COVID-19 and pregnancy: epidemiology, clinical features, maternal and perinatal outcomes. A systematic review




pregnancy, COVID-19, clinical features, perinatal outcomes


Background and objectives: COVID-19 pandemic had quite a significant impact on a number of obstetric outcomes. This is often directly attributed to complications of COVID-19. This article is a systematically review literature on the epidemiology, clinical features, maternal and perinatal outcomes of COVID-19 in pregnancy.
Materials and methods. A PRISMA methodology search was conducted on the databases of PubMed, Scopus, Medline, Google Scholar, Web of Science and Central BMJ using MeSH keywords or combinations of the words “COVID-19”, “SARS-CoV-2”, “pregnancy”, “epidemiology”, “comorbid disease”, “pregnancy and childbirth outcome”, “preeclampsia”, “fetus”. Only articles published between December 1, 2019 to February 28, 2022 were considered. After preliminary analysis of more than 600 publications, 21 articles were short-listed for final processing. The studies were selected using a Newcastle-Ottawa scale style questionnaire. The clinical features, risk factors, co-morbid conditions, maternal and neonatal outcomes were presented in two separate tables respectively. Results. COVID-19 incidence in pregnancy ranged from 4.9% to 10.0%. Such women were 5.4 times more likely to be hospitalized and 1.5 times more to need ICU care. Dyspnoea and hyperthermia were associated with a high risk of severe maternal (OR 2.56; 95% CI 1.92–3.40) and neonatal complications
(OR 4.97; 95% CI 2.11–11.69). One in ten of neonates had a small weight for gestational age (9.27 ± 3.18%) and one in three required intensive care unit observation.
Conclusions. Despite the increasingly emerging evidence on the associations between pregnancy and COVID-19 infection, the data is sometimes contradictory necessitating further studies.

