Adverse Outcomes of COVID-19 in Pregnant Women: A Case Cohort Study in Iran

Abstract

Background: Pregnant women face an increased risk of serious complications related to coronavirus disease (COVID-19) infection. However, existing research on the risk factors associated with severe COVID-19 in pregnant women is limited. Objectives: The present study aimed to investigate the factors related to adverse outcomes in pregnant women with COVID-19. Methods: This case-cohort study analyzed data from 2021 to 2023, obtained from Medical Care Monitoring Center (MCMC) and Integrated Health System (SIB) databases, on pregnant women with COVID-19 in Zahedan, Iran. It included 400 patients with adverse outcomes and 800 controls without adverse outcomes, using logistic regression to identify risk factors. Results: The primary cohort included 1,783 COVID-19 patients, with a prevalence of adverse outcomes of 22.4%. Of the pregnant women with adverse outcomes, 98% required hospitalization, 11.5% were admitted to the ICU, 4.2% needed mechanical ventilation, and 8.5% died. Women in their third trimester of pregnancy were 3.2 times more likely to experience adverse outcomes compared to those in the first trimester (AOR = 3.2, 95% CI: 2.0 - 5.1). The presence of pregnancy complications heightened this risk to 2.5 times (AOR = 2.5, 95% CI: 1.5 - 4.1), while underlying health conditions increased it to 1.6 times (AOR = 1.6, 95% CI: 1.2 - 2.2). Conclusions: Elevated case fatality rates and adverse COVID-19 outcomes among pregnant women in this study highlight significant health disparities in southeastern Iran. Healthcare providers must enhance antenatal surveillance for pregnant women with COVID-19, focusing on adverse outcomes, earlier hospitalization criteria, and targeted vaccination for underprivileged women.