 31.5 29.7 28.3 25.5
30-34 25.1 29.4 24.4 28.0 26.0 31.7
35-39 13.0 16.0 12.1 13.6 14.3 20.0
40 or more 3.1 3.7 2.6 2.8 3.8 5.2
Educational attainment
Total2,6 100.0 100.1 99.9 100.1 99.9 100.0
Less than High School 21.0 11.6 20.1 11.9 22.2 11.0
High School graduate or GED 32.2 27.1 31.4 27.8 33.3 25.9
Some college 20.9 20.1 19.4 20.4 23.1 20.0
Associate degree 6.9 8.0 7.9 8.4 5.5 7.3
Bachelor's degree 12.9 20.5 14.1 19.6 11.2 22.1
Master's degree 4.7 9.7 5.5 9.4 3.4 10.2
Doctorate 1.4 3.1 1.5 2.9 1.2 3.5
Percentage
Source of Payment – Medicaid 56.5 41.6 54.6 42.8 59.0 39.7
ICU admission 0.9 0.1 1.0 0.1 0.8 0.2
Infant characteristics
Total preterm7 12.77 9.79 13.18 10.52 12.20 8.59
   34-36 weeks 9.38 7.19 9.69 7.65 8.97 6.43
   Less than 34 weeks 3.38 2.60 3.49 2.87 3.23 2.16
Low birthweight8 9.11 7.93 9.66 8.60 8.37 6.82
   Very low birthweight9 1.62 1.28 1.76 1.45 1.43 0.99
NICU admission 11.0 8.7 11.3 9.3 10.7 7.6
Infant living10 99.8 99.8 99.8 99.7 99.7 99.9
Table

 

 

 

Maternal or infant characteristic

All reporting areas Reporting area excluding California California only
April-December April-December June-December
Yes
COVID-191
No
COVID-19
Yes
COVID-191
No
COVID-19
Yes
COVID-191
No
COVID-19

1 Confirmed or presumed COVID-19
2 May not add to 100.0 percent due to rounding error.
3 Race and Hispanic origin are reported separately on birth certificates; persons of Hispanic origin may be of any race. In this table, non-Hispanic women are classified by race. Race categories are consistent with the 1997 Office of Management and Budget standards; see reference 1. Single-race is defined as only one race reported on the birth certificate.
4 Includes births to race and origin groups not shown separately, such as non-Hispanic American Indian or Alaska Native, non-Hispanic Native Hawaiian or Other Pacific Islander, non-Hispanic multiple race and Hispanic origin not stated.
5 Includes all persons of Hispanic origin of any race; see reference 1.
6 Includes women who may not have had time to complete their education.
7 Gestational age in completed weeks; based on the obstetric estimate of gestation.
8 Less than 2,500 grams
9 Less than 1,500 grams
10 Infant living at time of discharge or transfer from hospital.

NOTES: Reporting area includes Alabama, Alaska, Arkansas, California, District of Columbia, Idaho, Maine, Maryland, New Hampshire, North Dakota, Ohio, Oklahoma, Oregon, Tennessee, and West Virginia. See Technical notes for numbers and distributions of cases by state and details on state maternal COVID-19 reporting.

Source

NCHS, National Vital Statistics System.

References

1. National Center for Health Statistics. Vital statistics data available. Natality public use. Hyattsville, MD: National Center for Health Statistics. Published annually. Available from: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm
2. Gregory ECW, Ely DM. Trends and characteristics of sexually transmitted infections during pregnancy: United States, 2016-2018. National Vital Statistics Report. Vol 69 (3): Hyattsville, Maryland. National Center for Health Statistics. 2020.

Page last reviewed: March 8, 2021