Impact of Clinical Severity on Maternal and Perinatal Outcome Across Trimesters in COVID 19 Pregnancies: A Prospective Cohort Study

Aims: To analyze the impact of clinical severity on maternal and perinatal outcomes across trimesters in coronavirus disease 2019 (COVID-19) pregnancies. Study design: This was a prospective open cohort study of pregnant women with COVID-19 during the prenatal, delivery, postpartum periods from September 2020 to March 2022. Methodology: For data analysis, 132 pregnant women who had no pre-existing comorbidities or pregnancy-related complications at the beginning of the cohort were selected. Data related to COVID-19, demographic, clinical, obstetric, laboratory, ultrasound and birth outcomes were collected. Results: A total of 132 pregnant women with COVID-19 were followed up for 2237 women-week. Among them, 19.7% experienced maternal complications such as premature rupture of membranes (19.7%), premature delivery (10.6%), postpartum hemorrhage (8.3%), and preeclampsia (6.8%), or fetal/neonatal complications, including small for gestational age (9.1%), need for neonatal intensive care unit (9.1%), and acute fetal distress (6.1%). Having moderate/severe COVID-19 on prenatal care admission (hazard ratio (HR):3.75) and 95% confidence interval (CI95%):1.63; 8.61 or contracting the infection during the second (HR: 6.35; CI95%: 2.35; 17.17) or third trimester (HR:14.35; CI95%:4.85; 42.41) of pregnancy were significantly associated with these maternal complications. Similarly, having moderate/severe COVID-19 on prenatal care admission (HR:3.90; CI95%:1.48; 10.24) or contracting the infection during the second (HR:6.84; CI95%:2.05; 22.84) or third trimester (HR:22.4; CI95%:6.57; 76.33) of pregnancy were also associated with fetal/neonatal complications. Conclusion: Pregnant women with COVID-19 have a higher risk of maternal or fetal/neonatal complications if they present with a moderate/severe COVID-19 on prenatal care admission or if the infection occurs in the second or third trimester of pregnancy.