BACKGROUND: Risk factors for severe SARS-CoV2 infection in pregnancy have not been extensively studied . This information can help guide the management of pregnant women with COVID-19.

OBJECTIVE: Examine risk factors for severe COVID-19 in pregnant women .

METHODS: We reviewed the records of all pregnant women with positive SARS-CoV2 tests (qRT-PCR) managed at a single tertiary private maternity in Sao Paulo, Brazil . We categorized women as having non-severe (mild or moderate) or severe (severe or critical) COVID-19 . We conducted multivariable analyses to identify differences in sociodemographic and clinical characteristics of the two groups as risk factors for severe COVID-19 .

RESULTS: Between March 13 and June 7 2020 , 114 women tested positive for SARS-CoV-2; 80.7% (n = 92) had non-severe disease (69 mild , 23 moderate), 15.7% (n = 18) had severe, and 3.5% (n = 4) had critical COVID-19 . Women with severe/critical COVID-19 (n = 22) were significantly older (35.0 ± 5.9 × 31.8 ± 5.1 years, p = 0.011), more likely to have at least one medical comorbidity (81.8% × 52.2%, p = .011) or a history of asthma (18.2% × 3.3%, p = .025), and tended to have a higher median body mass index (30.1 kg/m2, IQR 28.1-33.9 × 28.6, IQR 26.2-32.0, p = .056) than women with non-severe disease . Multivariate logistic regression analysis identified four factors as independent predictors of severe/critical COVID-19: asthma (OR 34.469 , 95% CI 1.151-78.030, p = .026), non-white ethnicity (OR 7.932 , 95% CI 1.311-47.973, p = .024), maternal age with a best cutoff of & #8805; 34 years (OR 1.195 , 95% CI 1.001-1.427, p = .048) and gestational age at diagnosis with a best cut-off of & #8805; 35 weeks (OR 0.876 , 95% CI 0.780-0.983, p = .025). The predictive value of the model including all variables was 0.823 (p <.001).

CONCLUSION: A history of asthma, non-white ethnicity, and older maternal age were risk factors for, while higher gestational age was protective against severe/critical COVID-19 in pregnant Brazilian women.