AbstractBackgroundMultiple studies have described increased risk of severe coronavirus disease (COVID‐19) among pregnant women compared to nonpregnant women. The risk in middle‐income countries where the distributions of age groups and preexisting conditions may differ is less known.ObjectivesTo determine whether pregnant women with SARS‐CoV‐2 infection are at increased risk for severe COVID‐19 compared to nonpregnant women in Colombia.MethodsWe analysed national surveillance data from Colombia, of women aged 15–44 years with laboratory‐confirmed infection with SARS‐CoV‐2 by molecular or antigen testing, from 6 March 2020 to 12 December 2020. An enhanced follow‐up of pregnant women with COVID‐19 was established to monitor pregnancy and birth outcomes.ResultsOf 371,363 women aged 15–44 years with laboratory‐confirmed SARS‐CoV‐2 infection, 1.5% (n = 5614) were reported as pregnant; among those, 2610 (46.5%) were considered a complete pregnancy for reporting purposes at the time of analysis. Hospitalisation (23.9%) and death (1.3%) occurred more frequently among pregnant symptomatic women compared to nonpregnant symptomatic women (2.9% and 0.3%, respectively). Compared to nonpregnant symptomatic women, pregnant symptomatic women were at increased risk of hospitalisation (adjusted risk ratio [RR] 2.19, 95% confidence interval [CI] 2.07, 2.32) and death (RR 1.82, 95% CI 1.60, 2.07), after adjusting for age, type of health insurance and presence of certain underlying medical conditions. Among complete pregnancies, 55 (2.1%) were pregnancy losses, 72 (2.8%) resulted in term low birthweight infants and 375 (14.4%) were preterm deliveries.ConclusionsAlthough pregnant women were infrequently reported with laboratory‐confirmed SARS‐CoV‐2 infection, pregnant symptomatic women with COVID‐19 were at increased risk for hospitalisation and death compared to nonpregnant symptomatic women. Almost all infections we reported on were third‐trimester infections; ongoing follow‐up is needed to determine pregnancy outcomes among women infected earlier in pregnancy. Healthcare providers should counsel pregnant women about preventive measures to protect from SARS‐CoV‐2 infection and when to seek care.