Maternal outcomes in pregnant women with COVID-19: impact of disease severity, timing of intervention, and SARS-CoV-2 variants

Abstract

This study aimed to analyze maternal outcomes in pregnant women infected with COVID-19, focusing on the impact of disease severity, timing of medical intervention, and the effect of different SARS-CoV-2 variants. A retrospective analysis was conducted on 9,288 pregnant women diagnosed with COVID-19. Disease severity was classified as mild (30%), moderate (52%), severe (17%), and critical (2%). The study also examined the timing of medical care, with 41.6% of women seeking care within 7 days of symptom onset and 58.4% after 7 days. The average gestational age was 271.8 days, with the majority (93.8%) at full-term pregnancy. Results indicated that 88.2% of women continued their pregnancies during treatment, while 11.9% experienced pregnancy termination, including preterm deliveries and miscarriages. The study found a significant (p<0.01) association between COVID-19 severity and adverse outcomes, such as preterm birth and maternal mortality. Severe and critical cases demonstrated increased risks of uteroplacental insufficiency (52.1% and 85.5%, respectively), the need for intensive respiratory support, and ICU admission. The differences in outcomes between the Delta and Omicron variants are also highlighted. The Delta variant was associated with more severe disease and higher rates of complications, including a higher need for cesarean sections, compared to the Omicron variant. The overall 30-day survival rate was 98.05%, with a noticeable drop to 43.59% in critically ill patients. This study underscores the importance of early medical intervention and continuous monitoring in managing COVID-19 in pregnant women. The findings also emphasize the need to consider the variant-specific effects of SARS-CoV-2 on maternal and neonatal outcomes, which can guide clinical decision-making and improve the prognosis for both mother and child.