Coronavirus disease 2019 in pregnancy: clinical manifestations, maternal, and perinatal outcomes

Clinical manifestations, maternal and fetal complications


  • Asan Nashaat Khaleel Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Nagham Younus Alhur Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq.



Covid-19, Pregnancy, Clinical manifestation, Maternal outcomes, Fetal outcomes


Background and objective: The current COVID-19 pandemic has become a main health threat worldwide and concerns have been raised regarding the effect of the Covid-19 infection on the wellbeing of pregnant women and their unborn baby. This study aimed to determine the clinical manifestations in addition to maternal and perinatal outcomes in pregnant women with confirmed COVID-19.

Methods: A cross sectional study conducted in the Maternity Teaching Hospital and some private obstetric clinics in Erbil city/Kurdistan region, Iraq. The study started from the 1st April 2020 until the end of April of 2021. Seventy-one women who represent all infectedwithCOVID-19 during that period during pregnancy who were 16 years old or more were included in the study. Swabs were taken from nasopharynx by citoswab were diagnosed by quantitative real-time polymerase chain (qRT-PCR) at central laboratory of Erbil city/Iraq. The data were collected through direct interview with the patients using a special questionnaire, prepared for this purpose.

Results: More than half (53.5%) of participants were 25-34 years old, 80.3% of women were housewives and 29.6% of them were illiterate. The majority (87.3%) of women did not have chronic illnesses and 43.7% of them were in second trimester during COVID-19 infection. The following symptoms were reported: fever (91.5%), cough (80.3%), headache (77.5%), weakness (73.2%), loss of smell (69%), aguesia (67.6%), sore throat (66.2%), arthralgia and myalgia (64.8%), flu like illness (62%), dyspnea (39.4 %), and diarrhea and/or vomiting (26.8%). The majority (84.51%) of women did notreport any fetal complications or none has happened and 1.4% of the fetuses suffered from fetal distress and FGR. Caesarean section was the commonest mode of delivery. A significant statistical association was found between age group and fetal complications suggesting that fetal complications increased with becoming older.

Conclusion: Manifestations such as fever, sore throat, cough, headache, fatigue, loss of smell and taste, arthralgia and myalgia were commonly observed in Covid-19 pregnant patients. Cough was still the highest reported symptom followed by weakness and dyspnea even six months post Covid-19 infection. Adverse maternal and neonatal outcomes were observed in pregnant patients infected with Covid-19.


Metrics Loading ...


Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during Pregnancy and Possible Vertical Transmission. AJP 2020; 37(8):861–5. DOI:10.1055/s-0040-1710050.

WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020; Available from:

Shabu SA, M-Amin K, Mahmood KI, Shabila NP. Risk Perception and Behavioral Response to COVID-19: A Survey of University Students and Staff in the Iraqi Kurdistan Region. Social Work in Public Health 2021; 36(4):474–85. DOI:10.1080/19371918.2021.1915909

M-Amen K, Mahmood KI, Shabu SA, Shabila NP. Exploring perspectives on COVID-19 risk, protective behavior and control measures. J Risk Res 2021:1–13. DOI:10.1080/13669877.2021.1936607.

WHO. Weekly epidemiological update on COVID-19 - 1 March 2022. 2022 [cited 2022 1 March]; Available from:

WHO. WHO Coronavirus (COVID-19) Dashboard. 2022 [cited 2022 29 January ]; Available from:

KRG. Dashboard Coronavirus (COVID-19). 2022b [cited 2022 30/1]; Available from:

Madjunkov M, Dviri M, Librach C. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res 2020; 13(1):140. DOI:10.1186/s13048-020-00737-1.

Jamieson DJ Rasmussen SA. An update on COVID-19 and pregnancy. American journal of obstetrics and gynecology 2022; 226(2):177–86. DOI:10.1016/j.ajog.2021.08.054.

Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on Pregnancy. Int J Med Sci 2021; 18(3):763–7. DOI:10.7150/ijms.49923.

Al-Maiahy TJ, Al-Kuraishy HM, Al-Gareeb AI. Pregnancy and risk of vertical transmission in Covid-19. J Pak Med Assoc 2021; 71(Suppl 8)(12): S137–S43.

Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR Am J Roentgenol 2020; 215(1):127–32. DOI:10.2214/ajr.20.23072.

Oshay RR, Chen MYC, Fields BKK, Demirjian NL, Lee RS, Mosallaei D, et al. COVID-19 in pregnancy: a systematic review of chest CT findings and associated clinical features in 427 patients. Clinical imaging 2021; 75:75–82. DOI:10.1016/j.clinimag.2021.01.004.

Mattar CN, Kalimuddin S, Sadarangani SP, Tagore S, Thain S, Thoon KC, et al. Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore. Ann Acad Med Singap 2020; 49(11):857–69. DOI:10.47102/annals-acadmedsg.2020437.


Lucas DN Bamber JH. Pandemics and maternal health: the indirect effects of COVID-19. Anaesthesia 2021; 76 Suppl 4(Suppl 4):69–75. DOI:10.1111/anae.15408.

Kazemi SN, Hajikhani B, Didar H, Hosseini SS, Haddadi S, Khalili F, et al. COVID-19 and cause of pregnancy loss during the pandemic: A systematic review. PLoS One 2021; 16(8):e0255994. DOI:10.1371/journal.pone.0255994.

Arthurs AL, Jankovic-Karasoulos T, Roberts CT. COVID-19 in pregnancy: What we know from the first year of the pandemic. Biochim Biophys Acta Mol Basis Dis 2021; 1867(12):166248. DOI:10.1016/j.bbadis.2021.166248.

Naidu SAG, Clemens RA, Pressman P, Zaigham M, Kadkhoda K, Davies KJA, et al. COVID-19 during Pregnancy and Postpartum. J Diet Suppl 2022; 19(1):115–42. DOI:10.1080/19390211.2020.1834049.

Villar J, Ariff S, Gunier RB, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study. JAMA Pediatr 2021; 175(8):817–26. DOI:10.1001/jamapediatrics.2021.1050.

Rajewska A, Mikołajek-Bedner W, Lebdowicz-Knul J, Sokołowska M, Kwiatkowski S, Torbé A. COVID-19 and pregnancy - where are we now? A review. J Perinat Med 2020; 48(5):428–34. DOI:10.1515/jpm-2020-0132.

Gulic T Blagojevic Zagorac G. COVID-19 and pregnancy: are they friends or enemies? Horm Mol Biol Clin Investig 2021; 42(1):57–62. DOI:10.1515/hmbci-2020-0054.

RCOG. Coronavirus (COVID-19) Infection in Pregnancy. 2022; Information for healthcare professionals Version 15: Published Monday 7 March 2022]. Available from:

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet 2020; 395(10223): 497–506. DOI:10.1016/S0140-6736(20)30183-5

Khan MMA, Khan MN, Mustagir MG, Rana J, Haque MR, Rahman MM. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes. Med Rxiv 2020.

Yang Z, Wang M, Zhu Z, Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. J Matern.-Fetal Neonatal Med 2022; 35(8):1619–22. DOI:10.1080/14767058.2020.1759541.

Agolli A, Agolli O, Velazco DFS, Ahammed MR, Patel M, Cardona-Guzman J, et al. Fetal Complications in COVID-19 Infected Pregnant x

Woman: A Systematic Review and Meta-Analysis. Avicenna journal of medicine. 2021; 11(4):200–9. DOI:10.1055/s-0041-1736540.

Shmakov RG, Prikhodko A, Polushkina E, Shmakova E, Pyregov A, Bychenko V, et al. Clinical course of novel COVID-19 infection in pregnant women. The Journal of Maternal-Fetal & Neonatal Medicine 2020:1–7. DOI:10.1080/14767058.2020.1850683.