Author Biographies

G.S. Manasova, Odesa National Medical University, Odesa

MD, professor, Department of Obstetrics and Gynecology No. 2

V.V. Artomenko, Odesa National Medical University, Odesa

MD, professor, Department of Obstetrics and Gynecology No. 2

Y.O. Radchenko, Odesa National Medical University, Odesa

Graduate student, Department of Obstetrics and Gynaecology

O.V. Zhovtenko, Odesa National Medical University, Odesa

PhD, associate professor, Department of Obstetrics and Gynaecology


  1. Cui, J., Li, F., Shi, Z.-L. “Origin and evolution of pathogenic coronaviruses.” Nature Rev Microbiol 17.3 (2019): 181–92. DOI: 10.1038/s41579-018-0118-9
  2. Lai, C.-C., Shih, T.-P., Ko, W.-C., et al. “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges.” Int J Antimicrob Agents 55.3 (2020): 105924.
  3. Soliman, N.S., Hassan, Y.M., Nada, A.M. Chapter 1 – Epidemiology, virology, and history of Covid-19 infection. In: Maged El-Goly AM, ed. COVID-19 Infections and Pregnancy. Academic Press (2021): 1–22.
  4. Li, Q., Guan, X., Wu, P., et al. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia.” N Engl J Med 382.13 (2020): 1199–207. DOI: 10.1056/nejmoa2001316
  5. Wells, G.A., Shea, B., O’Connell, D., et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Oxford (2000).
  6. World Health Organization. Coronavirus disease (COVID-19) outbreak – WHO announces COVID-19 outbreak a pandemic (2020). Available from: [https://www.euro.who. int/en/healthtopics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announcescovid-19-outbreak-a-pandemic].
  7. European Centre for Disease Prevention and Control. Threats and Outbreaks, COVID-19, latest evidence. Updated 21st January 2022. Available from: [].
  8. Kotlar, B., Gerson, E., Petrillo, S., et al. “The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review.” Reprod Health 18.1 (2021): 10. DOI: 10.1186/s12978-021-01070-6
  9. Wastnedge, E.A.N., Reynolds, R.M., Van Boeckel, S.R., et al. “Pregnancy and COVID-19.” Physiological Reviews 101.1 (2021): 303–18. DOI: 10.1152/physrev.00024.2020
  10. Bourne, T., Kyriacou, C., Coomarasamy, A., et al. “ISUOG Consensus Statement on rationalization of early-pregnancy care and provision of ultrasonography in context of SARS-CoV-2.” Ultrasound Obstet Gynecol 55.6 (2020): 871–8.
  11. Poon, L.C., Yang, H., Kapur, A., et al. “Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals.” Int J Gynecol Obstet 149.3 (2020): 273–86. DOI: 10.1002/ijgo.13156
  12. Royal College of Obstetricians and Gynaecologists. Guidance for antenatal and postnatal services in the evolving coronavirus (COVID-19) pandemic (2020). Available from: [].
  13. Page, M.J., McKenzie, J.E., Bossuyt, P.M., et al. “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.” Systematic Reviews 10.1 (2021). DOI: 10.1186/s13643-021-01626-4
  14. Dixit, A., Zhou, D., Sheikh, J., et al. “Prevalence and risk-factors of COVID-19 in pregnancy: Living systematic review and metaanalysis.” BJOG (2021): 196–7.
  15. Knight, M., Bunch, K., Vousden, N., et al. “Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study.” BMJ 369 (2020): m2107. DOI: 10.1136/bmj.m2107
  16. Kim, S.H., Choi, Y., Lee, D., et al. “Impact of COVID-19 on pregnant women in South Korea: Focusing on prevalence, severity, and clinical outcomes.” J Infect Public Health 15.2 (2022): 270–6. DOI: 10.1016/j.jiph.2022.01.004
  17. Ellington, S., Strid, P., Tong, V.T., et al. “Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22 – June 7, 2020.” MMWR Morb Mortal Wkly Rep 69.25 (2020): 769–75. DOI: 10.15585/mmwr.mm6925a1
  18. Zha, L., Sobue, T., Hirayama, A., et al. “Characteristics and Outcomes of COVID-19 in Reproductive-Aged Pregnant and Nonpregnant Women in Osaka, Japan.” Int J Infect Dis 117 (2022): 195–200.
  19. Parums, D.V. “Maternal SARS-CoV-2 infection and pregnancy outcomes from current global study data.” Med Sci Monitor 27 (2021): e933831-1.
  20. Abbas, A.K., Lohr, J., Knoechel, B. “Balancing autoaggressive and protective T cell responses.” J Autoimmun 28.2–3 (2007): 59–61.
