Objectives: To evaluate the effect of COVID-19 severity on maternal, perinatal, and neonatal outcomes in pregnant women infected with SARS-CoV-2 and assess the effect of medical comorbidities on the severity of COVID-19 infection.

Methods: A retrospective cohort study was conducted on pregnant women who were infected with SARS- CoV-2 and delivered at Sultan Qaboos University Hospital from 1 March 2020 to 31 December 2021.

Results: A total of 118 pregnant women with COVID-19 infection were included in this study. The mean maternal age was 32.0 years, with 61.0% of women infected in the third trimester. The majority of those had mild symptoms. Eleven women had moderate infections needing inpatient care, and six women had severe infections needing intensive care unit to treat COVID-19 pneumonia. The chronic diseases among the infected women were hypothyroidism, obesity, sickle cell disease, epilepsy, and diabetes. The mean gestational age at delivery was 37.0 weeks with 20.6% of women delivering by a cesarean section which 37.5% of women had moderate to severe disease. The most common complications affected by COVID-19 severity were preterm labor (p = 0.002), preeclampsia (p = 0.002), and intrauterine fetal death (p=0.089). Moreover, a total of 118 newborns were included, 111 singleton deliveries, three sets of twins, one had fetal death, and three had miscarriages. Placental histopathology was examined in 64 women over the study period, and most of them had no COVID-specific findings on histopathology.

Conclusions: Most pregnant women with COVID-19 infection had mild symptoms. The majority of women with moderate to severe infection were admitted for COVID-19 pneumonia. There was no direct effect of COVID-19 severity on neonatal outcomes or placental histopathology changes.