Qom University of Medical Sciences Journal

Introduction
Pregnancy is one of the most important events in the life of a woman.  Pregnant women experience different physical and mental changes during this period, including changes in the immune system and lung function, which increase their sensitivity and vulnerability. Pneumonia in pregnant women can be associated with several adverse gynecological and obstetric outcomes, such as premature rupture of membranes (PROM) and preterm labor (PTL), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), and even maternal death. 
The COVID-19 outbreak was a serious public health concern and a threat to vulnerable populations such as pregnant women and their babies. There was little information about the consequences of this disease in pregnant women and their babies. Adverse outcomes in babies of infected mothers, such as miscarriage, premature birth, fetal tachycardia, and infant death, have been reported in various studies. However, it is not obvious that these consequences were definitely related to the mothers’ infection with COVID-19. The data pertaining to previous viruses (SARS-CoV and MERS-CoV) have shown that pregnant women are at risk of severe illness, complications, or death compared to the general population. Therefore, the prevention and control of COVID-19 in pregnant women and its effects on mothers and babies, and the transmission from mother to baby became a major concern. Considering that limited studies have been conducted on the effect of COVID-19 on pregnancy and newborn outcomes, this research aimed to investigate the clinical and laboratory findings of hospitalized women with COVID-19 in Iran during and after pregnancy to assess the effect of infection on the maternal and neonatal outcomes.
Methods
This descriptive cross-sectional study was conducted in 2020 on hospitalized pregnant mothers with COVID-19 (positive PCR) and their babies at Fatemieh Hospital in Hamadan, Iran. For sampling, a census method was used. The data collection tool was a scale for measuring maternal and neonatal outcomes, which included four sections: demographic information, obstetric information, delivery-related information, disease-related information, and infant-related information. The information was completed by the researcher through interviews with mothers or using the medical files of mothers and their babies. All pregnant mothers and their babies were examined in terms of clinical symptoms and paraclinical results such as laboratory tests and CT scan. For mothers who were infected with COVID-19 in the last few weeks of pregnancy and then discharged, information was collected through telephone, among whom 21 had not yet given birth, but the mothers and their fetuses were in perfect health.
Results
The data of 69 mothers were examined. The mean age of pregnant women was 30.27±6.38 years; their mean gestational age was 31.04±8.2 weeks, and their mean length of hospital stay was 2.42±6.07 days. The most common symptoms were fever, cough and shortness of breath. 49.3% have had their first pregnancy. Also, 23.2% had a normal delivery and 50.7% had a cesarean delivery, of whom 23.2% had emergency cesarean section due to reduced fetal movements, decreased heart rate and lack of progress in delivery. In the CT scan results, the most common manifestation was multiple mottling and ground-glass opacity. Among 69 mothers, 63 were discharged, 5 were sent to other medical centers, and one mother died. Moreover, 44% of pregnant women had high white blood cell count; 28% had high C-reactive protein (CRP), 44.8% had high erythrocyte sedimentation rate (ESR), and 46.1% had high creatine phosphokinase (CPK). In 30%, a decrease in hemoglobin was reported. Regarding neonatal outcomes, 68.8% of newborns were alive and healthy, and the PCR result was negative in 89.58% of newborns.
Conclusion 
The clinical features of COVID-19 in pregnant women are similar to those reported in non-pregnant women; however, the findings suggest that early diagnosis of COVID-19 is essential in pregnant women, since there is a possibility of worsening conditions in the mother and fetus. The protocols and health care applied to the general population should also be applied to pregnant women. It is also necessary to take preventive measures at the community level for pregnant women and monitor and follow up with them during pregnancy.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Hamadan University of Medical Sciences, Hamadan, Iran (Code: IR.UMSHA.REC.1399.270).
Funding
This study was funded by Hamadan University of Medical Sciences, Hamadan, Iran.
Authors contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interpretation of the result and drafting of the manuscript. Each author approved the final version of the manuscript for submission.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank the Vice-Chancellor of Research and Technology of Hamadan University of Medical Sciences, Fatemieh Hospitals’ Research Development Unit, and all participants for their support and cooperation in this study.