  21. Maged El-Goly, A.M. COVID-19 Infections and Pregnancy. Academic Press (2021).
  22. Moffett, A., Loke, Y. “The immunological paradox of pregnancy: a reappraisal.” Placenta 25.1 (2004): 1–8.
  23. Wegmann, T.G., Lin, H., Guilbert, L., Mosmann, T.R. “Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?” Immunology today 14.7 (1993): 353–6.
  24. Brandt, J.S., Hill, J., Reddy, A., et al. “Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.” Am J Obstet Gynecol 224.4 (2021): 389.e1–389.e9. DOI: 10.1016/j.ajog.2020.09.043
  25. Di Mascio, D., Khalil, A., Saccone, G., et al. “Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis.” Am J Obstet Gynecol MFM 2.2 (2020): 100107. DOI: 10.1016/j.ajogmf.2020.100107
  26. Chen, L., Li, Q., Zheng, D., et al. “Clinical Characteristics of Pregnant Women with COVID-19 in Wuhan, China.” N Engl J Med 382.25 (2020): e100. DOI: 10.1056/nejmc2009226
  27. Allotey, J., Fernandez, S., Bonet, M., et al. “Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.” BMJ (2020): m3320. DOI: 10.1136/bmj.m3320
  28. Bellos, I., Pandita, A., Panza, R. “Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis.” Eur J Obstet Gynecol Reprod Biol 256 (2021): 194–204. DOI: 10.1016/j.ejogrb.2020.11.038
  29. Churiso, G., Diriba, K., Girma, H., Tafere, S. “Clinical Features and Time to Recovery of Admitted COVID-19 Cases at Dilla University Referral Hospital Treatment Center, South Ethiopia.” Infect Drug Resist 15 (2022): 795–806. DOI: 10.2147/idr.S356606
  30. Villar, J., Ariff, S., Gunier, R.B., et al. “Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection.” JAMA Pediatrics 175.8 (2021): 817. DOI: 10.1001/jamapediatrics.2021.1050
  31. Juan, J., Gil, M.M., Rong, Z., et al. “Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review.” Ultrasound Obstet Gynecol 56.1 (2020): 15–27. DOI: 10.1002/uog.22088
  32. Diriba, K., Awulachew, E., Getu, E. “The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis.” Eur J Med Res 25.1 (2020): 39. DOI: 10.1186/s40001-020-00439-w
  33. Carrasco, I., Muñoz-Chapuli, M., Vigil-Vázquez, S., et al. “SARS-CoV-2 infection in pregnant women and newborns in a Spanish cohort (GESNEO-COVID) during the first wave.” BMC Pregnancy Childbirth 21.1 (2021): 326. DOI: 10.1186/s12884-021-03784-8
  34. Metz, T.D., Clifton, R.G., Hughes, B.L., et al. “Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19).” Obstet Gynecol 137.4 (2021): 571.
  35. Stock, S.J., Carruthers, J., Denny, C., et al. “Cohort Profile: The COVID-19 in Pregnancy in Scotland (COPS) dynamic cohort of pregnant women to assess effects of viral and vaccine exposures on pregnancy.” Int J Epidemiol (2022). DOI: 10.1093/ije/dyab243
  36. Khoury, R., Bernstein, P.S., Debolt, C., et al. “Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers.” Obstet Gynecol 136.2 (2020): 273–82. DOI: 10.1097/aog.0000000000004025
  37. Pierce-Williams, R.A.M., Burd, J., Felder, L., et al. “Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study.” Am J Obstet Gynecol MFM 2.3 (2020): 100134. DOI: 10.1016/j.ajogmf.2020.100134
  38. Frolov, A., Botasheva, T., Kaushanskaya, L., et al. “Functional Features of External Breath System in Pregnant Women in perinatal period and in labour in dependence of stereoisomerism of female body.” Modern problems of Science and Education 4 (2015): 347.
  39. Mozheiko, L., Tsareva, N., Tsareva, S. “Features of the course of pregnancy and indicators of respiratory function in women with abdominal obesity.” BDMU 3 (2015): 91–5.
  40. Epelboin, S., Labrosse, J., De Mouzon, J., et al. “Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study.” PLOS Med 18.11 (2021): e1003857. DOI: 10.1371/journal.pmed.1003857
  41. Khan, D.S.A., Hamid, L.R., Ali, A., et al. “Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis.” BMC Pregnancy Childbirth 21.1 (2021): 801. DOI: 10.1186/s12884-021-04250-1
  42. Figueiro-Filho, E.A., Yudin, M., Farine, D. “COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries.” J Perinat Med 48.9 (2020): 900–11. DOI: 10.1515/jpm-2020-0364
