Incidence Rate of COVID-19 and Pregnancy Outcomes in Women Affected With COVID-19: A Cross-Sectional Study in Tehran, Iran

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Background: The current epidemic of SARS-CoV-2 has spread fear and worry all over the world, and the number of maternal mortality due to this virus is on the rise. We described the incidence rate and the effect of COVID-19 virus on pregnancy and neonatal outcomes.Methods: In this study, 15,257 medical records of pregnant women were screened for COVID-19 between February and July 2020, in which 263 pregnant women with COVID-19 were identified. These patients referred to either outpatient or inpatient medical centers in Tehran province. Data was collected from medical records and all patients were followed until the delivery time to see the maternal and neonatal outcomes. We compared clinical characteristics and outcomes in participants with and without adverse pregnancy outcomes. The Chi-square test, Fisher's exact test, Independent t-test, Mann-Whitney U test, Kruskal-Wallis and the logistic regression model were used for analyzing data.Findings: The incidence of COVID-19 among pregnant women was 17 per 1000 (95% CI: 15-19). Of these patients, 3.4%, 30.8%, and 65.8% were in their first, second, and third trimesters, respectively. Women who were in the second trimester were more likely to experience adverse pregnancy complications. Overall, 65(24.7%) mothers and 53(20.2%) neonates had adverse maternal and neonatal outcomes. Also, 73.5% of the patients underwent cesarean-section. Maternal outcomes included preterm labor (17.8%), intensive care unit admission (2.7%), maternal mortality (1.1%), mechanical ventilation (1.1%), stillbirth (0.8%), and preeclampsia (0.38). The neonatal outcomes included admission to neonatal intensive care unit (15.2%), neonatal mortality without COVID -19 (2.3%), and neonatal infection with COVID-19 (1.9%). Women with higher BMI and low blood oxygen were 1.198 and 0.886 times more likely to show maternal and neonatal adverse effects (95% CI: 1.003-1.431 and 95% CI: 0.808-0.970) respectively.Interpretation: Infection with COVID-19 during pregnancy can increases adverse outcomes such as preterm birth, need for hospitalization, maternal mortality, stillbirth and C- section. Risk of adverse pregnancy outcomes increases in the second trimester. Vertical transmission of SARS-CoV-2 was detected in few neonates. Our findings can provide guidelines for the management of prenatal care offered to women affected with COVID-19 and can serve as an information resource for policy makers.Funding Statement: All expenses of this study was provided by Tehran University of Medical Sciences.Declaration of Interests: Authors have nothing to declare. Ethics Approval Statement: The design of this study was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1399.230).