Characteristics and Medication Use Patterns of Pregnancies with COVID-19 Ending in Live-Birth in the Sentinel System

Background: Pregnant individuals are at high risk for developing severe illness related to COVID-19. We adapted the “COVID-19 infectiOn aNd medicineS In pregnancy” (CONSIGN) CONSIGN study protocol as part of an international collaboration to understand the natural history of COVID-19 disease among pregnant individuals in the U.S. Methods: : We identified individuals aged 12 to 55 years with documented live-birth deliveries in the Sentinel Distributed Database who had at least one qualifying diagnosis for COVID-19 or positive-confirmed nucleic acid amplification test for SARS-CoV-2. We conducted separate 1:1 propensity score matched analyses comparing pregnant individuals with COVID-19 to: 1) pregnant individuals without COVID-19 during six months prior to or during pregnancy; and 2) non-pregnant individuals with COVID-19. Results: : From January 2020 to December 2022 , we identified 52,355 pregnant individuals with COVID-19 matched to 52,355 pregnant individuals without COVID-19. Outpatient medication use in the 30 days surrounding COVID-19 date (or matched date) was generally low but similar between pregnant individuals with and without COVID-19. We identified 40,518 pregnant individuals with COVID-19 matched to 40,518 non-pregnant individuals with COVID-19. Medication use in 30 days prior to COVID-19 was higher among non-pregnant than pregnant individuals with COVID-19. More pregnant individuals than matched non-pregnant individuals were classified as non-severe (87.2% vs. 79.9%); however, more non-pregnant individuals could not have their COVID-19 severity determined (19.0% vs. 10.0%). Conclusions: : Medication use is generally low in pregnancies with COVID-19, compared to pregnancies without COVID-19 and non-pregnant individuals with COVID-19. Interpretation of medication utilization patterns is challenging due to changing treatment and prevention recommendations during the pandemic.