  43. Unnikrishnan, R., Misra, A. “Diabetes and COVID-19: a bidirectional relationship.” Nutr Diabetes 11.1 (2021): 21. DOI: 10.1038/s41387-021-00163-2
  44. Digtiar, N.I., Gerasimenko, N.D., Savchenko, L.V., Racine, M.S. “Low-Grade Systemic Inflammation as a General Framework of Chronic Obstructive Pulmonary Disease and Comorbid Conditions.” Ukr Pulmonol J 3 (2016): 64–8.
  45. Ellulu, M.S., Patimah, I., Khaza’ai, H., et al. “Obesity and inflammation: the linking mechanism and the complications.” Arch Med Sci 4 (2017): 851–63. DOI: 10.5114/aoms.2016.58928
  46. Robinson, E., Boyland, E., Chisholm, A., et al. “Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults.” Appetite 156 (2021): 104853.
  47. Landstra, C.P., de Koning, E.J. “COVID-19 and diabetes: understanding the interrelationship and risks for a severe course.” Front Endocrinol 12 (2021): 649525.
  48. Vousden, N., Ramakrishnan, R., Bunch, K., et al. “Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort.” Acta Obstet Gynecol Scand 101.4 (2022): 461–70. DOI: 10.1111/aogs.14329
  49. Lundström, A., Ziegler, L., Havervall, S., et al. “Soluble angiotensin-converting enzyme 2 is transiently elevated in COVID-19 and correlates with specific inflammatory and endothelial markers.” J Med Virol 93.10 (2021): 5908–16. DOI: 10.1002/jmv.27144
  50. Wallentin, L., Lindbäck, J., Eriksson, N., et al. “Angiotensin-converting enzyme 2 (ACE2) levels in relation to risk factors for COVID-19 in two large cohorts of patients with atrial fibrillation.” Eur Heart J 41 (2020): 4037–46. DOI: 10.1093/eurheartj/ehaa697
  51. Seki, H. “The role of the renin-angiotensin system in the pathogenesis of preeclampsia – new insights into the renin-angiotensin system in preeclampsia.” Med Hypotheses 82.3 (2014): 362–7.
  52. Erez, O., Romero, R., Jung, E., et al. “Preeclampsia and eclampsia: the conceptual evolution of a syndrome.” Am J Obstet Gynecol 226.2s (2022): S786-s803. DOI: 10.1016/j.ajog.2021.12.001
  53. Wilkinson, M., Johnstone, E.D., Simcox, L.E., Myers, J.E. “The impact of COVID-19 on pregnancy outcomes in a diverse cohort in England.” Sci Rep 12.1 (2022). DOI: 10.1038/s41598-022-04898-5
  54. Banerjee, J., Mullins, E., Townson, J., et al. “Pregnancy and neonatal outcomes in COVID-19: study protocol for a global registry of women with suspected or confirmed SARS-CoV-2 infection in pregnancy and their neonates, understanding natural history to guide treatment and prevention.” BMJ Open 11.1 (2021): e041247. DOI: 10.1136/bmjopen-2020-041247
  55. Godoi, A.P.N., Bernardes, G.C.S., Nogueira, L.S., et al. “Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times.” Rev Bras Ginecol Obstet 43.5 (2021): 384–94. DOI: 10.1055/s-0041-1729145
  56. Mullins, E., Hudak, M.L., Banerjee, J., et al. “Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries.” Ultrasound Obst Gynecol 57.4 (2021): 573–81. DOI: 10.1002/uog.23619
  57. Jamieson, D.J., Rasmussen, S.A. “An update on COVID-19 and pregnancy.” Am J Obstet Gynecol 226.2 (2022): 177–86. DOI: 10.1016/j.ajog.2021.08.054
  58. Yap, M., Debenham, L., Kew, T., et al. “Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.” BMJ Open 10.12 (2020): e041868. DOI: 10.1136/bmjopen-2020-041868
  59. Yee, J., Kim, W., Han, J.M., et al. “Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis.” Sci Rep 10.1 (2020). DOI: 10.1038/s41598-020-75096-4
  60. Hanff, T.C., Mohareb, A.M., Giri, J., et al. “Thrombosis in COVID-19.” Am J Hematol 95.12 (2020): 1578–89. DOI: 10.1002/ajh.25982
  61. Loo, J., Spittle, D.A., Newnham, M. “COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms.” Thorax 76.4 (2021): 412–20. DOI: 10.1136/thoraxjnl-2020-216243




How to Cite

Manasova, G., Artomenko, V., Radchenko, Y., & Zhovtenko, O. (2022). COVID-19 and pregnancy: epidemiology, clinical features, maternal and perinatal outcomes. A systematic review. REPRODUCTIVE ENDOCRINOLOGY, (65), 29–37.



Pregnancy and childbirth