SARS-CoV-2 infection among hospitalised pregnant women and impact of different viral strains on COVID-19 severity in Italy: a national prospective population-based cohort study

BJOG. 2022 Jan;129(2):221-231. doi: 10.1111/1471-0528.16980. Epub 2021 Nov 20.


Objective: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes.

Design: National population-based prospective cohort study.

Setting: A total of 315 Italian maternity hospitals.

Sample: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission.

Methods: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses.

Main outcome measures: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality.

Results: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28).

Conclusions: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.

Keywords: COVID-19 pneumonia; Cohort studies; Italy; SARS-CoV-2; pregnancy.

MeSH terms

  • Adult
  • COVID-19 Testing / methods
  • COVID-19 Testing / statistics & numerical data
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Cohort Studies
  • Comorbidity
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Maternity / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Italy / epidemiology
  • Pregnancy
  • Pregnancy Complications, Infectious* / diagnosis
  • Pregnancy Complications, Infectious* / epidemiology
  • Pregnancy Complications, Infectious* / therapy
  • Pregnancy Outcome / epidemiology
  • Premature Birth / epidemiology*
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • SARS-CoV-2* / genetics
  • SARS-CoV-2* / isolation & purification
  • Severity of Illness Index