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COVID-19 has posed significant challenges worldwide, with pregnant individuals identified as being at increased risk for severe illness and poor outcomes compared to the general population. This study aimed to compare the course of critical illness due to COVID-19 of pregnant patients to nonpregnant reproductive-age women and describe their perinatal outcomes. A retrospective cohort study was conducted including women ages 14-49 years admitted to the intensive care unit (ICU) with COVID-19-related illness from 3/2020 to 2/2022 at Vanderbilt University Medical Center in Nashville, Tennessee. Demographic, clinical characteristics, and outcomes were compared between pregnant/postpartum and nonpregnant patients. Neonatal outcomes were also analyzed. Among 159 women, 35 (22%) were pregnant or postpartum. Pregnant patients had a lower body mass index, were more likely to be publicly insured, and were less likely to have underlying comorbidities. The groups had similar proportions of mechanical ventilation, venous thromboembolism, and death. However, pregnant patients were more likely to require extracorporeal membrane oxygenation (ECMO). The proportion of individuals who were vaccinated against COVID-19 was low in both groups. Of 19 neonates born, the mean gestational age was 32.9 weeks, with 94.7% delivered via cesarean and 78.9% requiring NICU admission. Five intrauterine fetal demises and one neonatal death occurred. Though pregnant patients admitted to the ICU with COVID-19 had fewer comorbidities compared to nonpregnant women, nearly one-fifth of them required ECMO. Pregnant patients with COVID-19 ICU admission face high risks of ECMO, preterm delivery, cesarean, and fetal loss. Improving vaccination uptake is critical, especially in this population.