Pirjani R, Hosseini R, Soori T, Rabiei M, Hosseini L, Abiri A, et al. Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort study. J Travel Med 2020; 27(7). DOI:10.1093/jtm/taaa158.

Reale SC, Lumbreras-Marquez MI, King CH, Burns SL, Fields KG, Diouf K, et al. Patient characteristics associated with SARS-CoV-2 infection in parturients admitted for labour and delivery in Massachusetts during the spring 2020 surge: A prospective cohort study. Paediatr Perinat Epidemiol 2021; 35(1):24–33. DOI:10.1111/ppe.12743.

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, 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; 370. DOI:10.1136/bmj.m3320

Ochiai D, Kasuga Y, Iida M, Ikenoue S, Tanaka M. Universal screening for SARS‐CoV‐2 in asymptomatic obstetric patients in Tokyo, Japan. International Journal of Gynecology & Obstetrics 2020; 150(2):268–9. DOI:10.1002/ijgo.13252

Dubey P, Reddy SY, Manuel S, Dwivedi AK. Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 252:490–501. DOI:10.1016/j.ejogrb.2020.07.034.

Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. American Journal of Obstetrics & Gynecology MFM 2020; 2 (2, Supplement):100118. DOI:10.1016/j.ajogmf.2020.100118.

Wastnedge EA, Reynolds RM, Van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev 2021; 101(1):303–18. DOI:10.1152/physrev.00024.2020

Akhtar H, Patel C, Abuelgasim E, Harky A. COVID-19 (SARS-CoV-2) infection in pregnancy: a systematic review. Gynecol Obstet Invest 2020; 85(4):295–306. DOI:10.1159/000509290

Vousden N, Bunch K, Morris E, Simpson N, Gale C, O’Brien P, et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS One 2021; 16(5):e0251123.

Antoun L, Taweel NE, Ahmed I, Patni S, Honest H. Maternal COVID-19 infection, clinical characteristics, pregnancy, and neonatal outcome: A prospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 252:559–62. DOI:10.1016/j.ejogrb.2020.07.008.

Dileep A, ZainAlAbdin S, AbuRuz S. Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes. Sci Rep 2022; 12(1):3024. DOI:10.1038/s41598-022-07093-8.

Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi 2020; 55(3):166–71. DOI:10.3760/cma.j.cn112141-20200218-00111.

Lopes de Sousa ÁF, Carvalho HEFd, Oliveira LBd, Schneider G, Camargo ELS, Watanabe E, et al. Effects of COVID-19 infection during pregnancy and neonatal prognosis: what is the evidence? Int J Environ Res Public Health 2020; 17(11):4176. DOI:10.3390/ijerph17114176

Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides K. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013; 42(6):634–43. DOI:10.1002/uog.13234

Frederiksen LE, Ernst A, Brix N, Braskhøj Lauridsen LL, Roos L, Ramlau-Hansen CH, et al. Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age. Obstet Gynecol 2018; 131(3):457–63. DOI:10.1097/AOG.0000000000002504

Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal Age and Risk of Labor and Delivery Complications. Maternal and Child Health Journal 2015; 19(6):1202–11. DOI:10.1007/s10995-014-1624-7.

Ovesen P, Rasmussen S, Kesmodel U. Effect of Prepregnancy Maternal Overweight and Obesity on Pregnancy Outcome. Obstet Gynecol 2011; 118(2 Part 1):305–12. DOI:10.1097/AOG.0b013e3182245d49




How to Cite

Khaleel, A. N. ., & Alhur, N. Y. . (2024). Coronavirus disease 2019 in pregnancy: clinical manifestations, maternal, and perinatal outcomes: Clinical manifestations, maternal and fetal complications . Zanco Journal of Medical Sciences (Zanco J Med Sci), 28(1), 19–31.



Original Articles