# COVID-19 in pregnancy: A cross-sectional study on clinical features, disease severity, and health outcome

## TL;DR

This study compares how pregnant and non-pregnant women experience and recover from COVID-19, finding more severe symptoms in pregnant women but better survival rates.

## Contribution

The study provides new insights into the clinical differences and outcomes of COVID-19 in pregnant versus non-pregnant women.

## Key findings

- Pregnant women with COVID-19 had higher odds of requiring intensive care but lower odds of death compared to non-pregnant women.
- Pregnant women reported more frequent diarrhea and skin lesions, and had higher rates of diabetes and hypertension.
- Cough and fever were the most common symptoms in pregnant women, while cough and muscle ache were more common in non-pregnant women.

## Abstract

Assessing the impact of coronavirus disease 2019 (COVID-19) reveals unique challenges for pregnant women, who experience distinct clinical manifestations and health outcomes compared to their non-pregnant counterparts. We aimed to evaluate the clinical features, disease severity, and health outcomes of COVID-19 in pregnant women and compare them to those of non-pregnant women. In this population-based study, we included all women diagnosed with COVID-19 across the province of Tehran during the first two years of the epidemic. Descriptive statistics, the chi-squared test, and the logistic regression model were applied. Overall, 79,338 non-pregnant women and 3249 pregnant women diagnosed with COVID-19 were included. Pregnant women were most commonly in the age group of 25–34 years (54%, n ═ 1758), while the age group of 34–44 had the highest representation among non-pregnant women (56%, n ═ 44,492). After accounting for age and comorbidities, pregnancy was associated with an increased risk of requiring intensive care (odds ratio [OR] 1.38, confidence interval [CI] 1.223–1.564). However, the probability of dying due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was lower in pregnant women compared to non-pregnant women (OR 0.55, CI 0.394–0.793). Cough (41%) and fever (30%) were the most frequent clinical presentations in pregnant women, whereas cough (57%) and muscle ache (38%) were the most common symptoms in non-pregnant women. Furthermore, diarrhea (P < 0.001) and skin lesions (P < 0.001) were reported more frequently by pregnant patients than non-pregnant patients. A significant prevalence of diabetes (P < 0.001), hypertension (P < 0.001), cancers (P < 0.001), and chronic hematological diseases (P < 0.001) was observed in pregnant patients. In conclusion, COVID-19-infected pregnant women exhibit different clinical manifestations and a more severe clinical course but have better health outcomes compared to their non-pregnant counterparts.